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Volume 55, Number 2
March/April 2010

    Interview with Daniel J. Wolterman, FACHE, President and Chief Executive Officer, Memorial Hermann Healthcare System, Stephen J. O'Connor

    Guide to CMS Compliance, Ruth M. Elzer

    Is Billboard Advertising Beneficial for Healthcare Organizations? An Investigation of Efficacy and Acceptability to Patients
    John L. Fortenberry Jr., and Peter J. McGoldrick
    Cost and Quality Impact of Intermountain's Mental Health Integration Program
    Brenda Reiss-Brennan, Pascal C. Briot, Lucy A. Savitz, Wayne Cannon, and Russ Staheli
    The Volunteer Activities of Healthcare Executives
    Peter A. Weil and Peter A. Kimball
    Pay-for-Performance in Safety Net Settings: Issues, Opportunities, and Challenges for the Future
    Gary Young, Mark Meterko, Bert White, Karen Sautter, Barbara Bokhour, Errol Baker, and Jason Silver

Executive Summary

Is Billboard Advertising Beneficial for Healthcare Organizations? An Investigation of Efficacy and Acceptability to Patients, John L. Fortenberry Jr. and Peter J. McGoldrick

The healthcare industry is increasingly turning to billboard advertising to promote various medical services, yet little attention has been directed toward understanding the performance and policy implications of billboard advertising from the perspective of the patients targeted. To shed light on this, we initiated a field experiment investigating the impact of an urgent care center’s billboard advertising campaign, collecting primary data over a 32-day period at the center’s two clinics. Over the course of the billboard campaign, perspectives from 1,640 patients were collected via questionnaire. Institutionally supplied business metrics were also monitored. Our principal findings indicate that billboard advertisements are noticed by patients, favorably viewed by patients, and effective across the sequence of steps leading to patient patronage. Enhancement of awareness exerts the most powerful influence on patronage, but the capacity to inform consumers is also highly significant.

These effects are not limited to new patients, as many returning clients were made more aware of the clinics and were influenced by the campaign. The study offers insights for creative billboard treatments and campaign planning. Although effects remained strong throughout the campaign, some degree of “wearout” was evident after three weeks, which suggests the need to rotate billboards frequently and to consider digital billboards. Corner tabs—small announcements sometimes placed in the corners of billboard advertisements—proved largely ineffective as a promotional device and may clutter the central messages. Given these findings, we believe healthcare institutions are justified in using billboards, as they perform effectively and appear relatively free of controversy. Careful planning of creative billboard treatments and appropriate scheduling patterns are essential to maximize their communications potential.

Executive Summary
Cost and Quality Impact of Intermountain’s Mental Health Integration Program, Brenda Reiss-Brennan, Pascal C. Briot, Lucy A. Savitz, Wayne Cannon, and Russ Staheli

Most patients with mental health (MH) conditions, such as depression, receive care for their conditions from a primary care physician (PCP) in their health/medical home. Providing MH care, however, presents many challenges for the PCP, including (1) the difficulty of getting needed consultation from an MH specialist; (2) the time constraints of a busy PCP practice; (3) the complicated nature of recognizing depression, which may be described with only somatic complaints; (4) the barriers to reimbursement and compensation; and (5) associated medical and social comorbidities. Practice managers, emergency departments, and health plans are stretched to provide care for complex patients with unmet MH needs. At the same time, payment reform linked to accountable care organizations and/or episodic bundle payments, MH parity rules, and increasing MH costs to large employers and payers all highlight the critical need to identify high-quality, efficient, integrated MH care delivery practices.

Over the past ten years, Intermountain Healthcare has developed a team-based approach—known as mental health integration (MHI)—for caring for these patients and their families. The team includes the PCPs and their staff, and they, in turn, are integrated with MH professionals, community resources, care management, and the patient and his or her family. The integration model goes far beyond co-location in
its team-based approach; it is operationalized at the clinic, thereby improving both physician and staff satisfaction. Patients treated in MHI clinics also show improved satisfaction, lower costs, and better quality outcomes. The MHI program is financially sustainable in routinized clinics without subsidies. MHI is a successful approach to improving care for patients with MH conditions in primary care health homes.

Executive Summary
The Volunteer Activities of Healthcare Executives, Peter A. Weil and Peter A. Kimball

The role requirements of healthcare executives have received considerable attention from researchers; however, the volunteer efforts of executives have not been examined. This study investigates the relationship between an executive’s position in the organizational hierarchy and his or her propensity to volunteer in general and to volunteer for the executive’s professional society in particular.

The study found that nearly all executives volunteered for some organization, but the type of work they performed was associated with their position level. For example, more than 90 percent of chief executive officers (CEOs) served on a board or a committee compared with less than half of mid-level executives. Also, more CEOs than lower-level executives were involved in fund-raising, setting professional standards, and testifying to legislatures. In general, we suggest that CEOs commit to volunteering, which facilitates their ability to achieve and retain their high-level position, recognition, and rewards.

Fewer than half of the executives surveyed had volunteered for the American College of Healthcare Executives (ACHE), their professional society; the most common reasons given for not volunteering were lack of awareness of volunteer opportunities or not being asked to volunteer. Those that had volunteered for ACHE were primarily motivated by altruistic motives, such as the desire to help others, feelings of compassion for people in need, or the desire to do something for the profession. Career advancement was deemed to be a less important motivator in volunteering for ACHE. However, mid-level executives rated these motives more highly than did senior-level executives and CEOs. Because of the creation of local ACHE chapters, many more opportunities will become available for healthcare executives to volunteer for their professional society in the future.

Executive Summary
Pay-for-Performance in Safety Net Settings: Issues, Opportunities, and Challenges for the Future Gary Young, Mark Meterko, Bert White,Karen Sautter, Barbara Bokhour, Errol Baker, and Jason Silver

A major trend among Medicaid programs is the adoption of pay-for-performance (P4P) programs, but little evidence exists about the impact of these programs on quality improvement. Our in-depth case investigation of P4P in two safety net settings suggests that such programs may have minimal short-term effect on quality improvement. Two potentially important barriers for P4P in safety net settings are limited motivational effects from financial incentives and complex patient care requirements. We did not uncover any opposition against P4P among providers, nor did we find any evidence that P4P programs may compromise quality of care through unintended consequences. Overall, study results point to opportunities to improve the design and implementation of P4P programs in safety net settings.