streamlining - hida epub... · 4 streamlining healthcare | november/december 2013 by the numbers...

streamliningI n n o v a t i o n s i n s u p p l y c h a i n m a n a g e m e n t HEALTHCARE

MILLIONS GAIN INSURANCE ELIGIBILITY

HEALTHCARE NEEDS PATIENT ADVOCATES

HIDA TACKLES CONTRACTING INEFFICIENCY

Banner Health increases savings

during clinical expansion

Smart

growth

November/December 2013

2 Streamlining Healthcare | November/December 2013

insights

F rom hospitals to physicians’ offices, providers often wonder whether their product pricing is accurate. It’s understandable: roughly 20% of price changes are submitted after contracts expire, creating numerous credit and invoicing issues.

Often, distributors get caught in the middle.

This issue has plagued our industry for years, yet better pricing accuracy isn’t an insur-mountable challenge.

Current contracting structures involve providers, manufacturers, group purchasing organi-zations (GPOs), and distributors. Each is empowered to drive contracting efficiency, lead-ing to improved price accuracy. By following this four-step approach, we can greatly reduce the time and resources spent chasing the right price:

1. Begin negotiations early. Ideally, all contract negotiations should conclude 45 days beforecontract expirations.

2. Collaborate with manufacturers to ensure pricing accuracy. Distributors administer pric-ing, yet manufacturers own it.

3. Encourage price change communications in a timely manner. Set up a process whereprice change notifications occur as early as possible (at least one month prior to a contract’s end), providing enough time to update pricing files before actual price change dates.

4. Pay constant attention. Accurate pricing requires vigilance and sustained attention. Reg-ular communication between all parties involved is essential, since change is an industry constant.

Ultimately, there’s no magic wand for better pricing accuracy; it’s a common sense ap-proach of ongoing collaboration and timely communication between partners. Let’s help drive this approach and benefit our industry.

Supply chain efficiency: A pricing accuracy road map

Bill AbramsPresidentDistributed Products DivisionMedline Industries, Inc.2013 HIDA Education Foundation Board Member

in this issue

8 10 12

November/December 2013 | Streamlining Healthcare 3

8 SMART GROWTHA new online ordering system helps Banner Health control costs and produce valuable data in a time of rapid growth.

10 HIDA TACKLES CONTRACTING INEFFICIENCYManufacturer and distributor professionals discuss the complex contract-ing process and offer strategies to boost efficiency.

12 SUPPLY CHAIN STRATEGYIndustry leaders share insights on the changing healthcare environment at HIDA’s 2013 Streamlining Healthcare Conference.

DEPARTMENTS4 BY THE NUMBERS

News, trends, and stats in the healthcare supply chain

5 WHAT I’VE LEARNEDDesmond Smith, MD, Cardiologist, Smith Center for Cardiovascular Wellness, on the value of patient advocates

6 CAPITAL REPORTA roundup of federal and regulatory issues to track in the coming months

7 HEALTHCARE SNAPSHOT A quick, visual look at key industry issues

14 THE BIG PICTUREMillions of Americans gain insurance eligibility through the Affordable Care Act

15 CLOSE UPStanton McComb, President, McKesson Medical-Surgical

Vol. 2 No. 4

Streamlining Healthcare is published by the Health Industry Distributors Association, 310 Montgomery St., Alexandria, VA, 22314.

www.hida.org

Publication Management & Design Stratton Publishing & Marketing Inc.

Publication Manager Lia Dangelico

Art Director Janelle Welch

For more information or to sign up to receive future issues, contact Jeff Girardi, Commu-nications Manager, 703-838-6110, or email [email protected].

6


by the numbers News, trends, and stats in the healthcare supply chain

The cost of careDemand trends

The number of potential caregivers available for every person who is at least 80 years old is expect-ed to fall from 7 to 1 in 2010 to 4 to 1 by 2030 (AARP, 2013).

The number of new physicians accepting Medicare patients rose by one-third between 2007 and 2011. Roughly 30% of both Medicare and privately insured beneficiaries, however, express difficulty finding a doctor who accepts their insurance (HHS, Medicare Payment Advisory Commission, 2013).

Hospitals eliminate 1.7 full-time jobs for every $100,000 reduc-tion in Medicare revenue (Health Services Re-search, 2013).

Two out of every three hospital readmis-sions in the past year were for theoretically pre-ventable reasons. Averting a tenth of these returns could save Medicare $1 billion annually (Medicare Payment Advisory Commission, 2013).

Drug-resistant bacteria, like methicillin-resistant Staphylococcus aureus (MRSA), kill at least 23,000 people annually and add $20 billion in healthcare costs each year (CDC, 2013).

60%More than 60% of the 2,225 hospitalspenalized under Round Two of Medicare’s Hospital Readmissions Reduction Program will receive lower fines than those assessed during Round One (CMS, 2013).

Average healthcare premiums will cost $355 less for workers at companies with fewer than 100 employees as a result of the Affordable Care Act’s implementation (RAND Corporation, 2013).

Health reform

Technology updateThe median IT expenditure per full-time equivalent physi-cian has increased by nearly 28% since 2008 (Medical Group Management Association, 2013).

Switching from paper to electronic health records at health clinics can reduce ER visits and hospital admissions for diabetics by up to 6% (Journal of the American Medical Association, 2013).

$355


what i’ve learned

The best budget isn’t always the lowest.Most people agree that the path to improving healthcare relies on doing more with less, but preserving a patient’s best interests is essen-tial. If you under-treat a heart failure patient who ends up in the hospital with a stroke, you’ve created an entirely new cost trail. Buy-ing the right products that provide the right care for the right patients will always benefit you in the long-run.

The drink may change, but the glass is always half-full. Declining Medicare reim-bursements have limited my ability to treat elderly patients, who experience heart prob-lems often. It’s been an unexpected blessing, however, because I can devote more time to treating younger patients with diabetes and vascular disease. We even opened an obesity clinic and have already made a significant dif-ference in the lives of these new patients.

If the roof leaks, patch it. I realized early on that the costs of sending patients out to hospitals for echocardiogram and carotid ar-tery ultrasound procedures were becoming too high, both for my patients and in lost practice revenue. The benefits and convenience of do-ing these tests within seconds—versus send-ing someone to the ER—are well worth the investment.

Stay hungry or stop eating. I see myself as a patient advocate, not just a healthcare pro-vider. I am always looking for new evidence and outcomes data from my supply chain partners to share with my patients that jus-tify my recommendations. Patients want to be empowered to make informed healthcare de-

cisions; the moment I can no longer provide this service will be the day I retire.

Know your limitations. When evaluating the benefits of in-office lab testing, I realized that proper training and professional experi-ence were required to succeed. Hiring a tech-nician to assist with the on-boarding process made product implementation seamless for my practice and allowed me to rapidly develop my expertise.

Don’t ask for blueprints when a sketch will do. Everyone is waiting for a silver bul-let to navigate health reform, yet providers, suppliers, and even the government still can’t figure out the details. You can’t cookbook medicine, especially when a clinical referral versus an in-house test could mean a cost dif-ference of three to four times. The only thing I worry about is putting patients first in the deci-sions I make, and it continues to serve me well.

Healthcare needs more patient advocates

Desmond Smith, MDCardiologist, Smith Center for Cardiovascular Wellness

“I see myself as a patient advocate, not just a healthcare provider. Patients want to be empowered to make informed healthcare decisions.”


capital report Roundup of federal legislation and regulatory issues to watch

CMS turns up the heat on readmissions penalties After October 1, 2013 (FY2014), hospitals exceeding re-admission benchmarks for three conditions—heart attack, heart failure, and pneumonia—will receive a maximum penalty equal to 2% of Medicare base payments, a 1% in-crease from FY2013. For FY2015, hospitals will also need to reduce readmissions for two additional conditions—hip or knee arthroplasty and chronic obstructive pulmonary disease (COPD)—and the penalty increases to a maximum of 3%.

The Centers for Medicare & Medicaid Services identi-fied 2,225 hospitals nationwide that will receive reduced Medicare reimbursements in the second round of its readmissions penalty program. While the overall number of penalized hospitals remained flat from the first round to the second, more than 60% (1,371) of these hospitals will receive a lower penalty than in Round One.

Medical device tax repeal still a possibilityA 2.3% medical device sales tax implemented on January 1, 2013, has netted an estimated $1 billion in semi-monthly tax payments, cost-ing medical device makers an average of approximately $194 million each month. Support for repeal continues to build, but progress has been hindered by disagreements on how to account for the $30 billion in revenue the tax is estimated to raise over the next 10 years.

Republican lawmakers failed to win a delay of the tax during heated Congressional debates to end the recent government shutdown and raise the nation’s debt ceiling. Initial proposals for a two-year repeal of the tax garnered bipartisan support, however, leaving lawmakers hopeful that repeal is a realistic possibility when long-term government funding discussions pick up again in early 2014.

“Pedigree” legislation gains momentumThe U.S. House of Representatives recently passed the Drug Quality and Security Act (H.R. 3204), establishing a strong, uniform federal prescription drug-tracing standard. The bill was negotiated between the House and Senate chambers during the August Congressional recess and passed the House by a voice vote, demonstrating bipartisan commitment to the issue.

Passage of the bill went into limbo during October’s government shutdown, leaving Congressional lawmakers with their hands tied until the stalemate was lifted. The Senate can now approve the bill and send it to the President to be signed into law, which is expected before the end of 2013.


healthcare snapshot

Overall healthcare spending has dropped in recent years, but researchers can’t settle on the primary cause. Here is a brief summary of three recent studies addressing the complexity of the recent health spending slowdown.

Researchers disagree on healthcare spending slowdown

THE HENRY J. KAISER FAMILY FOUNDATION

HEALTH AFFAIRS FITCH RATINGS

ECONOMY

The national economy is respon-sible for 77% of health spending declines.

The recent economic recession is responsible for 37% of decreased healthcare spending.

Analysts did not assign a value for the economic or recessionary impact on healthcare spend-ing. Healthcare spending hasn’t bounced back as quickly as the overall economy, however, and care delivery shifts are anticipated.

GOVERNMENT ACTIONS

Structural changes in the healthcare system—including the Affordable Care Act and Medicare payments—are modest influenc-ers on the slowdown.

Changes in Medicare policies and the mix of public/private insurance policies account for an additional 8% of lower spending.

Insurance shifts under the Afford-able Care Act are placing higher medical cost burdens on patients. Same-store hospital admission rates dropped 3.8% in the first quarter of 2013 as a result, con-tributing to the healthcare spending slowdown.

OUTLOOK

Growth in healthcare spending should remain flat for the next few years before increasing to 7.1% by the end of the decade.

More than half (55%) of the slow-down remains unexplained. Public sector healthcare spending could be as much as $770 billion less than predicted by CMS over the next decade.

Since health reform favors larger, integrated systems, more health-care mergers are anticipated in the coming years. It is unclear how this will contribute to overall healthcare spending.

SNAPSHOT

“Over time, the economy is by far the biggest determinant of chang-es in health spending overall. Increases in health expenditures are likely to trend upwards in the coming decade as the economy returns to a more normal rate of growth.”

“Greater provider efficiency contributes to the slowdown in healthcare spending growth….Even spread over several years, the impact of eliminating mistakes and readmissions could be sub-stantial. And these areas may just be the tip of the iceberg.”

“Assuming a continued evolution in the industry toward value-based care, hospitals may find it harder to manage the effects of weak vol-umes from the topline down, such as through acquisitions or expan-sion of outpatient capabilities.”

Sources: “Assessing the Effects of the Economy on the Recent Slowdown in Health Spending,” The Henry J. Kaiser Family Foundation, April 22, 2013; “If Slow Rate of Health Care Spend-ing Growth Persists, Projections May Be Off By $770 Billion,” published in Health Affairs, May 2013; “Hospitals’ Credit Diagnosis: Weak Volume Trend Possible Evidence of Systemic Shifts in Care Delivery,” Fitch Ratings’ Report, June 2013.


Smart growthBanner Health increases savings during clinical expansion

feature

About Banner Health

n Operates in seven states: Alaska, Arizona, California, Colorado, Nebraska, Nevada, Wyoming

n Headquartered in Phoenix

n Includes 24 acute care hospitals, 142 ambula-tory locations, 60 primary care clinics/centers, 82 specialist clinics, 1,188 Banner Health Medical Group (BMG) providers, 928 physicians

Banner Health is in heavy growth mode, increasing its number of clinics both through acquisitions and

new locations. The goal is to help the system navigate Affordable Care Act changes as it functions as an account-able care organization.

But rapid growth has its challenges, especially with a network as widespread as Banner’s. With locations from Arizona to Alaska, the system’s clinic acquisition and growth strategy initially allowed for variation in ordering practices and lost savings opportunities due to a lack of standardization.


“Supply chain management is not a base function for clinical staff at our non-acute facilities; it’s a task given to employees in addition to their role,” says Raymond Davis, Supply Chain Non-Acute Senior Director, Banner Health Medical Group (BMG). “With the rapid change in our care delivery model, we needed to implement proactive cost containment controls through a low-touch, intuitive model for clinical staff to follow.”

Working with McKesson Medical-Surgical, a longtime partner in its hos-pital business, Banner implemented the SupplyManager online ordering system for its clinics. The system blocks non-formulary items and suggests items pre-approved by BMG. Each clinic orders independently while McKesson packs, ships, and bills per department. Davis estimates this change yields approxi-mately $15,000-$20,000 in savings each month, and this is just a starting point for savings.

“The growth of BMG provided a unique opportunity to standardize pro-cesses and products for all new and

existing sites in real-time,” Davis says. “Installing that level of control saves us money, prevents future cost overruns, and makes ordering easier for everyone.”

While the system has made ordering easier for clinical staff, it also provides plenty of analytics for Banner execu-tives to analyze and improve.

“Data will be key as BMG continues to grow,” says Adam Younger, Director of Health Systems and Corporate Ac-counts, McKesson. “Identifying new efficiency opportunities involves col-laboration between the distributor and supply chain partners to see what we can implement organization-wide to cut costs and achieve goals.”

McKesson has identified another 7% in savings if Banner chooses to implement all supply chain recommen-dations. And that’s just the beginning. “We think we can take the analytics and cost savings up a level,” Younger says. “As their business partner, we’re continuing to look for savings as new items come on board. It ’s a constant evolution of working the list and set-ting the bar higher.”

Banner Health’s keys to smart growthn Early executive

leadership buy-in. When Banner implemented supply changes to its medical group, it was BMG executives who supported supply chain’s efforts to create a supply formulary. Executive leader-ship outlined to the BMG staff the necessary steps and processes for approving standards. Davis credits this, plus the ongoing inclusion of BMG staff in decision-making, as vital to a relatively seam-less adoption.

n Mutual oversight of analytics. McKesson pro-vides purchasing habit data to Banner and both sides look for savings and anoma-lies as they assess Banner’s overall spend, fill rates, and per-location expenses. This leads to improved communi-cation between partners and increases the potential to identify savings.

n Keeping it simple for end users. McKesson has dedicated resources behind its data, building supply chain management processes for BMG and showing staff how to follow it. This saves BMG a precious step when implementing new process standards and educating its clinical staff.

Raymond Davis explains Banner Health’s clinic acquisition and growth strategy with McKesson partners Adam Younger and Monica LaBarr.


feature

inefficiencyIndustry professionals

try to simplify a complicated process

contractingHIDA tackles

Talk to people who administer pricing contracts for medical products, and you’ll learn one thing very quickly: most con-tracting processes are a complicated mess. More than 50 professionals from manufacturer and distribu-

tor companies met recently to discuss these complex processes and fig-ure out how to make them more efficient. The meeting is one step in a new initiative by the Health Industry Distributors Association (HIDA) focusing on contracting improvements.

Distributor and manufacturer executives discuss ways to make contracting processes more consistent and efficient at the 2013 HIDA Streamlining Healthcare Conference.


Contracts are typically negotiated between a group purchasing organization (GPO) and a manufacturer, and sometimes between a pro-vider organization and a manufacturer.

Individual GPO members are assigned to a “tier” in the contract.

Distributors must be notified as to contract pricing, terms, participating providers, and tier levels, so that they can invoice customers cor-rectly.

Distributors usually must notify providers in advance as to pricing changes.

✔ Many providers belong to more than one GPO.✔ Providers may use the GPO price as a starting point and then negoti-

ate a local contract at a lower price.✔ Contract negotiations often run into “overtime” so that old contracts

have expired before the new ones are final. ✔ Contracting entities often expect the agreements to be implemented

retroactively.

✔ Many contracts have more tiers than ever before.✔ Providers commit to contract tiers via varying electronic or

manual processes.✔ Manufacturers must check and approve tier assignment and some-

times fail to do so in a timely manner.

✔ Manufacturers use various processes and media for notification, from electronic data interchange (EDI) to email messages.

✔ One manufacturer may use a single notification regarding a change that applies to hundreds of customers; another manufacturer may send each notification separately.

✔ Distributors often receive notice of contract changes without sufficient time to notify customers and for all parties to load the pricing before invoicing begins.

✔ Contracts are governed by “rules,” such as whether a provider can access manufacturers’ prices from multiple GPOs. These rules are usually not easily accessible to the distributor. This lack of transpar-ency results in rebate denials and costly rework.

Pieces of the process What makes them so complicated Contract negotiations

Contract tiers

Contract notification

Rebate management

Why is it important to improve contracting processes?• Everyone wants pricing accuracy—the provider, the manufacturer, the GPO, and

the distributor all agree on what the provider’s price should be.

• Inefficient processes hinder pricing accuracy and force all parties to waste timeand money resolving price mismatches.

• Efficient processes allow invoices to flow through electronically, reducing overallcosts for all parties.

What’s so inefficient about contracting processes?

Because distributor pricing is typically higher than GPO-contracted pricing, distributors must apply for a rebate from the manufacturer after selling a contracted product.


feature

The Health Industry Distributors Association’s annual Streamlining Healthcare Conference attracted hundreds of distributors, manufacturers, and providers to the nation’s capital to discuss strategic responses to a transforming healthcare environment.

Here are a few supply chain insights from speakers and participants at the conference:

FIVE SOUND BITES FROM HIDA’S 2013 STREAMLINING HEALTHCARE CONFERENCE

Supply chain strategy

“Labor may be the most expensive factor in a provider’s operations—some-times as high as 65% of expenses—but it’s also the hardest to trim for savings. Instead, we need to look at what those folks are buying, especially in terms of clinical items—inconsistent clinician ordering practices is one of the last mines of opportunity for hospitals. Costs need to come out of stuff, not staff.”

—Martin Basso, CPA, Senior Vice President for Finance, Treasurer, Suburban Hospital and Healthcare System

“We’re beginning to see early development of mobile apps with a tie-in to medi-cal devices and distributor websites. Improved ordering functionality, inventory monitoring, and data analytics are all areas where we think the market is head-ing. The more information providers have to make quick, informed decisions, the better.”

—Andy Wright, Chief Operating Officer, Mercedes Medical

FUTURE SAVINGS WILL COME FROM STUFF, NOT STAFF.

BETTER TECH WILL LEAD TO QUICK, INFORMED DECISIONS.

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“Now is the time for healthcare to resource appropriately by reducing product volume and velocity. Just as 1% of the population drives 30% of healthcare costs—and 5% drive 50%—why can’t we similarly focus on these high-use or high-cost supply chain items to help us improve our efficiency?”

—Kenneth Grant, Vice President of Supply Chain Management, The Johns Hopkins Hospital and Health System

“Supply chain partners are asserting themselves by focus-ing more on services and technology than disposables, particularly with electronic medical record consulting. The ‘whole product’ concept, which allows physicians to save time and practice medicine effectively, should be adopted industry-wide.”

—Chris Fagnani, Owner, Lynn Medical

“A healthy set of physicians will always want to maintain autonomy, even when faced with consolidation pressures. There’s so much healthcare demand right now that multiple models can thrive. We’re seeing physicians choose different options for staying independent and remaining ‘small business owners.’”

—E.V. Clarke, Vice President, Chief Marketing and Operations Officer, Henry Schein

THE TIME TO MOVE FROM VOLUME TO VALUE IS NOW.

FUTURE SUCCESS IS IN SERVICES, NOT PRODUCTS.

MULTIPLE HEALTH-CARE MODELS CAN THRIVE.

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the big picture

Millions gain health insurance coverage eligibility

Source: CMS, 2013.

Uninsured Americans by stateOn October 1, the federal online health insurance marketplace www.HealthCare.gov opened, selling newly available health insurance policies in 36 states for consumers lacking cover-age. Current estimates show that there are more than 45.7 million uninsured Americans nationwide.

Predicting future healthcare enrollment Although the Department of Health and Human Services declined to provide enrollment numbers from the health exchanges’ opening day, the Centers for Medicare & Medicaid Services confirmed that it would release enrollment statistics on a regular basis. The current economic makeup of the nonelderly uninsured helps serve as a possible indicator of future enrollees.

Projected growth in enrollment, total Medicaid spending As appropriated in state budgets for FY2014, enrollment growth for Medicaid is expected to increase by nearly 9% across the country in 2014, but only 25 states (including D.C.) have cho-sen to expand their state’s Medicaid program coverage under the Affordable Care Act.

All states States moving forward with expansion

States not moving forward with expansion

Enrollment growth Total spending growth

8.8%10.3%

11.8%13.0%

5.3%6.8%

Source: Kaiser Family Foundation, October 2013.

Source: U.S. Census Bureau.

<100% FPL100-250% FPL251-399% FPL400% FPL and above


Source: Kaiser Family Foundation, September 2013.

Nonelderly uninsured by family work status

Nonelderly uninsured by family income*

1 or more full-time workers

63%

*FPL: The federal poverty level was $23,050 for a family of 4 in 2012.

No workers

21%

Part-time workers

16%

<100,100 uninsured

100,000 - 500,000 uninsured

500,001 - 1.5 million uninsured

> 1.5 million uninsured

District of Columbia


10%

14%

38%

37%


close up

Streamlining Healthcare: How is the Affordable Care Act affecting the way you and your customers conduct business?

McComb: The level and intensity of com-petition in the healthcare marketplace is greater than ever before. With the Afford-able Care Act and other accelerating trends, we see more risk and cost shifting to patients or individuals.

This shift is causing healthcare providers to evolve and become more competitive and retail oriented. As more care and volume is pushed to lower-cost ambulatory and alter-native settings, more intense competitive dy-namics will result.

These changes absolutely affect the way we serve and partner with our providers—we must be far more than just a distributor.

Streamlining Healthcare: Can you elaborate on that and how these changes might be influencing your approach toward physicians and hospitals, particularly in light of integra-tion trends?

McComb: First, let me say that we believe that independent physicians and the related market will continue to thrive, and we expect them to remain a sizeable group.

That said, we continue to see larger ac-counts and health systems grow in scale and scope, and we are investing significant re-sources to further develop our value proposi-tions for such customers.

We are doing some very exciting things with technology and our broad solutions portfolio to help providers explore new mod-els and execute their own growth strategies.

Providers are going through significant

integration and growth shifts; we need to be more than just distributors, but rather strate-gic partners, to them.

Streamlining Healthcare: Are any other markets feeling the impact of these changes?

McComb: A lot of care is shifting to the home and, as a result, costs and reimburse-ment scrutiny have ramped up in home care and long-term care markets. The combina-tion of increased demand and incremental, material reimbursement pressure in home

care creates a dynamic and challenging envi-ronment for our partners.

We are very pleased with the unique value that we bring to such providers. We know that technology can certainly help our cus-tomers deliver value to their patients while achieving efficiencies that allow them to re-alize better business health. You can expect a significant investment in technology and value propositions for our post-acute care partners as well.

Stanton McComb, President, McKesson Medical-Surgical

Optimism for non-acute market growth

McKesson Medical-Surgical provides medical supplies and healthcare technology to physi-cians’ offices, surgery centers, and more.

“We believe that independent physicians and the related market will continue to thrive, and we expect them to remain a sizeable group.”

Tom HarvieuxSanford Health

Michael LouviereOchsner Health

System

David FinleyPremier, Inc.

Tonia KrausMedAssets

Sonja FabryMidland Medical Supply Company

Andy WrightMercedes Medical

Amanda LlewellynDimensions Health

John GoehleAmbulatory Healthcare

Service

Gina MarcheseMMS, A Medical Supply Company

Scott WakserMedline

Industries, Inc.

Linda Rouse O’NeillHIDA

Elizabeth HillaHIDA

Dave McKinleyHenry Schein, Inc.

Linda Rouse O’NeillHIDA

Terry NiverBillings Clinic

Chad McCammon West Florida

Medical Group

Steve InackerCardinal Health

Tracy HowardCardinal Health

Hospital and Health System Supply Chain Opportunities

Ambulatory Care, Primary Care, and Specialty Practice Opportunities

REGISTER FOR BOTH CONFERENCES AND SAVE! FIND OUT MORE AT

WWW.HIDA.ORG

Register today @ www.HIDA.org

Register today @ www.HIDA.org

Understand how to navigate the trends and chart a course for success in the IDN-Acute Care Market.

Hear insights on how healthcare reform, consolidation, and integration are impacting non-acute providers.

streamlining - hida epub... · 4 streamlining healthcare | november/december 2013 by the numbers...

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