Last December, AtlantiCare won the 2009 Malcolm Baldrige National Quality Award, the White House's highest honor for quality and organizational performance. AtlantiCare includes the 589-bed AtlantiCare Regional Medical Center, with campuses in Atlantic City and Pomona, N.J.; a physician group; two ASCs; and a partnership in a small health plan. The Baldrige prize recognizes outstanding performance in categories such as leadership, customer focus and quality results.
Jim Nolan, senior vice president of finance at AtlantiCare, explains how this integrated healthcare system in southeast New Jersey won this distinction.
Question: What are some reasons why you won the Baldrige award?
Jim Nolan: The award process helped us learn to focus management and staff on factors critical to our success and not be distracted by other issues. The entire organization aimed not just to be in the top decile of hospitals but to be simply the best. To win the award, you have to excel in five areas: quality, customer service, people and workplace, financial performance and growth.
The premise is that if we can achieve a high level of operating performance in those areas, much of the rest will take care of itself. It makes for a very simple message to everyone in the organization that doesn't change from month to month. While we still have room for improvement, services like our ASCs are very far along on the Baldrige journey to being the best.
Q: How have you been growing your market?
JN: AtlantiCare has a 73 percent "local" market share in its primary service area. (Note: The term "local" market excludes patients who migrate out of the area for services — in Atlanticare's case, mainly to Philadelphia.)
We have focused on reversing outmigration and expanding our service area. Outmigration has been reduced from 17 percent to 14 percent since 2000 and we have expanded our service in every direction except the east, which would have meant wading out into the Atlantic.
Our strategy is to build high-quality regional and tertiary services at a level of operating performance unsurpassed in quality and customer service. Our ASCs involve strong collaboration with physicians to build an operation with high volume and high quality.
Q: Any other ways you have been expanding market share?
JN: We listen and learn from our patients, staff and other stakeholders, incorporating their feedback and input as we develop our strategy, which is a key Baldrige criterion.
For example, we opened a special care center in Atlantic City with Local 54 of the Hotel and Restaurant Workers union. The center is a medical home exclusively for chronically ill patients with the most costly and complex cases. We use health coaches, social workers and dieticians to help manage care and lower hospital admissions and ED visits. The center has more than 1,000 members, from their 30s to their late 70s, and we recently expanded the program to include the general community.
Q: How do you address patient satisfaction?
JN: Our "Voice of the Customer" process is always seeking feedback. We perform formal customer satisfaction studies in counties where we operate and have established an access center, which is a toll-free physician and event scheduling line that tracks customers' requests and needs. We empower staff to provide customer service proactively and offer them an incentive-based compensation system linked directly to customer service and financial performance.
Additionally, we look for advice from community members when planning new programs and services, for example with our new Cancer Care Institute. The institute's community advisory group has provided invaluable input in planning stages and after the institute opened. Each board member links up with an "affinity group," a certain demographic segment of patients or community members. One board member chose working moms, for example.
These efforts have had terrific results. Customer satisfaction for multiple service lines was above the 90th percentile national benchmark from 2007 to 2009 in surveys by Professional Research Consultants.
Q: How loyal are your employees?
JN: Employee loyalty at AtlantiCare is equal to or approaching the 90th percentile in national performance levels in a 2009 survey by HR Solutions of key drivers of workforce engagement. Our nurse turnover rate fell from 7.75 percent in 2006 to 6.02 percent in 2008, compared with the state average of 12.43 percent, as reported by the New Jersey Hospital Association.
Q: What sort of quality initiatives has AtlantiCare been involved in?
JN: We have been using multidisciplinary teams to develop clinical practice guidelines, based on the latest medical evidence. As a past participant in the "100,000 Lives Campaign" by the Institute for Healthcare Improvement, we are making changes to enhance patient care and prevent avoidable deaths. And we are currently working to reduce post-operative complications as part of the nationwide Surgical Care Improvement Project.
We have performed very well on quality measures. AtlantiCare has been in the top 10 percent nationally on CMS patient care measures for congestive heart failure, acute myocardial infarction and pneumonia. Also based on CMS data, the Commonwealth Fund ranked us seventh in the nation for clinical results in patient care.
Q: How does AtlantiCare work with physicians?
JN: We are part of pilot projects with seven other New Jersey hospitals involving gainsharing, in which a hospital shares savings from increased efficiencies with cooperating physicians. Our pilots involve working with internists to reduce lengths of stay and with specialists to reduce the cost of procedures.
Q: Have you been acquiring physician practices?
JN: AtlantiCare employs 50-60 physicians, not including hospitalists. We have acquired a few practices that shared our business strategy and those acquisitions have picked up a little bit lately. But in addition to acquisitions, we work hard to collaborate with physicians who want to remain in private practice.
Q: How do you work with independent physicians in the community?
JN: We meet with them and ask how we can help them with their practices. We created a department of physician services to enhance communication. One way we can help physicians is by opening urgent care centers that complement their care and don't compete with them. We have opened five urgent care centers so far, including the region's first retail-based health center, which is in a ShopRite supermarket. The centers share results with physicians so they can follow-up with patients.
Q: Have you had success with information technology?
JN: Our two hospital campuses already have computerized physician order entry (CPOE) and electronic medical records (EMR) for employed physicians. Since 2009, we have been offering EMR to independent physicians on staff through a grant program. That involves underwriting their costs of introducing EMR into their practice and helping out with implementation.
We also lead a regional health information organization with other hospitals in the area. A key goal of our RHIO is to enable residents to have access to their medical records at every point of care in the area. The access point can be at any hospital. It doesn't have to be ours.
Q: It's unusual for an organization of your size to have a health plan. What has happened to it?
JN: For many years we owned a small health plan that offered HMO and PPO products, but we realized we did not have the critical mass to adequately spread risk, so we sold it to Horizon Blue Cross of New Jersey in 2002, and now we operate it as part of a joint venture with Horizon.
The joint venture offers the best of both organizations. Horizon, the largest insurer in the state, does what it knows best: writing the policies, marketing them and providing member services. And we do what we know best: managing the medical costs, performing the utilization management and taking care of large case management.
Learn more about AtlantiCare at www.atlanticare.org.