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What you should care about in healthcare today, from the editors of Becker's Hospital Review

Salesforce.com's plan to take on healthcare

Will one of America's most innovative companies be able to disrupt healthcare?

Earlier this week, Reuters broke the news of Salesforce.com's plans to enter the healthcare industry. The cloud-based CRM juggernaut has set its sights quite high — to the tune of $1 billion in annual revenue from healthcare clients.

If the company is successful in pulling in $1 billion in healthcare revenue, healthcare will makeup one-fifth of total company revenue, according to the Reuters report.

Salesforce.com already counts UCSF Medical Center and Blue Cross of California as customers, said Reuters' sources.

And in June, Salesforce.com and Philips partnered to create a data-sharing platform and apps to aid providers and patients in care coordination. Two of the first apps to be launched on the platform, Philips eCareCoordinator and Philips eCareCompanion, will aid remote monitoring for patients with chronic conditions.

Salesforce.com isn't expected to release official word on its plans for the industry until November, but the rumblings of a large-scale move into healthcare by one of America's 40 most innovative companies could mean big changes for the health IT competitive landscape.

Salesforce.com has conquered the world of CRM. And while CRM is related to health management, care coordination and patient engagement, keeping a patient healthy is a lot different than turning leads into customers. The question on the minds of those who understand the force that is Salesforce.com and the challenges that characterize the healthcare industry goes something like this: Is this 800-lb CRM gorilla good enough, and does it understand the nature of healthcare well enough, to become the dominant provider of care management solutions?



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3 of the most frightening things in healthcare today

Halloween will come and go, but three problems in healthcare today will likely persist for longer than anyone in their right mind would like.

1. Ebola.  Ebola is harrowing at its most basic pathological level, with severe symptoms, a high mortality rate and no vaccine. But the Ebola epidemic has proven deeply alarming in many ways beyond its science. There were more than 10,141 confirmed, probable or suspected cases reported as of last weekend, according to the World Health Organization. While Ebola cases in West Africa continued to climb, national attention turned inward as American public health officials and politicians sparred over how to appropriately stop the virus' spread. The debate unfolded as the number of diagnosed Ebola cases on American soil dropped to one Tuesday, when nurse Amber Vinson was discharged from Emory Hospital in Atlanta, Ebola-free.   

The American healthcare system has performed remarkably well in past moments of national distress. Remember how it functioned in the sobering aftermath of 9/11, and more recently, the Boston Marathon. Emergency workers, physicians, nurses and hospitals worked as a united front, delivering much-needed medical care that rose above tough media scrutiny and the fray of politics or opinion.

But the Ebola epidemic has proven more damaging to our domestic healthcare system and global health thinking. It has brought on a sense of self-interested panic that is feeding divisions over national security, whether between the White House, governors, media outlets, healthcare professionals, CDC, mission workers, Texans, New York City residents — the list goes on. The number of lives Ebola has affected or taken in West Africa is devastating and the United States' poor response is disappointing. If anything, the confusion, schisms and shifting of blame have only exacerbated the crisis, taking attention away from the intervention desperately needed in West Africa.

2. The depersonalization of medicine. Transitioning from Ebola is uncomfortable, since the weight of other problems seems to shrink in the shadows of a  global emergency. The depersonalization of medicine is not nearly as visible or grave. Rather, concerns about the weakening physician-patient bond have gradually intensified throughout the healthcare system and are likely to persist for some time. With no easy solution, if one at all, this dilemma is often placed on the backburner to make room for the dozens of other pressing healthcare concerns du jour.

In many cases, the term "burnout" is too mild to describe the disenchantment many physicians feel about their work. "I don't know about other physicians but I am tired — tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way I practice medicine," orthopedic surgeon Daniel Craviotto, MD, wrote in a Wall Street Journal op-ed this spring. Dr. Craviotto is just one of many physicians to take his thoughts to pen and paper. In a piece for The Atlantic, essayist Meghan O'Rourke drew attention to how many physicians are writing books about their professional problems. (The titles often share a common tone, such as "The Doctor Crisis" or "Doctored: The Disillusionment of an American Physician.")

"What's going on is more dysfunctional than I imagined in my worst moments," wrote Ms. O'Rourke. "Although we're all aware of pervasive healthcare problems and the coming shortage of general practitioners, few of us have a clear idea of how truly disillusioned many doctors are with a system that has shifted profoundly over the past four decades."



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10 leadership lessons from "The Front-Line Leader"

Chris Van Gorder, CEO of Scripps Health, has been a remarkable leader for the San Diego-based, five-hospital system. After joining the system in 2000, at a time when the medical staff had voted no confidence in the previous administration and the system was losing millions, Chris led its remarkable $150 million turnaround. And he did so without any layoffs. Today, Scripps' facilities routinely appear in national hospital rankings, and the system recently opened a $220 million cancer center and has a $450 million cardiac center in the works.

If you ask him how he did it though, he's quick to correct you: He didn't do it, the more than 13,000 dedicated physicians and staff did. He just guided them.

In fact, guidance — through vision, purpose and empowerment — is a key theme of his new book, "The Front-Line Leader: Building a High-Performance Organization from the Ground Up" (Jossey-Bass, 2014).

The book provides numerous leadership lessons and stories that highlight the importance of inclusive but accountable leadership. Here are 10 of our favorites:  Frontlineleader

1. Leadership should be hands-on. You can't understand your organization, its challenges and opportunities by staying in your office all day. Chris is the epitome of a hands-on leader, visiting departments and asking to be bossed around, so he can understand the duties of each team. His efforts have led to his assisting in surgery and even using a floor polisher under the supervision of the environmental staff. Hands-on leadership breeds trust, which is critical to gaining the buy-in of employees.   

2. Great leaders have a passion for what they do. That is, they love the industry they're a part of, not just leading. Chris started his career as a police officer in California. He was hospitalized after a domestic disturbance call that ended in him being hit by a car. While in the hospital, he became in awe of the care he received from his nurses. He recovered, but his injuries left him unable to return to the force. He asked the hospital that treated him to hire him as director of security. He got it by agreeing to work for minimum wage for 90 days. He proved himself, and the rest is history: He earned his master's in healthcare administration from University of Southern California and began working his way up through the hospital administration ranks. The experience of being a patient made him understand the importance of healthcare to our society and engrained in him a passion to improve it. 

3. The best leaders recognize organizational success isn't about the top of the organization, but the bottom — the front-line leaders. The leadership approach Chris shares is somewhat counter-intuitive: Leaders lead down, not up. He advocates leading or managing "down," whereby each level of management ensures those below have the tools and support they need to do their jobs well.

4. Leadership success is largely due to communication. Having a vision for an organization is one thing, but achieving it requires the buy-in from front-line workers and their understanding of what behaviors are needed to reach it. How do you gain buy in? Through communication and education. Employees don't have to love every decision leadership makes, but they need to understand the 'why' behind it.

5. Being a good communicator requires being accessible and responsive. Chris is a brilliant leader and skilled communicator. He understands the importance of communicating with all stakeholders, especially employees, and hosts regular town halls to hear employee concerns and feedback. And he's a whiz at email. Try emailing him; you'll likely hear back in less than an hour. He responds quickly because he values others' input, and wants to demonstrate that.



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A lesson for healthcare leaders from Cirque du Soleil

"We are living in a world where average is not an option. In an era of hyper-competition...the only way to stand out from the crowd is to do something different."

The importance of differentiating yourself and your organization from competitors was the theme of a keynote presentation by Bill Taylor, founding editor of Fast Company and best selling author of "Radical: Not-So-Crazy Ways to Transform Your Company, Share Up Your Industry, and Challenge Yourself," at the Becker's ASC 21st Annual Meeting in Chicago on October 24th. 

The key to a successful organization has changed dramatically in the last two decades. "For so long, the strong took from the weak," said Mr. Taylor, explaining how previously, the biggest, most established brands almost always beat out competitors. "That world is over; the new logic of success is 'the smart take from the strong.'"

Smart companies don't try to do the same thing as everyone else but better. Instead, the smartest companies "want to be the only one who does what [they] do," said Mr. Taylor.

If we take this idea to heart, the key to organizational success today is coming up with new, creative ways of delivering products and services. 

How will your organization identify these? Perhaps you can take a few cues from the revolutionary Cirque du Soleil, which has reinvented the circus and has been rewarded with hundreds of millions of dollars in annual revenue because of its daring to think differently. 

Aim for reinvention
Embrace big change. Circuses, since their invention, have been associated with animals and ringmasters. Cirque du Soleil reinvented the experience and the economics of the circus, explained Mr. Taylor.

Forty percent of the costs associated with a circus are tied to acquiring, feeding, caring for and transporting animals. The second largest line item is for "celebrity" performers, such as the ring master and lion tamer.

Cirque du Soleil completely did away with these previously required elements. No animals, and no celebrity performers. "The show is the star, and the cast is interchangeable," said Mr. Taylor, referring to Cirque's approach as "a way of being in that business that is different than anything before."

Often, outsiders are the first to see creative solutions that those within the industry or within an organization miss. This is referred to as the paradox of expertise. "Don't let what you know, limit what you imagine," warned Mr. Taylor.

"What's your version of live animals at the circus?" he asked.



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The 10 most admired CEOs in healthcare

One of the perks of being a healthcare journalist is the ability to meet, interview and interact with some of the top leaders in the industry. We're continuously impressed with their dedication to the mission of healthcare and their ability to seamlessly protect that mission while dealing with the numerous financial and regulatory challenges that confront their organizations.

As journalists, we're often asked at professional and even social events who we most admire in the industry. It seems everyone wants to know: Who is the best, and who is the worst? Thus, we've compiled a personal list (drawing insight from other Becker's Healthcare editors) of the ten best CEOs in healthcare. Here, we've defined 'best' as those most admired within the industry, who have the most noteworthy accomplishments as well as a personal magnetism. We've listed them in alphabetical order below (ranking these top 10 leaders against one another would be a task even Becker's isn't willing to take on!).

Ruth Brinkley, president and CEO of KentuckyOne Health (Louisville). Ms. Brinkley, an African American and preeminent advocate for women, commands the wheel of KentuckyOne Health. Ms. Brinkley is credited for the successful formation of the KentuckyOne Health system following the 2012 merger of Louisville-based Jewish Hospital & St. Mary's Healthcare and Lexington, Ky.-based Saint Joseph's Health System, but her grit and resiliency as a leader became most evident in her successful inclusion of the University of Louisville as an affiliate of KentuckyOne Health. In the face of the Kentucky attorney general's objection to include U of L and UniversityHospital in the official merger, Ms. Brinkley devised a joint operation agreement between U of L and KentuckyOne that resulted in the creation of a state-wide health system. With an emphasis on increasing access to healthcare in communities removed from the health system's downtown Louisville headquarters, part of Ms. Brinkley's vision is the implementation of technologically oriented solutions across the system, including telemedicine and EMRs.

Dr. Delos "Toby" Cosgrove, MD, president and CEO of Cleveland Clinic. Dr. Cosgrove, the poster child of healthcare, has spearheaded the Cleveland Clinic through numerous achievements since his appointment in 2004. His leadership style and engagement with patient issues is widely recognized, and even led to an offer by President Obama to become the next Secretary of the Department of Veteran Affairs following its patient wait time scandal this summer, which he declined in order to stay with the Clinic. In 2008, Dr. Cosgrove instituted a same-day appointment policy, a program that has seen great success. Often referred to as the system's "chief transparency officer," Dr. Cosgrove's value of system-wide transparency culminated in the development of the Cleveland Clinic's Outcomes Books, which makes performance outcomes data for its clinical institutes publicly available. In September 2014, the Cleveland Clinic broke ground in the construction of its new, $276 million multidisciplinary Cancer Institute on its main campus. As one central facility, this new building will be home to one of the most robust cancer research and care centers in the country.

Michael J. Dowling, president and CEO of North Shore-Long Island Jewish Health System (Great Neck, N.Y.). Since diving into his role as president and CEO of North Shore-Long Island Jewish Health System in 2002, Mr. Dowling has led North Shore-LIJ into numerous strategic relationships, with five affiliations or partnerships occurring within the last year alone. Standouts include a partnership with Access Clinical Partners to develop a network of 50 urgent care centers in the New York City area during the next three years, established in October, and the selection of North Shore-LIJ by the Cleveland Clinic Heart & Vascular Institute as an exclusive alliance member for providing heart patients in the New York metropolitan area with greater access to clinical trials and advances in cardiac care. In 2012, North Shore-LIJ and Cablevision System, the region's leading provider of healthcare and communications, launched North Shore-LIJ Health TV, an interactive health channel that offers timely, vital health and wellness information to viewers across New York, New Jersey and Connecticut. Mr. Dowling also has his eye on other care and payment opportunities that span beyond the confines of hospitals. He helped launch system's commercial health plan in 2013. More recently, the health plan partnered with MinuteClinic and added 900-plus sites of care to its network. "I want to be in the health business — not just the illness treatment business," Mr. Dowling told Becker's in 2012. 

Richard J. Gilfillan, MD, president and CEO of CHE Trinity Health (Livonia, Mich.). Dr. Gilfillan took the helm of CHE Trinity as president and CEO in November 2013 following the merger of Newton Square, Pa.-based Catholic Health East and former Trinity Health, which was located in Livonia, Mich. As part of his vision to increase access and the quality of care for the populations CHE Trinity serves, one of Dr. Gilfillan's goals includes having a Medicare Shared Savings Program ACO in each of the system's markets by Jan. 1, 2015. As of May, CHE Trinity has five ACOs, with 11 more applications in process for January 2015. Additionally, CHE Trinity has set a three-year objective to achieve $300 million in savings through merger synergies. Under Dr. Gilfillan's leadership, the Catholic health system has already surpassed its $80 million savings target for this year.

Kevin E. Lofton, MHA, President and CEO of Catholic Health Initiatives (Englewood, Colo.). Mr. Lofton has served on the frontlines of Catholic Health Initiatives as president and CEO since 2003. Under his leadership, the health system has continued to expand its reach across the nation. Most recently, CHI acquired Lufkin, Texas-based Memorial Health System of East Texas, in June 2014, and in 2013 it acquired St. Luke's Episcopal Health System in Houston. The system also issued $1.7 billion in taxable and tax-exempt bonds to fund market expansion, IT infrastructure, insurance products, clinically integrated networks and ACOs. In addition to his accomplishments as CHI's chief leader, Mr. Lofton is also an antiviolence advocate, championing CHI's United Against Violence initiative, a nationwide enterprise committing to combat violence and improve prevention. 

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Why a failing bookstore holds a key to the future of healthcare

Today, the use of predictive analytics by Internet retailers is ubiquitous. Amazon was one of the first to use it widely, creating algorithms to recommend books consumers might like based on their previous orders and ratings. Other bookstores, like Barnes & Noble, and other retailers have since widely adopted such technology for their e-commerce sites. Consumers, for the most part, have come to appreciate this technology. Who doesn't love discovering a great new book that you never would have read without a virtual recommendation?

The technology is now so widely used that it's easy to forget it didn't always exist. 

Two men that helped develop and implement this technology for leading retailers, including Barnes & Noble, have since set their sights on healthcare. What they have planned is exciting and groundbreaking.

Imagine receiving an email from your provider and clicking through to a secure portal where you're alerted that you're due for mammogram. The alert not only tells you when your last mammogram was, when the next available appointments are, but also exactly how much your insurer will cover and how much you'll owe out of pocket. This won't be a rough estimate, but the price you'll pay based on your specific health plan information.  

For those of us who know how difficult it has been to implement predictive analytics — let alone obtain transparent pricing information, this sort of scenario seems revolutionary. However, it's exactly what Jeff Kaplan and Paul Bradley of MethodCare have in mind.

The two former classmates at the University of Wisconsin founded the company in September 2011 to bring the power of predictive analytics to healthcare. Previously, they worked together at digiMine, where they developed predictive analytics for leading retailers. Just last month, revenue cycle management company ZirMed acquired MethodCare, and the partnership means they will now have access to data from the 1.2 billion annual claims ZirMed touches, says Thomas Butts, CEO and chairman of ZirMed.

I met with Jeff and Tom at MethodCare's Chicago office last week, which they'll be leaving soon for a bigger space. They plan to develop a Healthcare Analytics Center of Excellence here in Chicago, where they'll house some of the top IT talent in the country.

Jeff says the appetite for predictive analytics in healthcare has changed since launching the company, and it's about time. When he and Paul first approached health system executives some two to three years ago, they couldn't understand why someone who had done analytics for retailers like Barnes & Noble wanted to work with a hospital, he says. Today they are eagerly received. However, they realize the realm of healthcare is very different than retail.

"If you recommend the wrong book, big deal," says Jeff. In healthcare, "the stakes are much higher."

Many leading health systems have lauded their use of predictive analytics. However, most systems have thus far only engaged in small, one-off projects, such as using analytics to identify those patients most at risk for congestive heart failure. While this is a worthy endeavor, it only impacts a small subset of patients. What is possible in the near future is hundreds or thousands of simultaneous projects like this that result in automatic prompts to patients and providers suggesting appropriate interventions. Such a future could mean healthier patients while using fewer resources.

Thomas says the companies plan to release tools that allow for the "you're due for a mammogram" scenario as early as next year.

So, while Barnes & Noble has ultimately struggled, it understood the power of the predictive analytics and the value their use brings to consumers. Discovering a new book is valuable, but the ability to predict which patients are about to get sicker, and intervening to help them maintain their health, is truly valuable. Jeff, Paul and Thomas have realized this for years, and we soon will.



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How a well-connected CEO can hurt an organization

A CEO with an extensive social network may leave an organization — and its shareholders — worse for the experience.

That's because CEOs with the thickest Rolodexes, 500-plus LinkedIn connections and the closest ties to board members and other executives might be pull off an acquisition that will ultimately benefit them, but work against shareholder value.

A new study, co-authored by Rwan El-Khatib, PhD, from Zayed University in Dubai, Kathy Fogel, PhD, from Suffolk University in Boston, and Tomas Jandik, PhD, from University of Arkansas in Fayetteville, examines the "network centrality" or overall level of connectivity of CEOs and how this influences M&A activity. Dr. Jandik and his colleagues measured the connectedness of nearly 400,000 corporate officers and directors in the United States by analyzing their biographies and making note of their careers, education and social relationships.

Did CEOs attend college together or serve on the same board simultaneously? Did they cross paths earlier in their careers at another company? All of this information resulted in a family tree of sorts for each executive, identifying who knows who and how connected each person is to the larger social network of C-level executives.   

Researchers measured connectivity in four distinct dimensions. One is the sheer size of the basic network. This is similar to counting Facebook friends, as an example. The second is closeness: If you put yourself against everyone else, how many steps on average does it take for you to reach everybody in the network? (This resembles the parlor game Six Degrees of Kevin Bacon.) Next is betweenness, or how many times you're the connection between any two individuals, which is a measure of social importance. Finally, there is eigenvector centrality, or the value-rated number of connections you have. This places greater weight on people who are already influential. For instance, if you have 10 friends and one of them is Bill Gates, you are better connected than if you had 100 unimportant friends.

The researchers measured CEOs' network centrality year over year, placing them in percentiles. The following examples illustrated the breadth of connectedness they saw: One executive who fell in the 100th percentile had 792 direct connections. He could reach each individual in the network in an average of 3.2 steps. Another CEO fell on the opposite side of the spectrum, with only 10 direct connections and an average of 5.5 steps away from everyone in the network.

This all sounds like a very organized and data-driven popularity contest so far, doesn't it? What does this have to do with mergers and acquisitions?

Quite a bit, as it turns out.

After placing executives in percentiles, researchers examined their connectedness in the context of M&A activity among S&P 1500 companies from January 2000 to December 2009. They found highly connected CEOs pulled off transactions more frequently than CEOs with less network centrality.

Deals driven by well-connected CEOs also generated mostly negative stock returns for the bidder's shareholders, and often reduced the combined value of merged companies. Increasing CEO centrality from the 25th to the 75th percentile of the sample deepened bidder shareholder losses by an additional 3.4 percentage points on average, according to the study.



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Could Republicans dismantle the PPACA as we know it?

Nearly half of Americans think the Patient Protection and Affordable Care Act is a bad idea. While more than 50 percent of Americans supported the law in January, as of September, that number had dropped to the high thirties. And, the midterm elections are mere weeks away. Could Republicans get what they've been asking for where it concerns the PPACA?



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Our perfectly designed healthcare delivery system

In the United States, we have a perfectly designed $2.7 trillion healthcare delivery system. It's perfectly designed to deliver more and more healthcare, but not well-designed to "deliver" more health. And when you start asking the question, "How do you deliver more health, not just more healthcare services?” the answers are very different. As the proliferation of shared risk, accountable care and capitated payment arrangements has made clear, this will be an important area of focus for hospital executives in the coming decade.

In New York, Montefiore Medical Center can tell you — almost to the penny — how much an investment it takes to set up a school-based health center. They model how many pediatric asthma admissions will be prevented, how many days of school attendance can be saved, and how many teenage pregnancies will be averted. Ultimately, this data translates into more money for the school district with better attendance, better educational outcomes for children and in a capitated environment, savings from reduced ambulatory sensitive admissions to Montefiore. Most importantly, an "upstream" investment keeps kids healthier in the first place, with ancillary benefit to the community.

In California, Dr. Preston Maring at Kaiser Permanente noticed that there were vast differences among patients being readmitted for congestive heart failure, with low readmission rates in Richmond, and high rates in Oakland. He observed that many patients he sent home to Richmond were going home with families, while those living in Oakland were going home alone. Digging deeper, patients home alone were eating frozen meals, and these high sodium, low nutritional meals were leading to readmission. Based on these geospatial analysis results, Kaiser Permanente was able to contract with a private vendor to deliver high-quality, fresh meals at low cost to these members. Problem solved!

While I'm not suggesting that every hospital needs to start school based clinics or engage in geospatial analysis, understanding your patients' needs — sometimes better than they know themselves — will allow the "mass customization" that differentiates the highest performers in an era of retail healthcare. Whether you call it managing population health, addressing the social determinants, or the worst name — the "social non-medical needs" of patients, these skills and strategies are essential today.



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16 critical competencies for healthcare leaders

The healthcare industry faces momentous change ahead, and leaders of healthcare organizations must be ready to adapt, facing these changes head-on. Good leaders, who may have succeeded at leading their organizations during the somewhat steady years of fee-for-service reimbursement, may not be good enough to take on the challenges of preparing their organizations for such significant disruption. Instead, the industry needs exceptional leaders, say Carson Dye and Andrew Garman, authors of "Exceptional Leadership: 16 Critical Competencies for Healthcare Executives."

The second edition of the book, out this year, includes updated information around the 16 competencies in the Dye-Garman model for exceptional leadership. The 16 competencies, grouped into four cornerstones, provide an overview of the type of leadership skills and traits healthcare leaders must cultivate, as well as those boards should look for when selecting new leadership for their organizations. Below is a quick overview of each competency; for a more detailed analysis of each, along with case studies, click here.



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