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How’s Your Heart?

Heart and Stethoscope

I just had my birthday … and it’s Heart Month. This has gotten me thinking about what my heart might look like. I’m curious: does it look like that of a 30-year-old or is it more like a 70-year-old’s? I would imagine there would be a lot of variation and many Americans may have hearts that appear older than their actual age. Imagine that!

To assess your heart age, the Centers for Disease Control and Prevention and others offer tools that generate an estimate based on your risk factors. Putting in your weight, cholesterol level, blood pressure, diabetes and smoking history allows the tools to calculate your heart age and perhaps get you thinking about ways to reduce that age and live longer. As the daughter of a man who had his first heart attack at age 53 and who was 14 when he lost his father from a heart attack, I am happy that we now know so much more about how to prevent this from happening.

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Equip Yourself to Thrive During Times of Change

letter tiles

“It’s only after you’ve stepped outside your comfort zone that you begin to change, grow, and transform.” ― Roy T. Bennett

“The only way to make sense out of change is to plunge into it, move with it, and join the dance.” ― Alan W. Watts

“Welcome change.” – Fortune in cookie I opened on January 29, 2018 (no kidding).

Like many others, our organization is undergoing a transformation. There are exciting times ahead, as well as periods of change and uncertainty. But let’s be real – for many of us, we are creatures of habit and change is hard. When attending a multi-day meeting, do you tend to sit in the same area of the room each day? Do you have a typical routine for breakfast or getting ready for work? There is nothing wrong with a certain amount of predictability in life, but change can be an impetus toward excellence, a teacher, an opportunity for growth and a lesson in thriving or resilience.

As Juliana Preston mentioned in her recent blog, our amount of resilience isn’t fixed. Quoting Sheryl Sandberg, “Resilience is the strength and speed of our response to adversity [or change]—and we can build it. It isn’t about having a backbone. It’s about strengthening the muscles around our backbone.”

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Recommendations for Medicare’s Future Quality Improvement Initiatives

Group meeting

In my last post, I put forward some core “change principles” to guide our communities in working to transform the U.S. health care system. In this installment, I’ll try to apply those principles in recommending ways to enhance the value of the quality improvement work that HealthInsight and similar organizations perform for the Medicare program.

As the nation’s largest single purchaser of health care, the Centers for Medicare & Medicaid Services (CMS) has long been a pacesetter and incubator for change. The Quality Improvement Organization (QIO) program represents the largest sustained investment in large-scale quality improvement in history. HealthInsight has served as a contractor for this program since 1984, and our mission has evolved throughout the decades, at the leading edge of change in this national effort, to address changing goals, changing theories about what drives improvement, and changing models of care and care delivery support.

CMS is now designing its quality improvement initiatives for the Quality Innovation Network-QIOs (QIN-QIOs), spanning the 2019‒2024 contract period. These new initiatives give CMS a crucial opportunity to propel the health care system toward meaningful transformation.

At HealthInsight, we believe that sustainable quality gains and cost reductions will not occur without active participation from every segment of the health care system. Multiple stakeholders need to work together and employ diverse, but aligned, strategies and approaches to drive transformation.

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Change Principles for Health Care Transformation

Doctor, Patient and Family

HealthInsight has worked with providers and patients for more than 40 years to improve health and health care. We feel both proud of and humbled by this experience. Proud, because our services have improved health outcomes and helped transform the care delivered to millions of people. And humbled because experience has taught us that real transformation takes time and sustained commitment—and it is hard. We also know our efforts often fall short of the vision of what is possible. So, in quality improvement terms, we seek to design better models.

In support of our core business of improving health and health care, we seek to be a thought leader, shaping the future of our communities and nationally. We are continually considering and reconsidering the best ways to help our system work better. In that spirit, we’d like to share some of our ideas.

Broadly, we believe that sustainable improvement will happen only when patients, providers, payers and purchasers come together at the community level to promote, demand and support transformation based on the following change principles.

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Look for the Lean Routine

People taking Notes

This past month I was lucky to attend a workshop on Lean Rapid Process Improvement hosted by Qualis Health, the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Washington and Idaho. As our organizations hold similar contracts in Oregon and Washington to perform external quality review of the states’ Medicaid programs, Qualis invited me and three of my HealthInsight colleagues to provide an outside perspective on their efforts to “lean up” their workflow processes, with the goal of providing better value to the State of Washington.

The invitation excited me because I had heard a lot about Lean workshops but had never been able to participate. I knew that Lean manufacturing principles―aimed at minimizing waste in a system without sacrificing productivity―could be applied to non manufacturing settings, but I had not actually experienced it.

Over the course of the three-and-a-half-day workshop, we examined a process map that Qualis had developed for one of its workflow processes, with an eye toward reducing waste. We looked for eight types of waste: defects, overproduction, waiting, non utilized people, transportation, inventory, motion and extra processing.

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