Week 3 Problems  
Chapters 6, 7, and 8

A health system has established an ACO and has assumed risk for a substantial number of patients who have been attributed to this ACO. As a result, it is important that the organization now focus on population health as opposed to its historical position of medical intervention when a patient needs surgery because it is rewarded for keeping a person healthy as opposed to performing surgery, lab tests, diagnostic surgery, and so on. However, the patient base that is a part of the ACO represents a range of individuals. As the vice president of medical affairs looks over the patient base, he realizes he faces a significant challenge. Calling together a planning team that consists of the head of data analytics, the chief clinical officer, and the head of marketing and planning, he says, “I am not sure how we should slice this group up. We are entering a new group of care management here after years of just taking care of patients as they come through the door. This represents a new and exciting challenge. I think managing people to stay healthy is what we have always wanted to do but restructuring ourselves to do it efficiently and well is a very different approach. How do we go after this elephant?” The head of data analytics speaks up: “The one good thing is we now have an electronic medical record system that is functional, and people seem to have bought into pretty well.” The chief medical officer then chipped in: “I do agree that the clinical staff is excited about the challenge, but we need a plan fairly quickly that is clear and easy for us to lay out to all.” The marketing director is next. It is you. Lay out the best approach.
Anna Lenox recently accepted a new position as a marketing director at a medium-sized 350-bed hospital in a major metropolitan city. In her first meeting with the hospital CEO, he said, “Anna, we have a real challenge to deal with. I have established a patient ombudsperson who used to be part of our volunteer office. She has been a great contributor to the organization, and her spouse is a senior member of the hospital staff. The problem is several people have written into the local paper recently complaining that the hospital has not addressed their complaints and honestly some of these issues are pretty minor. However, last week, we had a pretty serious major clinical problem that the chief medical officer had to get involved in. I just don’t know what people want anymore. We have always tried to treat patients respectfully and fairly. I think it’s time we have a discussion with the leadership team. I’d like you to lead this discussion.” Outline the areas that you think should be discussed.
A large 50-person multispecialty group held a semiannual retreat on a Saturday to review the group’s operating progress and to assess financial targets, staffing issues, and any patient issues that had arisen. Monthly financial targets and the like were always reviewed by the executive committee, but this allowed the entire partnership to be informed of the status of the group. At this meeting, the administrator presented the patient satisfaction scores, which were generally quite good. However, she did want to call attention to some disconcerting tends. “We have a staff team that is assigned to monitor social media pages,” she said. “Lately, some of our patients have posted rather disparaging remarks concerning impersonal care during their visits, now that we have transitioned to the EHR. They feel some of our doctors are only looking at the computer. We have seen these remarks on Foursquare and on some blog posts. This isn’t good. One of the staff found come really negative comments on Yelp.” “Ridiculous,” said Dr. Johnson, one of the more senior member of the group. “I have not had a single patient complain to me. And I will admit that I do hate to look at that darn thing; it is a pain in the neck.” Two other physicians agreed with Dr. Johnson, saying no one complained to them. An assistant administrator who was responsible for the operations at the front desk, scheduling, and billing said he had reports from staff that some patients did complain to the billing department about visits with the clinical staff on discharge, but the number was small. During the lunch break, this issue was still a topic of conversation. What is this group experiencing? Is the physician correct?
The Radnor Pediatric Care group has grown dramatically in recent years. Located in a midsized city in the Southeast that had seen an influx of younger families, the practice had recruited pediatricians and physician extenders to meet the increasing demand of patients, The group was also quite aggressive in ensuring that the diversity of practitioners was a key part of its recruiting efforts and a hallmark of which senior group members were proud. Now entering the 10th year of the practice, the group had five locations throughout the metro area, but there were some early concerns in terms of the financials. At a quarterly meeting of the executive committee, the practice administrator reported for the first time that practice growth and revenues were both flat. This was a first in the group’s history. The timing of this message was somewhat fortuitous in that the group had already planned a fall meeting of all its clinicians at a local hotel. The group is trying to determine the best path forward. You are the marketing director for Radnor Pediatric and have been asked to provide a sense of possible direction and rationale. In assembling your notes, you provide an overview of the practice:

Radnor Pediatrics

Five clinic locations: two sites have weekend hours.
Website: This is updated on a quarterly basis.
After-hour support: This is provided by hospital urgent-care locations downtown.
Walk-in appointments: These are available at central Radnor Pediatric locations five days a week before regular appointment visits from 7 a.m. to 8a;30 a.m. when all offices open.
Prescription refill requests: These can be left after hours o the answering machine at the main clinic site.
Appointment requests: These are made at each office when the practice site opens. The hours for two office locations are from 9 a.m. to 4 p.m.; the main clinic site is open 8 a.m. to 5:30 p.m. (except the walk-in time), and the far west site is 8:30 a.m. to 5 p.m.

In today’s environment, how could Radnor Pediatric restore the growth possibilities for the group practice?