Week 3 Problems         

Chapters 6, 7, and 8

1. A health system has established an ACO and has assumed risk for a  substantial number of patients who have been attributed to this ACO.  As  a result, it is important that the organization now focus on population  health as opposed to its historical position of medical intervention  when a patient needs surgery because it is rewarded for keeping a person  healthy as opposed to performing surgery, lab tests, diagnostic  surgery, and so on.  However, the patient base that is a part of the ACO  represents a range of individuals.  As the vice  president of medical affairs looks over the patient base, he realizes he  faces a significant challenge.  Calling together a planning team that  consists of the head of data analytics, the chief clinical officer, and  the head of marketing and planning, he says, “I am not sure how we  should slice this group up.  We are entering a new group of care  management here after years of just taking care of patients as they come  through the door.  This represents a new and exciting challenge.   I  think managing people to stay healthy is what we have always wanted to  do but restructuring ourselves to do it efficiently and well is a very  different approach.  How do we go after this elephant?”   The head of  data analytics speaks up:  “The one good thing is we now have an  electronic medical record system that is functional, and people seem to  have bought into pretty well.”  The chief medical officer then chipped  in:  “I do agree that the clinical staff is excited about the challenge,  but we need a plan fairly quickly that is clear and easy for us to lay  out to all.”  The marketing director is next.  It is you.  Lay out the  best approach.
2. Anna Lenox recently accepted a new position as a marketing director  at a medium-sized 350-bed hospital in a major metropolitan city.  In her  first meeting with the hospital CEO, he said, “Anna, we have a real  challenge to deal with.  I have established a patient ombudsperson who  used to be part of our volunteer office.  She has been a great  contributor to the organization, and her spouse is a senior member of  the hospital staff.   The problem is several people have written into  the local paper recently complaining that the hospital has not addressed  their complaints and honestly some of these issues are pretty minor.   However, last week, we had a pretty serious major clinical problem that  the chief medical officer had to get involved in.   I just don’t know  what people want anymore.  We have always tried to treat patients  respectfully and fairly.  I think it’s time we have a discussion with  the leadership team.  I’d like you to lead this discussion.” Outline the  areas that you think should be discussed.
3. A large 50-person multispecialty group held a semiannual retreat on a  Saturday to review the group’s operating progress and to assess  financial targets, staffing issues, and any patient issues that had  arisen.  Monthly financial targets and the like were always reviewed by  the executive committee, but this allowed the entire partnership to be  informed of the status of the group.  At this meeting, the administrator  presented the patient satisfaction scores, which were generally quite  good.  However, she did want to call attention to some disconcerting  tends.  “We have a staff team that is assigned to monitor social media  pages,” she said.  “Lately, some of our patients have posted rather  disparaging remarks concerning impersonal care during their visits, now  that we have transitioned to the EHR.  They feel some of our doctors are  only looking at the computer.  We have seen these remarks on Foursquare  and on some blog posts.  This isn’t good.  One of the staff found come  really negative comments on Yelp.”  “Ridiculous,” said Dr. Johnson, one  of the more senior member of the group.  “I have not had a single  patient complain to me.   And I will admit that I do hate to look at  that darn thing; it is a pain in the neck.”  Two other physicians agreed  with Dr.  Johnson, saying no one complained to them.  An assistant  administrator who was responsible for the operations at the front desk,  scheduling, and billing said he had reports from staff that some  patients did complain to the billing department about visits with the  clinical staff on discharge, but the number was small.   During the  lunch break, this issue was still a topic of conversation.  What is this  group experiencing?  Is the physician correct?
4. The Radnor Pediatric Care group has grown dramatically in recent  years.  Located in a midsized city in the Southeast that had seen an  influx of younger families, the practice had recruited pediatricians and  physician extenders to meet the increasing demand of patients,  The  group was also quite aggressive in ensuring that the diversity of  practitioners was a key part of its recruiting efforts and a hallmark of  which senior group members were proud.  Now entering the 10th year of  the practice, the group had five locations throughout the metro area,  but there were some early concerns in terms of the financials.  At a  quarterly meeting of the executive committee, the practice administrator  reported for the first time that practice growth and revenues were both  flat.  This was a first in the group’s history.  The timing of this  message was somewhat fortuitous in that the group had already planned a  fall meeting of all its clinicians at a local hotel.  The group is  trying to determine the best path forward.  You are the marketing  director for Radnor Pediatric and have been asked to provide a sense of  possible direction and rationale.  In assembling your notes, you provide  an overview of the practice:

        Radnor Pediatrics

• Five clinic locations: two sites have weekend hours.
• Website: This is updated on a quarterly basis.
• After-hour support: This is provided by hospital urgent-care locations downtown.
• Walk-in appointments: These are available at central Radnor  Pediatric locations five days a week before regular appointment visits  from 7 a.m. to 8a;30 a.m. when all offices open.
• Prescription refill requests: These can be left after hours o the answering machine at the main clinic site.
• Appointment requests: These are made at each office when the  practice site opens.  The hours for two office locations are from 9 a.m.  to 4 p.m.; the main clinic site is open 8 a.m. to 5:30 p.m. (except the  walk-in time), and the far west site is 8:30 a.m. to 5 p.m.

In today’s environment, how could Radnor Pediatric restore the growth possibilities for the group practice?