Nancy H. Shanks

University Healthcare System (UHS) has been a major player and been successful for over 100 years in a large west coast metropolitan area. It operates an EMS system, is a Level 1 trauma facility, is affiliated with a major medical school, has associations with feeder hospitals around the state, maintains centers of excellence in many areas of medicine (including cardiac, cancer, and women's and children's care), is known for conducting cutting-edge research, and is viewed as one of the preeminent leaders of medical care in the community, as well as the state. That said, the UHS leadership team has begun to recognize that they may be out of sync and that the world of health care is rapidly changing.

Consumerism is becoming one of the waves of the future. After reading several recent articles and reports about disruptive innovation and how other large health systems around the country are beginning to work with retailers to provide services, to connect with consumers, and to potentially channel patients to other services within their health care systems, the UHS leadership team thinks that it may be time to consider moving in this direction. In particular, the team recently noted that Kaiser Permanente, one of its major competitors, had begun partnering with Target, had set up walk-in clinics in several Target stores, and was staffing the clinics with Kaiser employees. Kaiser had also hired a Director of Consumerism who was spear-heading its ventures into consumer directed health care.

UHS has always operated from a volume-oriented mindset, but now knows that this too is changing. The Centers for Medicare and Medicaid Services (CMS) is moving toward a value-based approach in reimbursing for Medicare patients. CMS does not want patients to have surgery, be discharged quickly, sent home, and then readmitted with complications. CMS also doesn't want to pay for a second admission and wants better quality and outcomes for patients. That is, CMS wants patients to be sent home, have their care coordinated, not experience complications, not have to struggle through multiple hospital stays, and not be exposed to nosocomial infections.

While the leadership always thought UHS was providing the best health care, the institution now realizes that it has focused on providing mainly medical care in an inpatient setting and has done little to keep people out of the hospital and to promote health and wellness. It's time to start thinking outside the box and to change the organizational mindset. UHS has, however, never done anything like this and really doesn't have the expertise to do it. This is going to force the leaders to make some significant changes in many different areas and to involve several different departments in brainstorming how to approach partnering with a retail organization to deliver care at different sites.

1. Should a team be put together to specifically work on this? Who should be included in this group? What type of team should be used?
2. What should the charge to this group be? What are the goals of this effort given the changes in consumer expectations?
3. From a strategic perspective, where does UHS stand? What are its internal strengths and weaknesses? What are its opportunities and threats?
4. Does UHS need someone whose job is to lead this effort? Would it make sense to hire from outside the organization or from within? What skills are needed?
5. What other types of staffing will be needed for this type of venture?
6. Can these new consumers be linked into the existing EHR system? How might that work?
7. What information will be helpful to learn about and understand these new users? How can this information be obtained? Should this become part of the EHR?
8. What are the estimated costs of setting up a clinic in a retail setting? What are the potential rewards to be gained? When will UHS start seeing a return on its investment?
9. What are the pros and cons of undertaking this type of venture?
10. Are there other types of approaches that UHS should also be considering? What expertise does it have that could be used in different ways? What needs to be done to change the organizational culture?