2016 Top Medical Innovations

For the past ten years, Cleveland Clinic has produced its annual listing of the ten most powerful medical innovations for the coming year.  Here, in order of anticipated importance, are Cleveland Clinic’s Top 10 Medical Innovations for 2016:

1.  Rapid Development of Epidemic-Battling Vaccines. Researchers are developing effective vaccines faster than ever to prevent epidemics, an effort given new urgency by the 2014 Ebola epidemic in Africa and of bacterial meningococcal outbreaks in the United States.

2.  Genomics-based Clinical Trials. Genetic profiling offers new hope to people suffering fatal diseases (e.g. cancer).  Genomic-based tests may increase the speed and flexibility of clinical trials and guide desperate patients to the most promising experimental treatments.

3.  Gene Editing Using CRISPR. Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) can identify and remove bad genes from a DNA strand for as little as $30.  This inexpensive gene editing technique is being adopted in labs everywhere.

4.  Water Purification System. A new kind of waste treatment plant may offer an affordable solution converting human waste into clean drinking water while also generating electricity to run the machine.

5.  Cell-free Fetal DNA Testing. Studies show that Cell-free Fetal DNA Testing more accurately predicts Down’s and Edwards’s syndromes than standard blood tests and ultrasounds.

6.  Cancer Screening via Protein Biomarker Analysis. Protein biomarker analysis focuses on changes in the structure of certain proteins circulating in the blood.  In contrast to examining genetic mutations, which can indicate the risk of cancer, the new tests give real-time information on cancer’s presence.

7.  Naturally Controlled Artificial Limbs. In recent years, researchers have discovered that neural signals associated with limb movement can be de-coded by computers, leading to computer-controlled artificial limbs.  Researchers are working on making brain-machine interfaces safer and cheaper with lower-cost robotic components.

8.  First Treatment for HSDD. In 2015, the FDA approved flibanserin, the first medication designed to treat female hypoactive sexual desire disorder (HSDD).  HSDD is the loss of sexual desire in premenopausal women.

9.  Frictionless Remote Monitoring. Frictionless remote monitoring devices in development include a bandage that reads sweat molecules to diagnose pregnancy, hypertension, or hydration.

10.  Neurovascular Stent Retrievers. A neurovascular stent retriever inserted into the body of a stroke victim through a catheter and threaded through the blood stream seizes a blood clot and removes it, resulting in speedier recoveries and improved chances.

More about these innovations and about the Cleveland Clinic Innovations can be found here.

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U.S. Telemedicine Adoption

Although organizations in the United States are still trying to optimize the use of current telehealth solutions, telehealth is undoubtedly poised for continued growth in the U.S. (and many other countries as well).  Telemedicine is gaining momentum as it has proven to increase access to care and reduce costs via teleconsultations and remote patient monitoring.  U.S. consumers are beginning to use wearable devices to track and collect their personal health data. Over time, we will see more of a willingness to share that data with healthcare providers and intermediaries.

The Healthcare Information and Management Systems Society (“HIMSS”) conducted a survey on telemedicine adoption in the United States.  The survey polled 276 healthcare decision makers and physician executives.  Brendan FitzGerald, research director at HIMSS Analytics, discussed the results with some of us last week.  Here are some highlights of the survey’s findings, of those engaged in telemedicine:

70% utilize a two-way videoconferencing system.

57% use a hub and spoke model (audio/visual only between originating sites).

49.7% are using a patient portal or application-focused patient engagement (services delivered via portal with mobile or desktop access).

20% utilize concierge services (i.e. eVisits and online consults).

The number of respondents engaged in remote patient monitoring in the home decreased from 38% in 2014 to 30% in 2015.

52% are still uncertain about future investment in telemedicine; 28% polled are not increasing their current investment; 20% are planning on future investment on top of their current program.

26% are planning to expand their telemedicine programs to add other specialties in the near future.

34% are engaged in telemedicine primarily to develop a service that increases access and integrates care across rural areas; 22% are focused on developing a service that reduces overall costs for their organization; 18% are seeking to develop specialty services not otherwise available in the region.

The HIMSS Analytics survey can be found here.

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Contact ABISA, a consultancy specializing in solo and small group practice management.  Visit us at ABISALLC.com.

Successful Strategy Implementation

Oftentimes physicians and administrators discuss strategies and may even devise a strategic plan, only to see nothing come of it.  The most common reason for strategy failure is that they failed to build execution into their strategic planning process.  We often see that budgets are not linked to strategy, staff incentives are not linked to strategy, and a very small number of employees understand the practice strategy.  There are three reasons strategy fails to execute:

• Practice initiatives don’t aligned with strategy
• Practice processes don’t align with strategy
• Employees and physicians fail to engage

To ensure that your strategies are successfully implemented, you must build the execution into and across the strategy and the strategy planning process.  Below are the 5 steps to successful strategy implementation.

1.  Align your initiatives

A key road to failed implementation is when we create a new strategy but then continue to do the same things of old.  A new strategy means new priorities and new activities across the practice. Every activity (other than the most functional) must be reviewed against its relevance to the new strategy.  A good way of doing this is to create a strategic value measurement tool for existing and new initiatives. Initiatives should be analyzed against their strategic value and the impact to the practice.  Measuring your initiatives as such will help highlight the priorities and ensure the right initiatives are adopted for delivery.

2.  Align budgets and performance

Ideally your budgets are structured in such a manner as to protect strategic expenditure from being re-allocated to short-term requirements of operating expenditures while subjecting strategic initiatives to a rigorous review (e.g. forecasted revenue growth and productivity) much like is done for capital expenditures.

The practice’s business performance should be closely aligned to strategy.  Performance measures should be placed against strategic goals across the practice and each physician and staff member.  All staff members will have job functions that will impact on strategy. Most staff members will have impacts across a series of strategic goals (e.g. financial, patient experience, operational, etc.). Ensure employees are aware of their role and influence on strategy delivery and performance.

Likewise performance incentives should be directly linked to performance against strategy. They should include a combination of individual, team and practice performance measures that ensure staff recognize their direct and indirect impact on strategy performance.

3.  Structure follows strategy

A transformational strategy may require a transformation to structure. Does the structure of your practice allow strategy to cascade across and down the organization in a way that meaningfully and efficiently delivers the strategy?  Practices that try and force a new strategy into an outdated structure will find their strategy implementation eventually reaches a deadlock.

4.  Engaging Staff

The key reason strategy execution fails is because the practice doesn’t get behind it. If you’re physicians and staff members don’t understand the strategy and fail to engage, then the strategy has failed.  So, how is this accomplished?

Prepare:  Strategy involves change. Change is difficult and human tendency is to resist it. So not matter how enlightened and inspiring your new strategic vision, it will come up against hurdles (cognitive, resource, motivation and political).  It is important to understand each of these hurdles and develop strategies to overcome them.

Include: Bring influential employees, not just managers into the planning process. Not only will they contribute meaningfully to strategy, they will also be critical in ensuring the practice engages with the strategy. Furthermore, listen across the practice during strategy formulation. Some of your best ideas will come from within your practice, not the management team.

Communicate: Ensure every staff member understands the strategic vision, the strategic themes and what their role will be in delivering the strategic vision.  And enrich the communication experience.  Communicate the strategy through a combination of presentations, meetings, emails, and updates. Continue strategy and performance updates throughout the year.  And engage staff members emotionally in the vision. The vision needs to give people goose bumps – a vision they believe in, that they want to invest and engage with.

Clarify: It is important that all employees are aware of expectations. How are they expected to change? What and how are they expected to deliver? Each individual must understand their functions within the strategy, the expected outcomes and how they will be measured. As mentioned above performance measures and incentives should be aligned with performance against strategic key performance indicators (“KPIs”).

5.  Monitor and Adapt

A strategy must be a living, breathing document. As we all know: if there’s one constant in healthcare these days it’s change. So our strategies must be adaptable and flexible so they can respond to changes in both our internal and external environments.  Strategy meetings should be held regularly throughout the year, where initiatives and direction are assessed for performance and strategic relevance. At least once a year we should put our strategy under full review to check it against changes in our external and competitive environments as well as our internal environments.

Strategy is not just a document written by physicians and managers and then filed away. It is a vision for the practice, owned by the practice. And to succeed the whole practice must engage with it and live and breathe it. Strategy should inform our operations, our structure, and how we go about doing what we do. It should be the pillar against which we assess our priorities, our actions and performance.  When execution is brought into strategic planning you will find that your strategy is weaved throughout the practice, and it’s from here that great leaps in growth and productivity can be achieved.

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Contact ABISA, a consultancy specializing in solo and small group practice management.  Visit us at ABISALLC.com.

Retail Pharmacy Market

By now, many of you reading this have heard of the proposed Rite Aid acquisition by Walgreens.  Here is a little insight into the current state of affairs of the U.S. retail pharmacy market.

The Market

In 2014, the sale of prescription drugs in the U.S. totaled $263 billion.  The top 15 pharmacies accounted for almost 80% of the pharmacy industry’s revenues.  Approximately 15% of U.S. prescriptions are filled through the mail.  It is estimated that CVS fills about 23.7% of prescriptions; Walgreens and Rite Aid combined fill about 22%.

The Landscape

Walgreens is the largest pharmacy chain with 8,200 stores.

CVS is the second-largest pharmacy chain with 7,800 stores.

Rite Aid is third with 4,600 locations in 31 states.

Wal-Mart has 4,000 locations.

Kroger has 2,000 locations.

The Chains

Chains operate more than 40,000 pharmacies.

The largest 25 chains total 34,700 locations and employ nearly 77,000 pharmacists.

Chains fill over 2.7 billion prescriptions yearly.

California has 9% of the U.S. pharmacies, followed next by Texas and New York with 7% each, and then Florida with 6.5%.

The Mergers & Acquisitions

Due to healthcare reform, profit margins are falling at the same time that drug prescriptions are increasing.  As we are seeing in the health insurance industry, the law is also spawning a lot of M&A activity in the pharmacy world.  In February, Rite Aid announced the $2 billion purchase of Envision Pharmaceutical Services (a pharmacy benefit manager).  In May, CVS paid $1 billion to acquire Omnicare.  In June, CVS announced the intent to buy Target’s pharmacies for $1.9 billion.  And now, Walgreens is proposing to buy Rite Aid for $9.4 billion.

If Walgreens acquires Rite Aid, the new conglomerate would yield three times as many pharmacies as Wal-Mart.  Walgreens would more than double its existing number of stores in 14 states.  The merger is expected to close in mid-2016, pending review by the Federal Trade Commission.  Meanwhile, review is already underway regarding the CVS proposal to buy Target’s pharmacies.  This would add 1,600 pharmacies to the CVS portfolio.

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Organizational Structure

The purpose of an organization chart is to depict the skeletal structure of the practice, including the functional relationships between, among, and within the specific components. An organization chart provides a point of reference and improves the flow and direction of communications. It allows people to see how they fit in the big picture, increases efficiency, and maintains a balance in the practice.

The development of good structure for organizations has been a concern for managers throughout history. Medical practices have both structure and process. The structure refers to the formal organization and the plans, schedules, and procedures that hold it together. Structure is the instrument by which people formally organize themselves to carry out a task. Process represents what actually goes on: what is done, how it is done, and the way individuals or groups behave and carry out their perceptions of the assigned tasks. The structure can be seen as the anatomy of a practice, and the process as the practice’s physiology.

There are six key aspects of an organization chart.

1. Division of work.

When too many people share responsibilities, it wastes time and resources. When staff is stretched thin, tasks are not completed on time. By referring to an organization chart, each person in the practice can determine what his or her responsibilities are. Because of this, the medical practice functions more efficiently.

2. Line of authority.

An organization chart is characterized by a rigid, formal structure of authority relationships in which the authority and the responsibility for performing each specialized task in the practice are legitimized. Authority is impersonal, since it is vested in the position rather than in the individual holding that position, and this is reflected in an organization chart.

3. Flow of authority.

Authority flows from top to bottom on an organization chart and defines the hierarchical structure of the medical practice. This accounts for the pyramidal shape of most organization charts.

4. Span of control.

The span of control concept of organization structure refers to the number of subordinates who can effectively be directed and coordinated by one supervisor. As the number of subordinates in each echelon increases, the shape of the organization chart changes from a tall pyramid to a flatter one.

5. Delegation and decentralization.

These are structural concepts that are closely related to the span of control. Delegation is the assignment of responsibility and the transfer of authority for directing and coordinating task performance to one or more subordinates by a supervisor. When this is done, authority is in effect decentralized, or removed from the single central position it once occupied. Continued decentralization has the effect of transferring authority and responsibility relationships to successively lower levels of the organization, widening the span of control at the higher levels.

6. Departmentalization.

This is a natural consequence of specialization and division of labor. As specialization increases, division of labor naturally results in the formation of organizational segments, usually referred to as departments. The larger a medical practice becomes, the more departmentalization it requires to facilitate the specialization of activities. In very large practices, the basis for departmentalization may vary at different levels. Although departmentalization is necessary in every practice to provide specialization, it usually poses problems in coordinating activities.

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Contact ABISA, a consultancy specializing in solo and small group practice management.  Visit us at ABISALLC.com.