The changing landscape of healthcare has meant a shift in strategy for CIOs. Whereas aligning with community health centers and physician practices was once merely on the radar, it’s now a top priority. New payment models and looming federal mandates have made care coordination vital — and that’s where Access comes in. “Care coordination is what we do,” says Julie Bonello, who is leveraging her past experience as a hospital CIO to lead the organization through a dramatic transformation and position it as a key partner to a dozen hospitals. In this interview, she talks about building an IT team from the ground up, her strategy for retaining top talent, and what’s next for CIOs.
- Staff retention — providing “great growth opportunities.”
- Role of IT in improving care
- Referral flow between hospitals and specialists
- Background in nursing, researching & consulting
- Aligning with community health centers — “That’s where all of us are beginning to migrate.”
- The unique opportunity for today’s CIOs
LISTEN NOW USING THE PLAYER BELOW OR CLICK HERE TO SUBSCRIBE TO OUR iTUNES PODCAST FEED
Everyone talks about care all day long; it really doesn’t matter what department you’re in. Sometimes as we’re talking about care, the CFO will say, ‘I really feel like I’ve gained my nursing degree today.’
If we both use Epic, we have tools to allow us to share the CCD in a robust manner and much more easily. So we’re going to focus on those relationships right away.
I got a really good sense from consulting of the marketplace, both from a HIT and a healthcare business standpoint. So when I became a hospital CIO, I understood the full breadth of what was required to support both care and operations and reimbursement.
It allows us to bring some of the traditional managed care workflows that at one point were completed in the managed care organization. Now we can transition those same workflows directly to the point of care.
Gamble: What do you think has been the key to retaining good people, especially in an environment like yours in a city like Chicago; I’m sure that that can be challenging. There’s a lot of competition for jobs.
Bonello: Yeah, I think there are maybe three things. First, what’s fascinating is when we all worked together to build the team in 2009, I think we built a team of people who all like to work with one another, and that’s huge. That gets known that people like to work with one another, outside of your own IS department across the organization. But I think other IT organizations know that. So when you have people that actually like to come to work and they really enjoy the people they work with, that’s really enormous, and we’ve spent a lot of time doing that.
Secondly, we changed our recruiting focus to choose people with a little bit more experience. We’re still willing to build capabilities, but only after applicants have gone through consulting. Everyone, it seems, has to go through a consulting experiment to see if they like it or not. I think those are two most significant pieces. In terms of retention, we’ve learned that we’re not going to be able to provide the highest pay, but we can definitely provide the best work environment. We really try to focus on that and have that be our strength, and it is.
Gamble: That’s really important. People want to feel engaged and want to feel that they’re part of something successful, and that’s a really big motivating factor.
Bonello: Exactly. We are a very small team, and when you’ve got a small team, you provide everyone great growth opportunities so they really get involved in many different things. And I think that they see their direct impact on patient care. I know I do, and I think that is very meaningful for everyone.
Gamble: Absolutely, and it can be a little more difficult for people to see that who aren’t clinicians but there are ways to help that along. That’s a really big thing knowing that you are impacting patient care.
Bonello: It is. It’s huge here. I think everyone talks about care all day long; it really doesn’t matter what department you’re in. Sometimes the chief financial officer, as we’re talking about care, will say, ‘I really feel like I’ve gained my nursing degree today.’
Gamble: I think that’s really important. As far as actual data exchange with the hospitals, you are dealing with different EHR systems. How does happen, and have there been challenges with that?
Bonello: They’re not really challenges but really knowing when both organizations are ready. If you have another Epic hospital partner, there is going to be a heightened readiness automatically, because if we both use Epic, we have tools to allow us to share the CCD in a robust manner and much more easily. So we’re going to focus on those relationships right away because we can hit it. And we’re going to focus first on making sure that we receive all of the pushes — all the discharge summaries for any of our patients at an Epic hospital that has been discharged. And then we’re going to work with some of our Epic partners on some of the referral flows to make sure that the hospitals and specialists particularly get all of the correct referral information. And so we’re doing it by specialty area.
We’re working on the Epic-to-Epic workflows first because they’re easier. Concurrent with that, because a lot of our patients go to non-Epic hospitals, we are beginning to work out the workflows, but that requires that we have an implemented HIE or HISP arrangement. So it just makes it a bit more complex. We’re doing both concurrently, but the timeframes might be longer with our non-Epic hospitals and specialists.
Gamble: Sure. So I don’t know if I want to call it low-hanging fruit, but maybe it’s a little lower.
Gamble: Okay. So talking a little bit about your career path, you have experience as a hospital CIO, correct?
Gamble: How do you think that has helped shape your current role and where you see some of the things that you got from that experience come out?
Bonello: Before I became a hospital CIO, I think all of the experiences I had prior to being hospital CIO made me a strong hospital CIO. And then once I was a hospital CIO, I could really use the breadth of my knowledge to form an entirely new department here — ambulatory only, with strong hospital based relationships — with greater ease.
I started as a nurse. I then went into research. While I was getting my Master’s in computer science, I worked as a hospital IS analyst. I then jumped over into consulting, and consulting gave me the structured methodologies and tools to pull it all together into really successful deliverables. I got a really good sense from consulting of the marketplace, both from a HIT standpoint and a healthcare business standpoint. So when I became a hospital CIO, I really understood the full breadth of what was required to support both care and operations and reimbursement. I’ve been around the Chicago area for many years, so coming here to Access was easy, because I really understood the entire hospital landscape and the hospital IT landscape.
Gamble: You’re right on in what you said about consultants; so many people we’ve talked to have had at least some time there, and it really does seem to be a good experience to learn from.
Bonello: Absolutely. I worked for really two great consulting firms. Both firms had very structured methodologies and training programs to make sure that there was always success for the project work we did. It was really wonderful.
Gamble: Having that background as a hospital CIO and being somebody who works very closely with CIOs, would you say there was anything that you could kind of pass along about aligning with community health centers? Maybe some best practices, or just something they should know if they’re in the process of aligning with an organization like yours.
Bonello: I would guess it’s already starting to change in that with value-based reimbursement, focus is really moving toward care coordination with the medical home. And so the focus will be on all of the systems to manage care across the continuum, regardless of where the patient is. We’re going to find that the focus that we had probably in the last decade on inpatient electronic health records, while it will remain significantly important, we’ll really see a balance of how to use all of the electronic health records to coordinate care across all of the continuum. All of us are beginning to migrate toward how best to do that for the different patient populations we serve, because there are a bunch of different ways you can meet the needs. There are a bunch of different solutions; a bunch of different ways you could do it.
Gamble: It really is interesting to see how quickly things have evolved, even since you started at Access in 2009. It’s a period of such rapid change in the industry, and I’m sure it’s been really interesting from your point of view to watch that all unfold and be part of it.
Bonello: It’s been probably the most rewarding experience of my career. Now, as we look at HealthCura, we are implementing the integrated managed care system from that backend. What that does is it allows us to bring some of the traditional managed care workflows that at one point were completed in the managed care organization. Now we can transition those same workflows directly to the point of care. Looking at benefits and utilization and all authorization requirements for the benefit plan is something that is immediately available to all the care team. So we can have our care coordinators really participate in case management in the future. And that’s really wonderful, because the care team is the team that really understands the patient, and that’s super exciting for me.
Gamble: There’s also something else we see happening that’s really encouraging, and that’s the emphasis on preventative care. This is the way that healthcare needs to go, and to see this starting to come to fruition is a great thing.
Bonello: It’s a great thing. As a patient, you want to know your care team, and you want to know who you need to call to get care when you need it. To make it easy to take away the fragmentation that we’ve seen for a while I think is really exciting.
Gamble: Okay, I know we’ve covered a lot and I think this was really helpful and I really think it’s going to be beneficial for our readers. I appreciate you giving us the time today.
Bonello: Thanks, I really appreciate it. I had fun.
Gamble: Me too. I’m sure that we’re going to have more to talk about in the future, so I’d love to check back with you down the road.
Bonello: Sure. I’d be happy to talk. I appreciate it, Kate.
Gamble: Thank you so much. Have a good day.
Bonello: You too,