The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.


Consistency – the Real Challenge of the Affordable Care Act for Health Systems, ACOs, and Insurers

Monday, May 5, 2014
Jean Chenoweth imageMany may not have noticed a requirement within the Affordable Care Act (ACA) that requires that both quality and price performance be posted on healthcare exchanges for both insurance company networks and ACOs. That is a huge help for consumers looking to make more reasonable choices. The purpose of the expansion of transparency is to expose insurance companies and ACOs that offer networks that are low cost, but offer poor quality. In other words, performance must be BALANCED.

The 15 Top Health System winners are clearly aware of the requirement. To measure consistency of performance across a health system, the 100 Top Hospitals team developed a metric to measure alignment of performance of the hospitals within a health system. To date, alignment of high performance is elusive. The data demonstrates that health systems leadership hasn’t been able to lead member hospitals to align performance on the vast majority of metrics. The good news is that Asante, OhioHealth, Advocate Health Care, and a small number of other 15 Top Health Systems have made progress. They are leading the way in establishing the methods to achieve consistency. However, the healthcare industry has many miles to go before it achieves the consistency of the airline industry or many other industries.

Jean Chenoweth
Senior Vice President, Performance Improvement and 100 Top Hospitals

The 2014 100 Top Hospitals Winners: Are They the Best Partners for Local Employers?

Wednesday, March 5, 2014
Jean Chenoweth imageThe newly announced 2014 100 Top Hospitals® winners once again exemplify balanced excellence in performance. These are hospitals that outperform peers across the whole organization, not in just one performance area. Why does that matter? 

It matters because the healthcare industry is in turmoil. The Accountable Care Act (ACA) is  a disruptive event that requires hospital leaders to maintain high performance while guiding the successful transformation of the organization, and this is critical to the organization’s health. The leaders of the 2014 100 Top Hospitals have demonstrated these skills and are increasingly raising the value provided to the community, while others are falling behind. The 100 Top Hospitals management teams are able to serve their communities with reliable, high performance in the areas we measure: good inpatient outcomes, safety and adherence to evidence-based medicine, excellent post-discharge outcomes, effective clinical and operational efficiency, stable financial performance as a major community employer, and high patient perception of care. These hospitals have leadership teams who are also more consistent than their peers in demanding a balance across these measures. It matters because these are the hospitals that are well managed and most able to make successful change during tumultuous times.
The ACA is a disruptive event for employers and insurers as well.
Employers are increasingly aware that quality is not a commodity, and there needs to be a balance between cost and quality. They are learning that demands for only lower costs can be counterproductive, especially given ACA requirements for increased value and community health. Routine contracting with the lowest-cost health plans, without regard to quality, will result in higher costs and employee dissatisfaction in the long run. ACA transparency requirements for healthcare exchanges are designed explicitly to expose very low-quality health plan networks that don’t improve quality and community health. These far-reaching effects of the ACA are leading employers and providers to warm to the idea of mutually agreed-upon goals to lower costs and improve quality across the community.

Will ACA requirements and incentives result in employers and providers working together in the future?
While it makes sense that employers and providers should collaborate, it’s difficult to know whether the idea is ephemeral or the beginning of a new way of operating for the good of the community. Both talk about higher value, but it's unclear if either will walk the walk. If the concept does begin to gain momentum, well-managed hospitals with proven leadership, like the 100 Top Hospitals, will be the best partners that employers can have. Strong, effective management is NOT a commodity. But strong hospitals with effective management are the most likely to be the best partners of employers to drive increasingly high value and improved community health.

See the full list of winners.
Download the study overview and research findings.
Learn more at

Jean Chenoweth
Senior Vice President, Performance Improvement and 100 Top Hospitals