Clinical Management
Hospitals target the unique needs of the 'Sandwich Generation,' bolstering a range of service lines and building lifelong loyalty
The women's health program at Aspirus Wausau (Wis.) Hospital began three years ago with a dream. Literally. "One night I woke up and said, 'We have got to do something about women's health. It seems like we have all these services, and they're so disjointed,' " says Diane Postler-Slattery, the facility's president and chief operating officer. She realized that no one was taking a step back and looking at what the hospital could provide for women in central Wisconsin that nobody else was offering.
Postler-Slattery charged her business development group to come up with a plan. That effort, which involved six or seven focus groups with 100 women from the Wausau area and neighboring counties, resulted in a new vision. The hospital would offer a truly integrated program just for women, and not only women having babies. It would provide a continuum of care throughout the female lifespan.
Now Postler-Slattery had to sell what she describes as a soft and fuzzy idea to the board of directors and other senior leaders, virtually all men. "They're like, 'There goes Diane off the deep end again,' " she jokes. But once she went through the details, everyone was on board. Why? Because the concept made sense from both the care and business standpoints. Women get improved access to the whole range of preventive and acute services they need, while the hospital earns their loyalty. Counting just new patients, the women's health program in fiscal year 2009 generated $4 million in downstream revenue, Postler-Slattery says.
With this attention to women's health, Aspirus Wausau Hospital became part of a trend that started less than a decade ago and is growing and becoming more sophisticated. Hospitals are moving beyond the idea that women's health equals obstetrics, says Rebecca Arbuckle, head of the women's health program at the Chicago-area consulting firm Sg2. It is now a much broader topic, encompassing conditions that are gender-specific, affect women differently and are more prevalent in women.
Science is largely driving the change, adds Kerry Shannon, a partner in the Chicago office of consulting group CSC. "Research is not being done only on men, and we're seeing diseases and disorders manifest themselves very differently between the sexes." For example, the symptoms of heart attack and stroke often are different between men and women. Gender differences are being found even in some non-gynecological cancers, such as lung and bladder.
At the same time, hospitals in many markets are beginning to realize that the notion that providing good maternity care makes a woman a patient for life often doesn't pan out, Arbuckle says. Women in their 20s and 30s move frequently, so hospitals can't rely on them as patients after their child-bearing years. Plus, most women don't need hospital care in the years immediately following childbirth, and they lose their connection to the facility.
That means in many markets there is a big population of midlife women with no hospital affiliation. "That's really the place to capture women. They haven't really sought a lot of services in several years, and it's the time when all of the sudden they need a lot of screening," Arbuckle says.
Attracting this population means drawing in the main drivers of health care for entire families, Arbuckle notes. Hospitals and health systems hope these midlife women will turn to them when their husbands, children, parents and in-laws need care. "It's that Sandwich Generation opportunity that's being seen."
Successfully marketing to women requires more than putting up mauve wallpaper and offering aromatherapy, Shannon says. Hospitals have to respect how educated women are, and that is happening more now, she says.
Women also want services that cover the continuum of their health needs, from breast and heart health to bladder control and the physical and psychological changes of menopause, Shannon says. "They are absolutely saying, 'Are you only going to offer me my routine internist when I'm done having babies? Because that's not going to fly. I need somebody who can work with me through these other things.' "
Hospitals are taking different approaches to creating programs that keep up with medical advances and patients' wants. Some facilities have hired care navigators, while others have opened wings or separate buildings to house women's services in one place.
"Practically any organization could have a comprehensive women's health program, whether it is a large, freestanding women's hospital or it's a small community hospital that has pieces of women's health care spread throughout the building," Arbuckle says. "The trick is coordinating the services through things like nurse navigators or something that makes it seem seamless to the patient."
At Aspirus, the program focuses on wellness but also offers advanced services for women with serious medical conditions. It features a women's health navigator program that begins with a risk assessment of an hour or longer that delves into nutrition and physical activity, as well as breast, heart, bone, intestinal, bladder, pelvic, sexual, mental and general health. "It's done in such a nonthreatening way that you end up exploring and talking about things that you never would have talked about with your primary care physician," says Postler-Slattery, who went through the program herself. Depending on the results, the nurse navigators follow up by making appointments with the appropriate health professionals and coordinating care.
Services are not located in one place, but a dedicated area is part of the master facility plan, Postler-Slattery says. Still, patients are happy with the care coordination the get now, she adds. A patient survey shows that more than 93 percent of women's health program patients would "definitely recommend" it to others.
Some 200 miles south and east of Wausau, Aurora Health Care opted to build a stand-alone center when it decided to broaden its focus on women's health. In 2002, the system opened the Aurora Women's Pavilion on its Aurora West Allis Medical Center campus, located just outside of Milwaukee. It does not compete with Aspirus.
Several factors went into the decision, says Claudette Hamm, R.N., regional director, women's health for Aurora. Demographic information and market research, including focus groups, showed that the hospital was losing market share in obstetrics and identified a population of women past their child-bearing years whose health care needs weren't being met.
Hamm, along with physicians, nurses and architects, traveled to women's health centers nationwide and took the best of what they saw. The resulting pavilion houses a birthing center with a Level 3 neonatal intensive care unit, maternal-fetal medicine, medical and radiation oncology, genetics counseling, urogynecology and behavioral health, among other services.
The program includes a comprehensive wellness evaluation by a nurse practitioner, physician or fellow. If, for example, a woman came in worried about a significant family history of heart attack, the session would get into her heart disease risks; whether the problem is just genetic or also environmental; whether lifestyle issues, such as nutrition, exercise, stress management and relationships play a role; and whether her heart is her only concern, Hamm says. The health professional then would work with the patient to develop a plan of care.
The range and complexity of many women's health conditions requires communication and coordination across specialties. Hamm gives the example of a patient with cancer. A team made up of radiation oncology, medical oncology, the surgeon, nurses and physical therapy needs to work together to tailor a treatment plan.
When the center was recruiting physicians, the goal of care integration was explained in the interviews, Hamm says. "[We asked] if this is the experience we want our patients to have, how does it feel to you, how would you realize this in your practice? It has helped us recruit folks who share our philosophy and who really are passionate about wanting to provide care this way."
Such integrated and coordination offers quality advantages, Arbuckle says. It often leads to implementation of care protocols, and improved staff and community education.
Aspirus Women's Health each month generates a report card on quality, Postler-Slattery says. It monitors performance on several Joint Commission core measures, as well as other national guidelines. Since Aspirus began monitoring these benchmarks, for example, the use of antibiotics for hysterectomy patients has increased to 100 percent. The report card also looks at the program's revenues, she says.
The financials can be a sticking point when hospitals investigate whether to go down this road, Arbuckle says, because many of the services don't make money directly. Most care is outpatient.
"You're not going to get rich by evaluation and management codes for an office visit," Postler-Slattery says. "But you will make revenue on radiology procedures and lab procedures. You will also make money on any surgical intervention that would need to happen based on the symptoms that the woman comes in with. You also make revenue on having the woman then loyal to your system." Postler-Slattery's visit with a nurse navigator led to a urology appointment and ultimately surgery.
Part of the role of hospital leadership is to be able to look at the potential for downstream revenue and improved brand image, Arbuckle says. Administrators should focus on market needs. They should work with the physician community and find out what doctors see as a need.
Physician supply is crucial when deciding which services to provide. For example, it wouldn't make sense to invest in urogynecology or maternal-fetal medicine if there aren't any subspecialists in the community.
"The biggest obstacle we had when we first started was how do we engage physicians to refer to our program if they feel that we're taking volumes away from their clinics," Postler-Slattery says. "We had, I swear, about 3 million meetings. We were constantly in front of them saying, 'We really are not trying to steal your patients. Let me show you how many referrals you've gotten from us and new patients.' "
The hospital also established a physician advisory council that includes primary care physicians and specialists. "We had a large contingency of physicians coming together every month just to make sure we weren't stepping on their territory," Postler-Slattery says.
If the hospital doesn't control the physicians, the doctors will likely see a new woman's health program as a threat, Shannon says. She urges hospital leaders to sit down with the medical staff to share the program's goals. "Then see where they want to align with you," she says.
Arbuckle advises CEOs to give women's health program leaders some leeway to experiment. "If [you] can capture these women, it's going to be huge, so it means being able to take a few risks to do that."
Clinical Management is a regular series that examines specific disease or treatment areas. Clinical Management aims to uncover trends in technology, staffing, financing and other issues of concern to senior hospital executives. Our February installment will look at imaging.
Geri Aston is a freelance writer in Chicago.
This article 1st appeared in the December 2009 issue of HHN Magazine.
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