About ECG Management Consultants

ECG is a strategic consulting firm that is leading healthcare forward, using the knowledge and expertise built over the course of four decades to help clients see clearly where healthcare is going and to navigate toward success. We work as trusted, professional partners with hospitals, health systems, medical groups, and academic medical centers across the country. We thrive on delivering smart counsel and pragmatic solutions to the critical challenges that will revolutionize the healthcare system. Client success is our primary objective.

Our Blog Has Moved

Dear readers,

Last year ECG launched a new website that dramatically improved the presentation and delivery of our thought leadership, including our blog posts. Although we’ve continued to maintain this stand-alone version of our blog, we will no longer be updating this page with new content.

But don’t fret – you can find all of this material, along with a new blog post every week, in the Thought Leadership section of our website.

Thanks so much for reading, and we’ll see you over at our new address!

Pursuing Success in a Value-Based World

The Affordable Care Act has fended off multiple legal challenges. CMS has already implemented one mandatory bundled payment initiative and is eyeing more. MACRA looms on the horizon.

It’s an understatement to say the healthcare industry is in a period of dramatic change, and the continuing shift to value-based care will require radical thinking on the part of health system executives. But for those leaders willing to embrace change, the evolving landscape offers tremendous opportunity to remake their organizations and achieve new levels of success.

In this brief video, ECG Principal Jim Lord talks about the transition to value-based care and how forward-thinking health organizations can position themselves to thrive.

A Banner Year for Bundles

An atmosphere of urgency permeated the National Bundled Payment Summit in Washington, D.C., earlier this month. That shouldn’t be surprising, given the number of major announcements in the first half of 2016 related to bundled payments.  Between rolling out two new programs and extending the Bundled Payments for Care Improvement (BPCI) initiative, CMS has signaled its ongoing commitment to bundled payments.

With the unprecedented growth of these initiatives over the past 5 years – including the CMS-mandated Comprehensive Care for Joint Replacement (CJR) program – there are more questions about bundles than answers. But as this year’s Summit demonstrated, that sense of uncertainty is at least matched, if not exceeded, by a growing resolve to thrive under episode-based reimbursement.

Bundles Take Flight

Sponsored in part by ECG Management Consultants, this 3-day event brought together providers, physicians, policymakers, payors, patients, and healthcare executives – a clear sign that the growth of bundles affects a wide range of industry stakeholders.

The Summit’s breadth and diversity of participants also served to underscore a fundamental truth: bundled payments are here to stay, but at the same time, they’re still evolving. No entity or organization has fully mastered this concept, but many are building on their BPCI experience to expand their bundle initiatives. One attendee likened it to “still building an airplane while we’re flying it.”

Remarks like that don’t exactly inspire confidence. But if you are in position of building an airplane while it’s in flight, you’ll want to have the best engineers on board with you. Fortunately, the Summit gathered some of the top leaders and thinkers within bundled payments.

Co-chairing the Summit were Deirdre Baggot, leader of ECG’s Bundled Payments Practice, former Expert Reviewer of the BPCI initiative, and former Lead for the Acute Care Episode (ACE) demonstration; and Erin Smith, Vice President and Executive Director of the Post-Acute Care Center for Research and former Director, Division of Technical Model Support, and Lead, for BPCI.

Baggot and other members of ECG’s Bundled Payments practice led a pre-conference session called “The CJR Playbook: Real-Life Best Practice in Smart Implementation.” It was an interactive session that presented a strategic roadmap for CJR implementation and offered proven best practices and recommendations from successful programs across the country. Baggot emphasized several key themes, most notably the need for bundled payment programs to be scalable and economically feasible.

bundled payment preconference

Deirdre Baggot, right, and ECG’s Bundled Payment practice talk CJR.

And while Baggot and her team brought data and case studies to support the benefits of bundled payment initiatives, they were candid about the challenges. Baggot cited the need for “failure tolerance” and urged attendees to view failure as nothing more than a data point. ECG Senior Manager Kimberly Hartsfield summed up the challenges succinctly: “This is innovation. This work is hard. If it was easy, you wouldn’t be sitting here today.”

Real-Life Experiences

The first full day of the Summit began with a keynote address from Amy Bassano, Deputy Director, Center for Medicare and Medicaid Innovation (CMMI). Bassano gave what you might call a “state of bundled payments” address, focusing on the parameters and rationale of the three Medicare Models – BPCI, CJR, the Oncology Care Model (OCM) – while promising that CMS would be testing new models and expanding existing ones.

bundled payment bassano

Amy Bassano of CMMI delivers a morning keynote address.

Attendees seemed to appreciate the opportunity to hear directly from CMMI, but a presentation from Mount Sinai Health Partners’ Lindsay Jubelt, M.D., Medical Director, and Alexis Kowalski, Senior Director, offered an on-the-ground perspective of implementing bundled payment initiatives. At the heart of their presentation was the importance of ensuring that physicians are invested in the bundled payment concept. “If we’re going to transform healthcare, we need physicians to lead it,” Jubelt said. “We need to turn physicians into partners – engage them in the care transformation process.”

The Summit’s focus on Medicare bundles made a presentation by a commercial payor all the more intriguing. Representing Horizon Blue Cross Blue Shield of New Jersey, Lili Brillstein, Director of Episodes of Care, and Joseph O’Hara, Director of Market Innovation, discussed the challenges of paying for care in New Jersey. Horizon experimented with episode-based care as a means to address costs, and since 2011, they’ve seen improvements in the form of higher quality, lower costs, and greater consumer satisfaction.

CMS was on hand to close out the conference. Patrick Conway, M.D., is Deputy Administrator for Innovation and Quality, Chief Medical Officer, and Director of CMMI, as well as the Director, Office of Clinical Standards and Quality, at CMS. Sharing early results of the shift toward value-based payments, Conway claimed that Medicare spent $473.1 billion less on personal healthcare expenditures between 2009 and 2014 than it would have spent if the 2000–2008 average growth rate had continued through 2014. That amount could grow to $648.6 billion if trends continue through 2015.1

bundled payment conway--edit

Patrick Conway, M.D., of CMS closes out the conference.

Encouraging as those figures may be, the conference ended not on a note of triumph, but on one of determination. A recurring theme among speakers and attendees was that this journey toward value had only just begun, and the road will not be easy.

Still, a sense of optimism prevailed. “Organizations were hopeful that a next-generation BPCI would be introduced by CMS, and leaders were excited for the chance to participate in a bundled program if they weren’t in one yet,” noted ECG Senior Manager Tori Manis, who led several panel discussions.

Looking Ahead

The Summit was also notable for its engagement following presentations and panels, with healthcare executives and CMS representatives willing to respond to tough questions from stakeholders from across the continuum.  Many inquired as to what would be the next area of focus for mandatory bundles; speculation centered on cardiac surgery. Another common question concerned how behavioral health could be integrated in a bundle. Conway himself called behavioral health “a huge opportunity for improvement.”

It wasn’t long ago that a pair of senators in Congress attempted to slow the growth of bundled payments initiatives, and there’s no doubt that change will continue to be gradual. But the overwhelming attitude at the summit was that it’s time to figure this out.

  1. https://aspe.hhs.gov/pdf-report/health-care-spending-growth-and-federal-policy

The Scenic Route: One Consultant’s Journey Through Healthcare

Many roads lead to the consulting profession. For established professionals, the field represents an opportunity to share the expertise they’ve gained over the course of a career. For others, consulting is the first stop after graduate school.

But few consultants take as circuitous a route as the one that Mark Maydew followed. “It’s a little goofy,” the New Mexico native says of the series of circumstances that led him to a career in consulting. Except it doesn’t sound that goofy when he describes it. Atypical, maybe. But Mark’s journey through healthcare has been driven by his desire to help people, leading him from night-shift ER tech to clinic manager and ultimately to a position from which he can effect large-scale change in the industry. Continue reading

Building a Balanced Trauma Team – Determining the Right Mix of Nonphysician Staff

The importance of trauma centers cannot be overstated. They are the first line of care for the most serious injuries that patients suffer, from broken bones to head trauma to gunshot wounds. The heroic actions of emergency physicians and their staff can be the difference between life and death. It’s surprising, then, that the American College of Surgeons (ACS), the association charged with setting standards for surgical care, offers little guidance on trauma center staffing – particularly for the nonphysician staff who extend and support physicians.

In a recent study, ECG Senior Manager Jason Lee and Senior Consultant Dwight Asuncion examined nonphysician staffing at 14 Level II trauma centers in an effort to offer guidance on appropriate staffing and personnel ratios. They published their results last month in an article for H&HN. Here, they discuss their findings and describe the challenges that trauma centers face in determining the most effective way to use nonphysician staff to bolster their services. Continue reading