Brown University's Masters in Healthcare Leadership: A Mission to Transform - Pharmaceutical Executive


Brown University's Masters in Healthcare Leadership: A Mission to Transform

Pharmaceutical Executive

Measuring value that matters

Deborah Pfeifle is CEO of Gould & Lamb, the leading provider of Medicare program compliance services for the global insurance and self-insured markets. Her Critical Challenge is to create a metric that will allow insurance underwriters to accurately value an individual life care plan for so-called "dual eligible" patients who are enrolled in Medicare but receive their care through the Medicaid program for the indigent. These are high-cost patients, usually with multiple chronic ailments, who also have very low incomes.

The Medicaid program has for some time been contracting with private insurers to cover this group and to find ways to deliver care more efficiently—thus creating the rationale for Pfeifle's project. "It is a priority for the insurance industry and actually for government and society as well, to be able to anticipate what dollar amounts will be needed to keep this population well and out of hospital," Pfeifle told Pharm Exec. "A life care plan is designed to estimate what the cost will be in services and supplies to help a patient with a chronic disease or condition maximize the ability to function for the rest of his/her life. This is hard to do for those who are ill, but it is particularly challenging for dual eligible patients due to the constraints imposed by the harshness of their underlying economic and social circumstances." Indeed, evidence shows that failure to anticipate these non-medical needs in a life care plan ends up driving healthcare costs even higher. "We must work to incorporate that fact into our metric."

Pfeifle told Pharm Exec she is working with a private non-profit, the Foundation for Life Care Planning Research, to establish a research analytics standard that allow underwriters to build cost estimates for this dual eligible population, which numbers more than 10 million people. Says Pfeifle, "this is something that has never been done before—there is no prior research and we have extremely limited precedents to go on. We are building this metric from the ground up."

Curative power of community

Nicolas Sandoval works for the patient at the most basic level, helping communities of economically marginalized workers to navigate the public health bureaucracy to obtain essential primary care services—services that can make the difference between wellness and disability. A bilingual health educator for Salud Para La Gente, a network of federally designated community health clinics in rural California, Sandoval has a strong interest in the "whole person" approach of population health, especially in identifying the most cost-effective way to treat poor patients with chronic illnesses. His Challenge project centers on the treatment of type 2 diabetes, a condition affecting as many as 60% of farm workers in the areas of the state covered by Salud's network.

"Control of diabetes requires a huge commitment to patient education, a need accentuated in the communities I support by economic troubles as well as cultural, linguistic, and even geographic barriers," says Sandoval. "Many of the people our clinics serve are unregistered immigrants with no fixed address, transient seasonal workers who follow the harvest and speak no English. Getting these diabetic patients to proactively self-manage their condition is almost impossible: how do we do it? This was the essential question deserving an answer. My project seeks to provide it."

What Sandoval is introducing, with the help of colleagues from Salud, is a structured program of group visits for diabetes patient treated in network clinics. It involves bringing 10-15 patients together for encounters with not only the physician, but a nurse, pharmacist, medical assistant, dietician, and health educator. "It creates a setting where basic messages about health maintenance are reinforced through a structured group exchange built around four behavioral pillars: physical activity, nutrition, medication adherence, and stress management." Sandoval says the training he is receiving through the EMHL program will move the project to the next step, which is developing a list of indicators to demonstrate the program's effectiveness in improving outcomes for covered populations. "Under the ACA, as a federally qualified health clinic, this metric is going to be necessary to scale up and obtain an ongoing source of funding."

Silo-busting precedents: Four lessons

All of the Critical Challenge projects undertaken by this first, 28-member 2015 class of the Brown EMHL program are intended to grow beyond the shelf life of academia; the students expect these will shape their future assignments in the workplace as well. Executing a project designed to establish something tangible around an academic program raises an inevitable question: are there lessons from the experience that can be applied to create a generic lesson plan for business success?

The consensus appears to be yes, with Pharm Exec's discussions with the class yielding four strategic principles: (1) understanding the goals of the organization first, to find ways to get others to align with your own goals; (2) avoiding the visionary prison of "thinking small," by going beyond internal politics to identify outside stakeholders who will be affected, for better or worse, by what you intend to do, and planning in advance to address each; (3) consider the underlying social and cultural aspects of health care, in addition to its more prominent scientific and clinical dimensions—that elusive 360 degree picture; and (4) always be transparent, which in the competitive precincts of healthcare is not an instinctive act, but learned behavior.

William Looney is Pharm Exec's Editor-in-Chief. He can be reached at
. Disclosure: he is a member of Brown's EMHL Advisory Committee.


blog comments powered by Disqus

Source: Pharmaceutical Executive,
Click here