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GroupHILL current/recent projects include:

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Strategic Planning, Operational Assessments, Feasibility Studies, Business Plan Development, Financial Analyses, Implementation Planning and initial Implementation Support leading to the Execution of a Single Shared CORE Laboratory Model for NSLIJ and NYCHHC servicing all five boroughs of New York and most of Long Island.

Ongoing guest lectureship series at the George Washington University/ Association of Public Health Laboratories International Laboratory Management Institute in Washington, D.C.  Lectures include Financial Management, Problem Solving and Decision Making (process and analytical tools) and Strategic Planning.

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Ongoing benchmarking for the Compass Group, a strategic alliance of 22 large integrated delivery networks (IDNs) that includes over 350 hospital laboratories with 18 large CORE labs.

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Strategic and Tactical Assessment of the laboratory system for Renown Health System in Reno, NV.  This multihospital system is now implementing reengineering recommendations in preparation for assessing and exploiting a natural market opportunity for outreach services in the region.

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Strategic planning for the Public Health Laboratory System and MOH (Ministry of Health) of Tanzania.  The result:  “A National Strategic Plan for Laboratory Support Program and the National Quality Assurance and Training Center” in Arusha, Tanzania.  The Plan has now been submitted to the Ministry of Health for finalization and implementation.

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Ongoing Operations Assessment and Market Opportunity Assessment for Crozer Keystone Health System, Philadelphia, PA.

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Operations assessment with process improvement and staffing recommendation based upon national and GroupHILL benchmarking data for Loma Linda University Medical Center Department of Pathology and Laboratory Medicine.

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Aligning of incentives and performance objectives for the senior laboratory leadership at a large and prestigious multi-hospital academic medical center (Stanford University and Lucille Packard Childrens Hospital) via the creation of a campus-wide strategic plan and a series of service agreements for the laboratory, pathology faculty and outreach program.

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Researched and created an internal/external hybrid benchmarking system for another prestigious academic medical center.  Evaluation of the feasibility of a formalized professional outreach program to provide a new revenue stream to support academic and practical research and development.

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Developed and implemented a plan that outperformed a proposed reference laboratory outsourcing model for a two hospital system in New England.

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Professional and technical assistance for Genzyme Genetics in the selection and acquisition of a new, integrated, and consolidated laboratory information system.

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Implementing a plan that outperformed a proposed reference laboratory outsourcing for a two hospital system in New England.

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Establishing a remotely controlled, operated, and validated laboratory service for a large medical foundation in California

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Integrating laboratory services for a three-hospital system in New England which is absorbing all anatomic and clinical laboratory services from a very large and prestigious physician group practice. In addition, the CORE laboratory infrastructure is being redesigned and optimized by the acquisition of a new laboratory information system, front-end automation and a reengineered leadership structure.

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The regionalization of blood product and transfusion services for three separate health systems

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Creation of a "culture of metrics" for a 30 hospital system in California whereby a validated internal and benchmarking program drive objective, measurable improvements for the affiliate institutions

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The creation and presentation of a week-long laboratory management course in Zimbabwe for the American Public Health Laboratory (APHL) under the sponsorship of the WHO/CDC/Global Health Program.  This course has now been presented seven times in five countries.

VISN:

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Situation - Eight VA Medical Centers had discussed identifying opportunities of shared services but had been unable to reach consensus on a protocol that would level the playing field and account for differences in physician ordering patterns, specialty needs and subtle differences in charge description masters.  The primary method used to compare productivity and look for opportunities for reduced cost was a modified CAP LMIP-like local system.  Determining what tests would remain on-site at the RRL labs and what would move to a CORE lab continued to be problematic.  

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Project - Create a framework for data collection that would normalize for panel size and variation and gain agreement on the methodology used and for the integration opportunities so identified.   Determine which operating model would be optimal and the cost savings that could be derived if that model were implemented.  Bring the groups together and build commitment via consensus. 

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Outcome - Using our broad data base and disciplined data collection processes, consensus was gained for a fair and equitable counting of billable tests and effort expended.  Benchmarking indicated an implementable labor savings potential of approximately $1.25 per billable procedure.  Implementation of a redesigned CORE laboratory is now complete and the transfer of testing is ongoing with savings in the projected range.   Additional savings and more consistent quality levels have also now been realized via the system-wide, GroupHILL facilitated standardization of major instrumentation and testing methodologies.

SJHS:

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Situation - A ten hospital Midwestern IDS to include a large academic medical center (AMC) was exploring integration opportunities.   Although it was agreed that the real savings potential rested in the creation of an anchor or core laboratory, the group could at best only agree to develop a bi-lobed core laboratory.  Actual savings potential was based only on educated conjecture. Even though the AMC had a fairly mature and successful outreach program, it was unclear how that success could be built upon for the additional institutions.  There was a significant rift between the AMC and two other large institutions within the system that had previously consolidated operations.

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Project - Determine the real and achievable consolidation opportunities.  Bring the various factions together and finally get agreement on the ideal model and, in this case, locate where a single core laboratory would be located.  Develop a disciplined business and implementation plan to ensure realization of savings potential.

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Outcome - Full integration indicated a savings opportunity of four million three hundred thousand dollars ($4,300,000) for a single core laboratory.  By using the first ever rapid design protocol for integration of laboratories, the warring parties were brought together to finally reach agreement on their future.  A detailed business and implementation plan was created in a very interactive fashion with representatives from each institution.  In unprecedented fashion the plan was unanimously signed and a unique monitoring system put in place to document actual realization of savings.

CG:

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Situation - CG is an eight hospital northeastern IDS to include two major AMCs.  The decision had been made to consolidate the two major AMCs but no real planning or analysis had been completed to justify the savings opportunities or to create the implementation plan.  The other six institutions were to send some portion of their testing to the core lab that would be created as the two AMCs merged, but there was significant disbelief on the part of the non-AMCs about the ability of the new core lab to adequately service their needs.   Again, the integration savings opportunities of the additional six institutions had not been quantified.

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Project - Quantify consolidation opportunities and the impacts of several options.  Create a highly focused series of observations and suggestions to augment a highly detailed business and implementation plan. 

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Outcome - AMC consolidation opportunity is $3.1 million dollars and the complete consolidation will take the total to $6.0 million.   Because of Y2K issues (LIS and HIS), the non-AMC consolidation ($2.9 M) will be delayed until summer of 2000.

MHN:

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Situation - MHN was a non-asset merged group of four mid-Atlantic hospitals with no formal or even informal ties that created a free standing, legal entity to explore networking opportunities. Laboratory consolidation came to the top of a list of potential ventures and, in the spirit of needing a first "win" for the network, a study of the feasibility and potential options for laboratory integration was commissioned.

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Project - Determine feasibility of consolidation, analyze the top options, determine infrastructure costs, assess the market for outreach services, review alternatives in joint venture opportunities, create business plan.

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Outcome - Savings opportunities were discovered to be in the area of two million six hundred thousand dollars ($2,600,000).   Commitment of the leadership to real integration was tested when after LIS costs, and to a much lesser extent courier costs, were discovered to drive the return to just below a pre-set hurdle for internal rate of return.  A new outreach business plan did not indicate profitability until approximately twenty months into the endeavor, although revenue and profitability ramped up quickly for the next three years.  In the final analysis, LIS costs were seen as the deal breaker - rather than a sound investment.   The project was abandoned.

UMC:

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Situation - UMC, a consolidated 2 hospital system had outsourced the ownership and management of the clinical laboratories.   Administration was concerned about service level issues raised by the medical staff and the actual financial results of the outsourcing.

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Project - Using our proprietary data base, a proxy was developed to determine the start up and ongoing costs should UMC decide to repatriate the clinical laboratories.  A determination of the outreach revenue opportunities was made to allow UMC to understand not only the costs, but foregone revenues of the agreement.

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Outcome - UMC had all the information to allow for a disciplined "make or buy" decision.

SMMC/DC:

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Situation - A medium sized acute care hospital and a large (300 plus physician) multi-specialty group practice each had full service laboratories on-site.  The two institutions were connected by a flying walkway.  The LIS and HIS systems were from different and incompatible vendors.

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Project - A consolidation feasibility study with a full model options analysis was performed.  Once the ideal model was agreed upon, a full business and implementation plan was created.  As part of the project, an LIS review was completed.

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Outcome - SMMC/DC agreed to consolidate laboratories and realize a documented savings of 18% in overall costs. The detailed implementation plan was of such quality, SMMC/DC personnel implemented the plan internally.

CHCC:

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Situation - A four hospital system had purchased a small independent clinical laboratory and had begun to consolidate services.   The profitability of the independent lab was in question and the consolidation had not resulted in the expected cost savings.

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Project - Determine the actual consolidation opportunities and assist in developing an action-oriented plan to realize the full opportunities.  Determine at a very detailed level, actual costs and a reasonable transfer pricing strategy for use between the institutions and the independent lab. Investigate and improve profitability of the independent lab.

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Outcome - Using proprietary software tools and best practice data bases, the actual costs / test were determined and a focused pricing strategy was developed both for within-system transfer pricing and for outreach testing.  To solve the profitability question the investigation was implemented which uncovered an insidious accounts receivable problem.  By pricing to cost and aggressively managing client accounts significant profitability was regained.  A special license and training to use the costing software was arranged and the client team now uses the software to price managed care and other contracts.

COH: 

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Situation - A major teaching and cancer center in Los Angeles felt uneasy about an upcoming CAP inspection and about regulatory compliance issues.  An informal pre-inspection survey indicated there might be a significant number of deficiencies.

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Project - Perform a formal pre-inspection survey to bring any serious problems to light.  Assist the client in addressing a plan to correct any deficiencies noted.  Review compliance to regulatory and safety issues as a parallel project with the CAP pre-inspection.

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Outcome - Worked closely with Hospital Administration, Pathologists and department personnel in identifying policy and procedure requirements, process improvement opportunities and required corrective actions.   Developed detailed policy and procedure manuals including a revised Quality Assurance Program, Safety Program, Administrative Policies, Job Descriptions, Technical Procedures and continuing education programs.  Facilitated a series of in-service education programs on OSHA, CLIA and a variety of technical requirements including method validation, alternative proficiency testing methodologies and quality assurance procedures.  As a result of these efforts the 100 deficiencies identified pre-survey were corrected.  The formal CAP survey was completed with only one minor Phase I deficiency in reference to adequate physical space.

UPMC:

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Situation - A 13 hospital major teaching system in Pennsylvania had not actually achieved the expected savings from consolidation.   The system was unclear as to what had been achieved and what the actual savings and other synergies ought to be.  What should the model be and where would it be located?

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Project - Lead the group in developing a unique and implementable plan to determine the feasibility and full opportunities of consolidation.  Ensure the plan has buy-in and commitment from all parties and results in significant improvement in the financial health of the clinical laboratories - while maintaining best practices in service levels.

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Outcome - Facilitated the design and modeling of a centralized laboratory testing service serving major academic medical centers and community hospitals.  Worked with system administrators in collecting detailed financial and operational data used to prepare a comparative database defining cost improvement opportunities and consolidation options.  Provided inter-laboratory benchmarking comparisons between member institutions and national peer laboratories.   A for-profit joint venture partner was brought in and is now completing the consolidation.

GroupHILL Sample Projects Fall 2008 Note:  This listing is not meant to be exhaustive, only representative of the type and scope of projects successfully completed by GroupHILL staff.