Innovation and upgrades drive ongoing NMHS redesign plan
Nov. 25—TUPELO — Innovation and upgrades to maximize efficiency and access to services are at the heart of the North Mississippi Health Services (NMHS) system's ongoing redesign plan.
"Every day, our team wakes up, dresses for work, begins thinking about what we could do differently every day — next week, next month, next year, a few years down the road — to achieve our mission, which is to continuously improve the health of the people in our region," Shane Spees, president and CEO of NMHS, said.
The system's desire is to provide the right level of care to patients at the right location at the right time, he added.
The G.R.E.A.T. redesign strategy consists of five components:
— Grow key profitable services
— Reimbursement changes
— Evolving how we do the work
— Alternative revenue sources
— Tools for redesign
The first is simple. To grow key profitable services, Spees said NMHS is focused on providing access to services in short supply across the region.
Changes to reimbursement are slow-going and have been years in the making as NMHS continually works to improve the quality of care.
"The way we're currently paid today by payers is based on seeing a patient, we're paid for it; doing a surgery, we're paid for it; admitting a patient, we're paid for it," Spees said. "Regardless of what the outcome is or the level of efficiency that we used. A very small portion of our payment is tied to incentives of high quality and low cost, yet we've been delivering."
The idea is to change how NMHS is reimbursed by payers so that they're not just incentivized by quality and cost, they're paid for delivering on it. It should lead to more revenue, which can be reinvested in people, services and technology, he said.
It's done by negotiating with each payer. One example is the recently launched Aetna/NMHS Medicare Advantage plan collaboration.
"We have changed the reimbursement model to where we're at risk for the level of quality and cost that we provide to their members," Spees said. "Our experience has shown, as you take a look at a certain population, like an Aetna Medicare Advantage population that's existed for several years, we know what our performance has been and it's been very good."
After the first two weeks of enrollment, Aetna reported that they had enrolled almost 400 members. It's a good start, Spees said, as Aetna's goal is to enroll more than 2,000 individuals.
The system has also seen success with other value-based models that incentivize quality and cost at a smaller level and plans to continue exploring more.
"We have to do it one payer at a time," Spees said.
The next component is evolving how work is done and helping employees grow within the health system.
"We know the labor challenges that existed pre-COVID have only gotten worse since COVID and there's nothing in the near future that tells us that's going to change any time soon," Spees said. "There are more jobs than there are candidates for those jobs today.
"If the market gives us a limited number of people to do the work, we've got to address how we're doing the work so that we can not only get it done but grow our capacity over time and be able to serve more patients over time with that limited staff," he added.
NMHS has established relationships with a number of nursing programs through the years, Spees said. Those relationships have been redesigned with the objective of encouraging more students to enter the health care field and connecting them to the NMHS system earlier.
Volunteer and mentorship programs for students have been created, and internships and externships for nursing students have evolved to include more interaction with the health care system as students earn credit towards their program.
NMHS is in the process of launching an apprenticeship program that will include a number of nursing programs. It will allow students to be paid for working a job in health care, receive credit hours towards their academic program and have an opportunity to get firsthand experience in the system in hopes that they'll stay with NMHS longterm.
"Fortunately, over the last several months, we've proven that we can generate a slight profit from delivering patient care," Spees said. "But who knows what the future holds? So our idea is to make sure that we can supplement our patient care and supplement the revenue that we get for actually delivering care to patients by some other means where it's not necessarily delivering care to a patient but there are services that are part of the health care process that could be revenue sources for us."
The most notable of those alternative revenue services thus far is NMHS's first-of-its-kind partnership with On Demand Pharmaceuticals, announced in September, to address drug shortages and the cost of drugs by producing generic drugs on-site at North Mississippi Medical Center-Tupelo. It should be operational by the end of December.
"That's an opportunity for us to be innovative in not only reducing the cost of health care but also addressing a significant need," Spees said.
One of the primary tools for redesign will be a conversion to the Epic software platform for health records in April 2024.
"Today, we work across six different health records and systems that rely on over 70 different applications to support those systems," Spees said.
Converting to a single system will simplify records, allow automation of some tasks and offer better functionality for patients.
"It provides us a suite of tools that we've not had access to before," Spees said. "And once all of our hospitals are on the same system our clinics are on, that opens up a lot of tools for not only simplifying the work of our staff and automating a number of tasks, but allows us to redesign areas like central scheduling."
In Oct. 2021, NMHS underwent a "systemness 2.0" reorganization, and in Jan. 2022, they introduced the SASSS concept, which stands for simplify, automate, scale, support and sustain.
"We'd like to think that we've been operating as a system prior to COVID, but certainly through COVID realized the true benefits of operating as a system," Spees said.
During the pandemic, they managed the beds they had across the entire system — which is comprised of the North Mississippi Medical Center in Tupelo, six community hospitals and dozens of clinics — not just at one individual hospital. Regardless of where a patient may enter the NMHS system, they have access to all care available, regardless of where that service or provider is located.
Another important tool for redesign has been the implementation of virtual nursing at NMMC-Tupelo.
Across the health care industry, Spees said, nurses are managing more patients during a shift than ever before. Virtual nursing compliments the bedside nurse by taking on key tasks of the admissions and discharge process, both of which can take anywhere from 20 to 45 minutes each. Virtual nurses are dedicated exclusively to admissions and discharges via a video screen in the room.
"Patients like it because it's an easier, faster process," Spees said. "The virtual nurse is dedicating themself to that patient so it's a better communication, the patients have an opportunity to get their questions answered and they walk away with more information than they may otherwise have had."
Patient experience has improved, readmission rates have declined in virtual nursing units and it allows bedside nurses to better manage and care for patients.
"Our team is just now realizing the potential," Spees said. "We're in the process of expanding to another 90 beds covered by virtual nursing, so we now have 144 medical-surgical beds that offer virtual nursing to complement bedside nursing."
Virtual nursing will expand to an additional 50 beds in early 2024 and NMHS will take the concept systemwide by the end of that year.
Many community members first heard of NMHS's redesign plan in July when word spread of layoffs, reassignments and reduced hours for employees.
Though unfortunate, those changes were a key step in setting NMHS in the right direction post-pandemic, Spees said.
"I go back to the old proverb, 'Necessity is the mother of invention,'" Spees said. "You think about the pandemic being the medical necessity that brought about a number of innovations in health care through a very difficult time. And then post-pandemic, we've had these factors changing the business model of health care that have now presented the business necessity of changing how we deliver health care."
It caused NMHS leaders and employees to focus on how work can be done smarter, not harder, and drove efficiencies within the health care system that reduced the cost of care as work is being done in different ways.
"The G.R.E.A.T. redesign is not a one-year strategy," Spees said. "It's a multi-year strategy, and it's not something we will accomplish in total during 2024. It's something we'll be working on in 2025 and 2026."
