Health Perspectives from Grandview

Keith Granger is the president and CEO of Grandview Health, Alabama’s newest hospital. Formerly called Trinity Medical Center, the hospital moved from a decades-old location in the Crestwood neighborhood of Birmingham to a renovated former HealthSouth Inc. hospital in the rapidly growing U.S. 280 corridor. The move was completed in October.

We caught up with Granger just after the grand opening to ask about the new facility and new technologies, but we first wanted to ask about the latest trends in the rapidly evolving and consolidating U.S. health care market. In that market, Grandview is part of Community Health Systems, the largest of the country’s for-profit hospital operators, with 191 short-term, acute-care hospitals, including 10 in Alabama. 

We started our conversation with the newest trend being talked about in the always-ongoing discussion of how to put a lid on U.S. health care costs. The newest agenda is called “value-based” health care. 

There is no question that we are hearing more and more references to value-based performance or purchasing systems. As the terms are used, there can be some confusion. While measuring outcomes and patient experience and quality metrics, those metrics often are used to steer patients to providers or required of providers to meet certain standards. 

While such payment systems are now relatively few, they are expected to grow into double digits in three to five years. Right now the system is primarily built around fee-based or a contracted fee schedule driven by the number of days or by diagnosis codes. But there is no question that it is moving rapidly to a fixed cost, where the value is perceived by those parties in some format. 

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Proponents of value-based systems clearly seem to be calling for the best clinical outcomes, while still ensuring patients a positive experience in your facility. In reality, the expectations continue to escalate. We want the best product for the best price. We seek the best medication and appliance — the best orthopedic product, the best pacemaker, the very best product — and that technology is very expensive. The question is: Can we afford it?

You can have a good technology, even the best, and at an affordable rate. That’s what’s driving the value base. If you are going to pay a lot for a procedure, you want to make sure that you are going to have a good outcome.

We are seeing more use of generic medications, and we’re going to see more use of outpatient procedures and what are often minimally invasive procedures that get you returning to activity at a faster rate. There will be greater collaboration among physicians and health providers to make sure they are not over-utilizing or doing unnecessary things to reach a diagnosis to correct a disease.

We’ve been very committed to measuring and identifying operations that improve performance. Every clinical diagnosis that we use is nationally recognized as the best practice and best evidence-based medicine, so that the patient is getting what they should and the outcomes are at the top of the pack. 

I think it’s all about the alignment of your team mates, getting your associates and employees to create a culture of high performance and achievement and putting into place the best systems and processes that enable people to be successful. You have people who are well trained to do their duties and can elevate themselves in the organization to create a culture of perfection. 

You also do this by using standardized tools: doing something in the operating room or the cath lab in very standardized ways that ensure that you get it right. You go down the checklist and make sure you’re getting it right every time. Whether it’s a patient fall or infection or medication being given in a timely manner. 

And you also do this by involving the patient in the care, so that they understand the diagnosis and what they need to do to overcome their problem, making a team of the caregivers and the patients and their families. 

In the old days, we thought we had the knowledge and we were the caregivers and everybody else should just listen. There is no question that patients and families expect more ownership and control and have a thirst for information as to how they can avoid coming back for that condition in the future. They have gone from a passive attitude of “Let the system take care of me” to an active management and participatory world. And we are all served by having that evolution, that thirst for more knowledge and a more inquisitive consumer. 

There is no question that there are duplications of services in the (health care) delivery system, but they are demanded and expected in the U.S., and that does cause duplication. People are looking for a one-stop shop and that forces all of us to have emergency room physicians 24-7, and you’ve got to be ready for the operating room, with blood and medication for virtually every treatable illness and even things that don’t occur very often. If you’re trying to be a full-service provider, it’s almost like the fire department: You have to be ready 24 hours and when you get a call you have to be there within minutes. As a society, our expectations are very high for convenience and performance.

It’s still in the early days of making that value determination (whether electronic records cut costs), but I’m encouraged and incentivized to move to electronic records. It clearly does make it possible to share records across thousands of miles, but that comes at the price of implementation, and it is not inexpensive, and maintaining it is not inexpensive. Here at Grandview, we have several systems that are an everyday part of our routine. We are able to monitor patients more closely from outside the room, and we are able to show patients videos about their diseases and have them ask questions. 

In our new facility, we designed it to facilitate vertical design, segregate patients with a similar diagnosis so that they can be taken care of on a particular floor. It improves workflow and enhances where and how services are delivered in the building. And we’ve added a great deal of new technology, including electronic health records, some of them with 42-inch digital displays to enhance patient experience, showing them pain levels, who the care givers are, the plan for the day.

If there is one unique characteristic of our site here it’s that the new location on U.S. 280, with its connectivity to I-459, has allowed us to be connected to I-65 and I-20. It will allow us to expand our influence around the state and attract the finest subspecialists in the country to locate at our hospital. We intend to create that type of vision and plan over the coming years.

I am very much involved in physician recruitment. It is a constant passion and a necessity for an organization’s survival. We are very much out there looking for the best. Any good hospital in the state is looking for a great medical staff and planning for it in the coming years. 

Chris McFadyen is the editorial director of Business Alabama.

Interview by Chris McFadyen

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