Bon Secours Virginia Health System developed an intensive seven-week course for finance professionals on value, covering the elements of reform, how to effectively collaborate with clinicians on value, and more.
At a Glance
- Health systems should take strong steps to ensure that their current and aspiring finance leaders are fully prepared to engage with clinicians in meeting the requirements of healthcare reform.
- In 2012, Bon Secours held a clinical transformation finance intensive to teach finance staff how to accelerate clinical transformation within their markets.
- The education and skills that Bon Secours’ finance professionals gained from the intensive have strengthened the health system’s ability to respond to the challenges of reform.
At Bon Secours Virginia Health System, leaders have taken a close look at the organization’s finance structure to determine whether the health system has the right mix of support to help guide it through an era of reform, which will require increased emphasis in areas such as analytics and business intelligence. Last year, Bon Secours’ leaders began to ask two important questions: How knowledgeable are our finance staff on reform? And what does value mean—and how many people in our finance department can speak to it?
Bon Secours, a participant in HFMA’s Value Project, is a recognized leader in clinical transformation. In FY11 alone, the health system was able to reduce variable care costs by more than $35 million across the enterprise. The organization’s efforts to improve quality of care, reduce costs, and enhance patient satisfaction involve the work of multidisciplinary teams that include finance executives from throughout the health system.
For more than six years, Bon Secours’ strategy has been to be ready and flexible for the dynamics of reform, regardless of the many forms that reform will take. But in 2012, the health system’s leaders realized that reform is not just coming—it’s here, now. They also recognized the need to ensure that key members of the finance team—not just current finance leaders, but also those who could one day serve in leadership positions—are prepared to engage with clinicians in improving value in their markets.
Bon Secours’ leaders knew that to be effective, any initiative to educate finance staff on reform must be undertaken at the system level. They also acknowledged the importance of finding ways to make this education relevant internally, so that finance professionals would understand the impact of reform as it relates to the health system as a whole and to hospitals in individual markets. A strong, focused effort on educating the health system’s team was needed so finance staff not only could speak about the mandatory elements of reform, but also could attest to Bon Secours’ voluntary efforts as a system to improve value.
In 2012, Bon Secours created its clinical transformation finance intensive, a seven-week course that brings together two to three finance staff from each of the health system’s six markets who take a “deep dive” into clinical transformation—developing an understanding not only of variations in cost and quality, but also of the financial impact of quality, how payment is beginning to be tied to value, and the ways reform is affecting the health system now and in the months and years ahead.
The education and skills that finance professionals have gained from the intensive have positioned them to accelerate clinical transformation within their markets, thereby strengthening the health system’s ability to respond to the challenges of reform.
How the Intensive Works
The definition of clinical transformation is continually evolving as health systems across the country prepare for the shift from volume-based to value-based business models. Clinical transformation encompasses a comprehensive approach to managing care across the care continuum and to redesigning care delivery through a multidisciplinary approach. It requires an intense focus from everyone within a healthcare organization—leaders, physicians, clinicians, finance professionals, and more—to improve quality of care and service; create holistic, patient-centered care experiences; reduce healthcare costs by reducing waste, variation, and duplication; and provide the right care at the right time in the right way.
Bon Secours achieved substantial results through its clinical transformation initiative, but health system leaders understand that more is needed to continue to truly transform the delivery of care: Finance professionals must be able to sit side by side with clinical leaders and have meaningful conversations related to value. They must work together to understand why variations in cost and quality occur and determine the best solutions, discuss the financial impact of the quality of care delivered and the ways the organization is being paid for value, and explain the impact of reform on current performance and its anticipated impact in the current fiscal year and the years ahead.
Bon Secours’ clinical transformation finance intensive is designed to provide a focused look at the mandatory elements of reform, the voluntary efforts the organization has undertaken as a system to improve value, the tools it has developed to support its work in improving value, and the role finance professionals should play in effectively engaging clinical counterparts in clinical transformation.
The course is divided into six components:
- Elements of reform (a two-week session)
- Tools and decision support for clinical transformation (including business intelligence tools and ConnectCare, the health system’s electronic health record)
- Clinical collaboration
- Managed care
- External tools for measuring value, as well as basics of achieving meaningful use
- Sharing of individual projects that team members have undertaken to accelerate clinical transformation in their markets
Participants commit to attending each session, presented in a webinar format to allow participants to take part from their own offices. They also are required to complete homework assignments each week.
For example, after the first session in 2012, participants visited the Hospital Compare website to determine how their hospital ranks in comparison with competitors and hospitals across the country on a variety of quality metrics that were discussed in class. After the second session, participants sat down with clinical leaders in their organizations, reviewed the quality data they had found, and learned what their organizations are doing to sustain or improve performance in a number of areas. Later, they led the development of a clinical transformation initiative at their own facilities, collaborating with clinicians and other staff to enhance quality, drive down costs, or reduce waste.
Much of the success of Bon Secours’ clinical transformation initiative can be traced to the partnerships developed between clinicians and finance professionals in the health system. Bon Secours’ leaders wanted to ensure that the next set of finance leaders would be comfortable in talking with clinicians and in partnering with their system’s clinical leaders to improve value. For this reason, participants in the intensive also are invited to take part in a clinical collaborative in which all chief nursing officers, chief medical officers, and CFOs from across the system participate in monthly phone meetings to discuss best practices in care, ways to redesign care delivery to achieve excellence throughout the continuum, and opportunities to effectively reduce costs and waste while enhancing the patient experience. The goal is to allow members of the finance team to hear first-hand how the system is addressing these types of issues and transforming care delivery.
True to the name of the course, each session of the clinical transformation intensive is intense. The course begins by building the case for reform—taking a close look at the level of healthcare spending in the nation compared with that of other countries, and examining the increase in obesity rates in the United States and the effect this increase has had on healthcare consumption and costs. Then, the course launches into a detailed discussion of the Affordable Care Act and the mandatory elements of reform, such as the need to reduce readmissions and the incidence of healthcare-acquired conditions, as well as the move toward value-based purchasing, which will realign Medicare payment for acute care hospitals based on their performance on certain quality measures. Participants also learn about the history of clinical transformation at Bon Secours, how the health system has progressed in this area, and why the health system’s efforts have positioned it beautifully for reform.
Time is also spent discussing the basics of managed care. Some participants had never been exposed to managed care contracts in their work in finance. It is important that finance professionals know that as the Centers for Medicare & Medicaid Services moves toward value-based payment, managed care ultimately will follow suit. For this reason, the course also covers the history of how Bon Secours has been paid for the care and services it provides, and how it is being paid now. The course looks at the similarities between payment reform and the ways in which commercial payers are beginning to shift greater risk to hospitals and health systems, and it addresses the importance of having a single source of truth for metrics and why it’s critical to avoid metric overload.
Participants in the 2012 intensive found it to be hard work. Some had a wide range of knowledge about clinical transformation and had been involved with value improvement initiatives in their organizations; others had very little exposure to clinical transformation. Some knew a lot about reform; others had a basic knowledge of the elements of reform. There were gaps in training and knowledge that each of these potential finance leaders faced, and these gaps could not be filled by simply sending them to a seminar on reform.
Bon Secours tackled this challenge by breaking the information down into bite-sized pieces that could be applied by finance professionals in their operating environment. Participants were told, “There is a whole new set of tools you need to have in your toolbox in an era of reform. In and of itself, the information we’re presenting isn’t that complicated; it just takes dedicated time to learn.”
Supporting a Culture of Transformation
The feedback received regarding the 2012 clinical transformation intensive—both participants and leaders who oversee their work throughout the system—demonstrated the value of the intensive.
Janice E. Burnett, CPA, CFO, Bon Secours Health System, Ellicott City, Md., attended the graduation celebration Bon Secours held for the participants, where each member of the group shared the clinical transformation project he or she had developed with the support of clinicians. One project focused on ways to reduce readmissions by improving access to pharmaceuticals after discharge; one concentrated on reducing Medicare spending per beneficiary, while another focused on reducing variation in supplies within each facility in a particular market.
“You could really tell that a number of those who took part in this intensive were actively engaged in clinical transformation and had a strong desire to remain engaged in this type of work,” Burnett says. “They were the ones who were describing two or three other initiatives they’d like to pursue at their facilities as well. Probably one-quarter of the participants discovered that clinical transformation was not going to be their niche, and that’s OK—they’ll likely go on to specialize in another aspect of finance, such as revenue analysis.”
Burnett underscores the importance of following up with clinical transformation intensive participants at the three-month and six-month mark, so that they may share progress on individual projects with the group. At Bon Secours, leaders also are dedicated to ensuring that graduates of the clinical transformation intensive have opportunities to contribute to the organization’s value strategy.
“One of the things we’re focusing on now is ensuring that we’re using these team members’ strengths to improve value, such as by including them in our clinical collaboratives,” Burnett says. “We’ve never had a finance staff person participate in these collaboratives; instead, finance representation came from our CFOs. Their participation will assist us in making sure we’re adding value operationally on a regular basis and that we’re staying ahead of the opportunities that exist for our system under reform.”
Michael McNeely, CHFP, director of finance for Bon Secours Memorial Regional Medical Center in Mechanicsville, Va., gained a greater understanding of value-based purchasing and other reform-related business models through the intensive, as well as strategies for helping his organization adapt to the challenges of reform.
“This program pushed finance staff out of their comfort zone and gave us the opportunity to have rich discussions with operational and clinical leaders on issues that are going to be important to the success of our organization in the future,” McNeely says. “It forced us to digest as much as we could about the elements of reform in a short amount of time. It also gave us the tools and the skills to dig deeper into the causes of deviations in length of stay, labor expenses, and supply costs within our organizations. The knowledge and experiences I gained will be valuable long after the course has ended.”
Looking forward, Bon Secours will continue to offer the clinical transformation intensive twice a year, in addition to intensives the organization has developed around operations finance and revenue analysis. Health system leaders also will seek additional opportunities to provide timely, relevant information on reform for the 225 members of the health system’s finance team in ways that are both easy to digest and apply in their work throughout the system.
Melinda S. Hancock, FHFMA, CPA, is senior vice president and CFO, Bon Secours Virginia Health System, Richmond, Va., and a member of HFMA’s Virginia-Washington D.C. Chapter.