As I mentioned in the last Open Mike, I’ve spent most of March in clinical immersion. I’ve been all over the state, getting together with our medical staff in small groups. These are really intimate settings, usually with about four to eight clinicians in any given meeting.

First, let me say that it’s been very personally and professionally energizing to get out into your workplaces and see you in person.

Lots of folks are curious about these talks, and what I’m learning. I’ve met with nearly a hundred of you so far, and I’ll be talking with another hundred or more of you through early April. Now that I’m roughly at the halfway point in these meetings, I want to share some early themes.

We spend about an hour together in each of the meetings, and I ask just three questions:

• Why did you come to Group Health, and why do you stay?
• What’s working and feels right to you?
• What’s not working, doesn’t feel right, or feels like it needs to change?

So far, I have notes on hundreds of your comments, and I’m starting to organize them. For a diverse group, you’ve actually got a lot in common. Where it comes through most obviously is when we’re talking about why each of us came to Group Health, and what keeps us here.

Why are we here?
Easily eight out of ten of you mention that our philosophy of medicine—the way we practice—drew you here. And paired with the people and relationships in your workplaces, it’s a major thing that keeps you here. You’re telling me that you’re feeling really integrated with the colleagues on your teams, and that you love working in an evidence-based environment. I am also hearing that you like working with other clinicians who want to do the right thing, and keep improving how we do it.

This impressed me so much that I mentioned it last week when I was presenting Group Health’s work at the Northern California Permanente Medical Group’s Board meeting. They invited me to talk to their 43-member board of directors and executive medical director Dr. Robert Pearl about you and your work. I mentioned specifically, and confidently, that the values you bring to work are so powerful that they’re clearly related to our many successes over recent years.

What’s working?
When we talk about what’s working and feels right, I’m hearing that you feel people here are really committed to their work. The doctors I have talked with say they notice that people around them are starting to listen more, to hear more. I’m hearing that Epic is, for the most part, great (though there are many areas where you feel it might improve). And in our multispecialty groups, you’re generally feeling supported in doing the right things.

What’s not working?
Because I’m going to so many locations, I'm hearing lots of specific things about your clinic environments. This ranges from use of space in Tacoma to concerns about off-site specialty appointing in Bellevue.

Operational issues come up, like the extra work it causes when a feature changes in Epic. And some of you aren’t satisfied with what you call “filler” that appears in charts, obscuring the patient’s real story in the midst of all the extra information. You also need more time and support for your virtual medicine workload.

Another common, big-picture theme is that it’s time to change from top-down management emphasis. You all want to see more front-line-initiated improvement.

What happens next?
I’m looking forward to my next meetings with you, because I know I’ll learn something unique each time I sit down and pose those three questions.

I intend to keep sorting the comments into themes. I’ll use them to influence our direction, especially in areas that are most broadly felt to need improvement, or especially critical local issues. I’ll be working with my operational colleagues to push toward improvement based on what you’re telling me. Obviously, we won’t be able to take on everything at once, but we’ll address the things you’re telling us are most important.

My takeaway from this experience, so far, is my deep appreciation for you as a medical group. Where you have problems and want to fix things it’s not coming from a place of anger or victimization. You voice your concerns and fears and complaints because you care.

And let me be the first to wish you a Happy Doctor’s Day. March 30 marks the date that ether anesthetic was first administered in surgery in 1842. People began celebrating this day in 1933, honoring doctors past and present for their work. We have the best medical group in the United States, and I am deeply appreciative of what you do every day. Thank you for doing what you do so well, and with such commitment.

Questions or comments? Respond to Open Mike

Group Health Physicians welcomes David Kauff, MD, as Medical Director for Practice and Leadership Development (PLD). Now settled into his new duties, Dr. Kauff is working on a vision for career development and training opportunities to support a high-nurture, high-expectation medical group.

Dr. Kauff says that after years of significant change and great outcomes at Group Health, there’s a realization that change implementation has been at times more work-centric than people-centric. He’s experienced some of Group Health’s most dynamic times himself as an internist at our Downtown Medical Center.

“Many of us are really looking to find our purpose again in our work. I believe that it’s our job in Practice and Leadership Development to create programs that not only encourage excellence, but also create a culture that, at its core, cares for people who care for people,” says Kauff.

Together with PLD Director Maureen Haley, Dr. Kauff and the PLD team are looking to help clinicians build strong career pathways that are both professionally and personally supportive over a long career at Group Health. “We need to be asking ‘where are you now, and where to you want to go?’ Maybe someone is mid-career and craving the space and time and budget to write grants for research, or to do community outreach projects in the schools. We want to figure out how to help people bring renewed purpose to their work lives.”

The team is also working on ways to tap the knowledge and experience of recently retired medical staff and those expected to retire in the near future, keeping them involved through emeritus teaching and coaching opportunities.

Building on the GHP Associates Program for new hires that’s now almost six years old, the PLD team is looking at what’s taught to new doctors that could be extended to the whole medical group. They’re brainstorming around curriculum for anyone who simply wants to work on being the best they can be—whether that means a leadership role or not.

Helping people move forward can be much more and varied than simply taking on a chief’s role, Kauff explains. “We want to use coaching and the development of professional career tracks to encourage clinical mastery in our doctors. And mastery can be defined in so many ways, such as helping to deepen their interests and expertise in medical fields, all with strong GHP support.”

Questions or comments? Respond to Open Mike

GHP medical staff: join an evening business meeting in your area between May 3 and June 2. Sponsored by the GHP Board, these twice-yearly meetings are a great opportunity to learn and talk about what's ahead for Group Health Physicians. Add your voice and help shape the future!

NEW: Compliance training the same day
We have simplified and enhanced the annual compliance training requirements for GHP medical staff in 2011. You now have the option to come early to a staff business meeting for your annual training and testing.

All of the Spring business meeting locations, except Lynnwood, will offer instructor-led, interactive compliance training before the business meeting.

Business meeting agenda
Bring a colleague who’s never been before. Get involved in shaping the business of our group. All medical staff and lead clinic administrators are invited and encouraged to attend.

We’ll be talking about:

• Feedback from Michael Soman's clinical immersion
• Preparing for growth: what’s next
• Specialty business plans
• How will growth impact your local area?
• Interactive discussions and breakout sessions
• Regional excellence award presentations

See full schedule and RSVP here
(link only available via InContext, GH's intranet site)

Quick reference – dates & places

May 3 - Lynwood (business meeting only - no compliance training)

May 4 - Tacoma

May 10 - Olympia

May 11 - Bellevue

May 12 - Spokane

June 1 - Silverdale

June 2 - Seattle

Questions or comments? Respond to Open Mike

There’s no time like the present to use the great tools we have to support our patients' understanding and satisfaction with their care.

Medicare is implementing a "Star Rating" system to rate health plans on a one-to-five scale, with five stars representing the highest quality. Health plan ratings are based on a combination of clinical patient data and patient survey data.

To date, U.S. health care payments have been linked more to quantity of care than to quality of care, resulting in expensive, lower-quality outcomes. The recently passed healthcare reform legislation created the Medicare Five Star program to incentivize quality care.

Beginning in 2012, this program reduces payment for Medicare Advantage plans such as Group Health Medicare, which accounts for about 98% of our Medicare patients. At the same time, there will be a bonus payment system linked to quality of care. Group Health is well positioned to receive the maximum bonus payment for its high clinical and service quality, potentially minimizing the impact of the payment reduction.

Group Health currently earns a 4.5 Star Rating from Medicare. This performance would translate into about $72.8 million over 3 years under the bonus program. Keeping our rating above four stars will ensure we receive appropriate reimbursement from Medicare beginning in 2012.

Medicare begins phone surveys in April 2011

Between April and August 2011, Medicare will randomly select 1,000 of Group Health's Medicare Advantage consumers for a phone survey. The survey will include questions about:

• Perceived health, mental and physical
• Depression
• Pain
• Activities of daily living
• Chest pain
• Shortness of breath
• Foot problems
• Arthritis
• Vision and hearing
• Chronic illnesses
• Cancer
• Tobacco
• Bladder control
• Exercise/physical activity
• Balance, walking and falls
• Bone density testing

Tools for clear care-giving

There are many ways that Group Health works to activate patients. And as clinicians, you have a particularly powerful influence. Take advantage of these patient communication tools and decision aids to boost the collaborative relationships you have with patients of all ages.

Using plain language to improve communication (link only available via InContext, GH's intranet site) from Clinical Update

Interactive Health and Wellness tools for patients on the Group Health Web site

Our Medicare Medical Director Steve Tarnoff, MD can answer your questions about Medicare and Medicaid developments at Group Health.

For a copy of the Medicare phone survey, please contact Kristine Moore at moore.ki@ghc.org, 206-326-3959 (330-3959).

Questions or comments? Respond to Open Mike

Take a moment to congratulate your Group Health Cooperative colleagues and partners in care. For the second year in a row, Group Health has earned top honors from J.D. Power and Associates. Once again we can proudly say we are ranked highest in member satisfaction among all health plans in the Northwest.

The 2011 U.S. Member Health Insurance Plan Study is based on responses from more than 34,000 members of commercial health plans. Now in its fifth year, the study measures member satisfaction among 137 health plans in 17 regions throughout the United States by examining seven key factors: coverage and benefits; provider choice; information and communication; claims processing; statements; customer service; and approval processes.

The study notes that members in integrated delivery systems tend to have a better understanding of their coverage and the processes necessary to receive services.

“While not every integrated delivery system is created alike, an advantage of these plans is that interactions center on the member as a patient, because the provider and plan are integrated,” said Richard Millard, senior director of the healthcare practice at J.D. Power and Associates.

According to the study, members of integrated plans tend to be more satisfied with information and communication, as well as coverage and benefits, than do members of non-IDS plans, which highlights how improvement in these factors may go a long way toward improving overall health plan satisfaction.

You should be especially proud of this honor because it’s based on interviews and feedback from thousands of our members. It reflects on all of our work serving members across the state and in every part of our organization.

Questions or comments? Respond to Open Mike

Your GHP Board of Directors hopes that you’ll join in an evening of dinner, entertainment and dancing under the big top. This is an evening to socialize and celebrate you, our incredible medical group.

The 2011 Group Health Physicians Dinner Dance takes place on April 16 at the Hyatt Regency Bellevue. Please send in your RSVP postcard that you received in the mail or email Siri Lindquist with your information, including your guest’s name and your menu choices.

Entrée Choices:

• Seared Halibut on Roasted Asparagus, White Bean Ragout and Sake Reduction
• Grilled New York Steak, Red Wine Reduction, Rosemary Fingerling Potatoes
• Grilled Vegetable and Goat Cheese Napoleon Stack with Roasted Pepper and Pesto

See you on Saturday, April 16 at 6:00 P.M.

Hyatt Regency Bellevue
900 Bellevue Way NE
Bellevue, Washington

Questions or comments? Respond to Open Mike

 Participating in groups such as the Washington State Medical Society helps us increase our visibility, credibility, and influence over issues that affect patient care.

To encourage involvement, GHP will reimburse clinicians working at .5 FTE or more for the full annual dues membership to WSMA. Physician assistants can be members of WSMA if their sponsoring physician is a member. Learn how to participate (link only available via InContext, GH's intranet site).