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Thursday, August 1, 2013 at 3:58 pm

Insource and UMMC appear to be classic case of the disruptor vs. the disrupted

post by Howard Owens in batavia, business, Health Care, Insource Urgent Care, UMMC

Glossary

Disruptive Innovation: An innovation through technology or process that takes root in an underserved portion of the market to create new business opportunities.

Incumbent: The market-leading business in an industry.

Unmet Need: When a business planner identifies a hole in the marketplace, where consumers -- either consciously or unconsciously -- have a need that a new product or service can meet.

Job to be Done: Much like an unmet need, the jobs-to-be-done metaphor helps a business planner target a market segment for a new product or service. The job-to-be-done metaphor is based on the idea that customers don't really buy a product or service, they hire the product or service to help with a specific task they want to accomplish.

Clayton  Christensen: Harvard Business School professor and creator of the term "disruptive innovation." His groundbreaking works are "Innovator's Dilemma" and "Innovator's Solution." He's also written a book on innovation in health care, "The Innovator's Prescription."

From the perspective of the folks who run Insource Urgent Care in Downtown Batavia, their first-of-its-kind clinic is apparently seen as a competitive threat by the executives at United Memorial Medical Center.

A threat that must be crushed.

If their perception is correct, it highlights the fear disruptive innovators can strike in the hearts of incumbent businesses, especially if that business has enjoyed a monopoly position in the market.

Since UMMC officials are not talking about the tensions between Insource and UMMC, we only have the perspective of Insource's owners, which they're willing to discuss, and is also part of a federal anti-trust suit filed by Insource on June 25.

The suit alleges that UMMC conspired with HealthNow, the region's BlueCross BlueShield franchise, to eradicate the hosptial's pesky new competitor.

UMMC, according to the lawsuit, has even tried to muscle other health care providers in the county in an effort to deny Insource the partners it needs to deliver its services.

HealthNow is the dominant health insurance company in Western New York and UMMC has held a monopoly position for emergency and hospital care in Genesee County since the year 2000 merger of Genesee Memorial and St. Jerome's.

Melissa Marsocci, VP of operations for Insource, who is a native of Batavia and well versed in the literature of disruptive innovation, said she wasn't surprised by the response from UMMC to the arrival of her new company. She wishes it had been different, that cooperation rather than competition would have been the watchword, but that's not the case.

"Being from here and knowing the corporate culture over there, I knew we weren't going to be welcomed with open arms," Marsocci said. "Whenever I go anywhere else (to open a clinic), I don't know that, but here, we're just little bugs to them."

Insource is a company designed around innovation. It's model uses more efficient processes for delivering patient care and employs technology to reduce costs while improving quality.

Insource is also willing and able to deliver what it believes is world-class care while accepting lower profit margins per patient.

The result, according to Marsocci, is faster and easier access to top specialists and lower costs for uninsured patients.

The Lawsuit

Key points raised in Insource Development Services of Batavia, LLC. vs. HealthNow New York, Inc. and United Memorial Medical Center.
  • UMMC operates two urgent care clinics, one at St. Jerome's and one in Le Roy. The suit alleges these clinics keep irregular hours and are frequently closed.
  • Services offered by these clinics are allegedly limited and patients are frequently referred to UMMC's emergency room.
  • HealthNow allegedly entered into discussions with Insource two years ago about opening an urgent care clinic in Batavia and encouraged Insource to take on the project. When Insource and HealthNow -- which covers 50 percent of the insured in Genesee County -- were about to agree to terms for rates, the suit alleges, HealthNow broke off communications unexpectedly and without explanation.
  • The suit alleges ER care at UMMC costs at least $1,500, below the now-common high-deductable plan of $3,000, and Insource provides the same service for $150.
  • The suit alleges that HealthNow and UMMC entered into an agreement to restrict competition in Genesee County.
  • UMMC allegedly used anti-competitive practices to drive Lakeside's urgent care clinic out of Le Roy.
  • UMMC has used "agents" to contact healthcare providers in Genesee County to discourage their cooperation with Insource.
  • Insource alleges that UMMC is acting to protect its monopoly position in Genesee County.

In its lawsuit, Insource claims a typical emergency room visit to UMMC costs at least $1,500. The same service through Insource would cost $150.

"I think people deserve a choice," Marsocci said. "Isn't free enterprise what America is all about? Competition is good. It ups the quality, or should, so why not? Why should United Memorial have a monopoly?"

The typical urgent care model is kind of like a doc-in-the-box. The clinics are usually only opened in high-volume communities -- such as well-populated suburbs or densely populated urban neighborhoods. They treat minor injuries and illnesses and do very little in the way of referrals. They're not the place to go if you're seriously ill.

Insource can provide health care as basic as a physical for a high school athlete, up to arranging a consultation with a heart surgeon.

In other words, from a patient perspective, the company can do everything UMMC does, but without the overhead.

When a business planner with an eye toward disruptive innovation looks at a potential opportunity, the planner will try to identify an unmet need and a job to be done.

The unmet need in Genesee County, according to Marsocci, is the lack of top-tier specialists. It's not that they're not here, but there are fewer of them.

And, many local residents -- like it or not, it's true, notes Marsocci -- also lack faith in specialist referrals through UMMC.

This isn't a problem unique to Genesee County or UMMC. It's common in rural counties across the United States.

For the local patient who needs or wants care with a top-tier specialist, the only option until now has been to drive 30 or 40 minutes to Rochester or Buffalo.

"The care here, unfortunately, and I can say this because I've lived in Genesee County all my life, the care here has been substandard for years," Marsocci said. "I don't mean that disparagingly, but I'm saying, call a spade a spade. When I need care beyond primary care, I travel. I have been in those situations where I used a local specialist and it didn't end positively for me, and I've had those times where I was lucky. But you learn through a couple of experiences and you're not going to do it again, so I go east or west."

The job to be done, then, for Insource, is to connect patients who need specialized service with specialists without making them drive for miles and miles.

Computers, laptops, smartphones, tablets, closed-circuit cameras, LCD screens and the Internet -- all the tools of telemedicine -- means those miles, and the wasted time that goes with them, disappear.

The example Marsocci used was of a patient who came to Insource in early Jully complaining of debilitating back pain.

Initially, the concern was that he had a kidney stone, but a CT scan found a growth on his spine. A surgeon and specialist in spinal problems who will soon be one of Insources subtenants was consulted using telemedicine tools. The doctor confirmed the diagnosis and told Insource to have the patient call him on his mobile phone the next day -- July 4 -- for a follow-up consultation.

Two weeks ago, the patient had surgery to remove the growth.

"If that man had gone to any other urgent care, they would not have wanted to spend any more time on him than they had to," Marsocci said. "If they didn't have access to a CT then they knew they were wasting time on him and not getting paid. They would just want to get him out the door.  He would have to go to the emergency room then, which means he's going to spend a lot of money for something we did perfectly well here."

"It's pretty exciting to say he had surgery probably before he even would have seen the spine surgeon had he went anywhere else," Marsocci added.

All of these improvements -- better access to specialists, lower costs -- just make good business sense.

"Why can't the people in this community have the same level of care as the people in Buffalo or the people in Rochester?" Marsocci asked.

The response from local doctors to Insource, even those associated with UMMC, has been uniformly positive, Marsocci said. Insource refers patients to local doctors and to UMMC on a daily basis. The goal is to get the patient the best treatment possible, and that often means local doctors and local specialists are the best resources for local patients.

And local health care providers have found Insource a valuable resource, even referring patients to Insource, she said.

If all this makes so much sense, why aren't established urgent care companies around the nation providing the same service? Why isn't UMMC?

Mark Celmer

Yesterday, Mark Celmer, president of Insource, spoke with The Batavian's news partner, WBTA, about the lawsuit. Here's what he said.

“I do find it absolutely reprehensible that any member of Genesee County that’s insured by HealthNow can travel 40 miles to Erie County and go to any of 22 urgent care sites and be fully covered for their urgent care visit, but they cannot come to the newest one on Main Street, Batavia. I find that just absolutely reprehensible.”

“I would like HealthNow to say, ‘Genesee County residents: if you want to go to the urgent care center at the Jerome Center, if you want to go the urgent care center in Le Roy, if you want to go to the emergency room at United Memorial, or if you want to go to Insource Urgent Care Center on Main Street, Godspeed, let’s get going.’ ”

As we said, we lack UMMC's perspective on this competitive climate, but we do know about the patterns of disruptive innovation.

In any classic case of disruptor vs. the disrupted, the incumbents either under-value the disruption or feel trapped by their established business model. The incumbent sees no way to extricate itself from its present business model, no matter how threatening the disruptive innovation might be.

Newspapers, for example, have found it difficult to transition to an online news model because higher profits are found in their dead tree editions. 

While it costs less to produce digital news, the revenues are also substantially lower -- The New York Times publisher once said it was like converting print dollars into digital dimes -- and profit margins are slender to nonexistent (especially if newspapers want to maintain their current newsroom cost structure). Even as readers flee from printed newspapers, incumbent publishers are loathe to go to an online-only business model.

It's very difficult for an incumbent to give up a profitable line of business in favor of a business model that means lower revenue and less profit, especially when successful models are few and far between.

Sailing ship builders couldn't do it when the steam engines came along; Detroit couldn't do it when Japanese cars hit the market; mainframe computer makers couldn't do it when personal computers were first being sold; and, Kodak couldn't do it when digital cameras became popular (and Kodak INVENTED the digital camera).

"We're trying to make sense of where everything should be -- lowering costs, improving quality, improving satisfaction, improving access," Marsocci said. "That's where we find ourselves as disruptive innovators. Nobody in the urgent care business wants to spend the amount of time that we did putting together a formal telemedicine program or the way we do things with continuity of care, having subtenant specialists in our center.

"They want the low-hanging fruit," she added. "It can be a very lucrative business, so they want to find a place in a heavy-traffic shopping plaza and just put up a center and see how many patients they can see each day and make as much money as they possibly can. Where we're really focused on what we're preaching. Continuity of care."

NOTE: Early yesterday evening, The Batavian sent an e-mail to Colleen Flynn, spokeswoman for UMMC, and outlined the nature of the article we were writing about the lawsuit and invited UMMC to comment on the topics raised in this article. The Batavian received no response to the e-mail.

Tuesday, July 23, 2013 at 12:49 pm

UMMC begins hosting free cancer support group

post by Billie Owens in announcements, batavia, cancer support group, UMMC

Press release:

United Memorial Medical Center will host a free cancer support group on the last Thursday of each month beginning at 5 p.m. The group will meet in United Memorial’s Healthy Living Department at 211 E. Main St., Batavia.

The group will provide information and support for those who are cancer survivors or have received a cancer diagnosis. In a group setting, individuals can find a warm and caring environment to learn, laugh and heal. Members can find comfort, renewed strength, and receive hope from others who truly understand their unique story and treatment journey.

Men and women who are interested in joining the group should call Healthy Living at 344-5331 to sign up or for more information.

Tuesday, July 23, 2013 at 12:44 pm

Red Cross to conduct blood drive at UMMC -- donors urgently needed

post by Billie Owens in batavia, Red Cross, UMMC

Press release:

The American Red Cross will conduct a blood drive at United Memorial Medical Center from 9 a.m. to 2 p.m. on Monday, July 29. The mobile unit will be in front of the hospital at 127 North St., Batavia.

There is an urgent need for blood donors to offset shortages incurred in summer months and for type O negative donors. Donations in June were down by over 50,000 nationally.

All presenting donors at the blood drive on July 29th will receive a free gift card to Dunkin’ Donuts. Appointments may be made by calling (585) 344-4474. Walk-ins are welcome.

Generally to be eligible to donate, individuals must be 17 years of age or older, healthy and weigh at least 110 pounds. On the day of the donation, the American Red Cross recommends drinking an extra 16 ounce glass of water before and after the donation. They also suggest eating a healthy meal, avoiding high fat foods, before donating.

For the appointment (walk-ins are welcome) bring a driver’s license or two other forms of identification and a list of any current medications. After registration, presenting donors will have their blood pressure, temperature, pulse and hemoglobin measured. They will also be asked for a brief health history and asked about their travels to foreign countries.

The donation process itself usually lasts 8-10 minutes, but can be longer based on the donation. After donating, refreshments are provided. The entire process usually takes less than an hour to complete.

People can donate multiple times but must wait eight weeks/56 days between donations of whole blood.

Friday, June 28, 2013 at 5:39 pm

Photo: New residents join staff at UMMC

post by Howard Owens in batavia, business, UMMC

UMMC welcomed a group of new residents to their team today. All six are training as doctors of osteopathic medicine. They are, from left, Tobin Carson, Adia Taylor, Cedric McKinney, Imeh Sampson Jr., J. Francis Asuquo and Mithun Daniel.

Wednesday, June 12, 2013 at 12:17 pm

UMMC honored for giving newborn baby from Medina a 'Safe Haven'

post by Howard Owens in batavia, busienss, Safe Haven, UMMC

Staff at UMMC were honored this morning for their participation recently in the "Safe Haven" drop off of a newborn baby by a mother in distress.

Timothy Jaccard, president and director of AMT Children of Hope Foundation, and author of the 1996 law that makes Safe Haven possible, presented plaques to the hospital and to staff for UMMC's acceptance of a Safe Haven baby last month.

In late may, a mother contacted Jaccard's organization looking for an option for a baby she could no longer care for. The mother was directed to the Medina Fire Department, which accepted the baby and transported it to UMMC.

The Safe Haven law allows mothers to hand over babies to Safe Haven ambulances and hospitals without any repercussions.

Prior to the law's adoption, Jaccard said, as many as 25 babies a year in New York were being left to die in Dumpsters and along roadways. Last year, only three babies in New York died after being abandoned.

"It’s very rewarding to know that we made a difference in the community," said Maryann Cogdill, who is in charge of the maternity ward.

The baby was given a medical examination to ensure it was healthy and then placed in a foster home and it will eventually be adopted.

Photo: Mary Beth Bowen, VP of nursing, Mark Schoell, CEO of UMMC, Denise Polovick, RN, Jaccard, Cogdill and Dan Ireland, VP of clinical support services.

Friday, May 31, 2013 at 5:16 pm

UMMC urgent care in Le Roy closed for two weeks for plumbing repair

post by Howard Owens in business, Le Roy, UMMC

Press release:

For the next two weeks, the lower suite of the building at 8745 Lake Street Road, Le Roy, which houses United Memorial’s Urgent Care and Diagnostic Services, will be undergoing extensive and disruptive repairs to its plumbing systems. After several discussions with the building’s owner, United Memorial feels that it is in the best interest and safety of our patients to temporarily close during this period.

During this time, patients are encouraged to utilize Urgent Care and Diagnostic Lab and Imaging Services at the Jerome Center at 16 Bank St., Batavia. Staffing at the Jerome Center will be enhanced to accommodate the expected increase in patient volumes.

United Memorial’s integrated computer system will allow any patient with standing orders for diagnostic laboratory or medical imaging, usually seen in Le Roy, to be seen at the Jerome Center without having to have orders resent from physician offices.

The Jerome Center is located in the center of Downtown Batavia. From Le Roy, take Route 5 (Main Street) to Batavia. Turn right onto Bank Street. The Jerome Center will be located on the right. Hours for Urgent Care are 11 a.m. to 8:30 p.m., Monday through Friday and 9 a.m. to 8:30 p.m. on weekends. Laboratory and Medical Imaging services are available 6 a.m. to 5 p.m. Monday through Friday and 6 a.m. to noon on Saturdays.

We apologize for any inconvenience and expect to reopen the Le Roy site on Monday, June 17.

Thursday, May 30, 2013 at 12:01 pm

UMMC unveils upgraded maternity unit

post by Howard Owens in batavia, business, UMMC

UMMC officially opened it's new postpartum maternity unit Wednesday. The unit features 10 private patient rooms, which include sleeping accomodations for a birth partner. The project cost $2 million.

Photo and information via The Batavian's news partner, WBTA.

Wednesday, May 29, 2013 at 1:20 pm

UMMC unveils its newly renovated postpartum Maternity Unit this afternoon

post by Billie Owens in batavia, business, UMMC

Press release:

United Memorial Medical Center will conduct a brief ribbon-cutting ceremony to mark the completion of major renovations to the postpartum Maternity Unit at 4:30 p.m. today (May 29). The ceremony will be held on the fourth floor of the Hospital at 127 North St., Batavia.

United Memorial’s Maternity Renovation Project was a $2 million reinvestment into the Hospital facility to create 10 private postpartum patient rooms with private bathrooms and sleeping accommodations for the birth partner. Also included in the project is a family lounge area, Nurses’ Station, visitor restrooms, storage and office areas and improvements to the Nursery. The United Memorial Medical Center League pledged $100,000 to the project over four years.

The postpartum maternity wing on the fourth floor was closed in November 2012 for demolition and construction. Postpartum was temporarily moved to a closed unit on the second floor for the duration of the renovation. Patients will be placed on the new unit following a final cleaning later this week.

Last year, there were 653 babies delivered at United Memorial; an increase of more than 20 percent from 2011. To assure healthy women and babies, United Memorial Medical Center provides an array of services to women in our area. They include obstetrical and gynecological services at the Women’s Care centers in Medina and Batavia, childbirth education classes, nutrition counseling and lactation support services; as well as the MOMS program, which assists uninsured pregnant women with prenatal care. Diagnostic testing for bone density, 3D/4D ultrasound and digital mammography are also available.

For the Maternity Renovation Project, architectural services were provided by Clark Patterson Lee and construction management was under the direction of Manning Squires Hennig.

The public is invited to attend today's ceremony. Tours will be available until 7 p.m. Light refreshments provided.

Tuesday, May 7, 2013 at 1:44 pm

UMMC receives surgical care award

post by Howard Owens in batavia, business, UMMC

Press release:

On April 29, 2013, Univera Healthcare presented United Memorial with an award recognizing the greatest improvement in Surgical Care Improvement Project (SCIP) Measures for the 2012 Hospital Performance Incentive Program (HPIP) Measurement period for the Western New York region. Daniel Ireland, COO and VP of Support Services accepted the award on behalf of United Memorial at the annual HPIP Quality Forum.

The Surgical Care Improvement Project (SCIP) is a national quality partnership of organizations interested in improving surgical care by significantly reducing surgical complications.

United Memorial was selected for this prestigious award out of participating HPIP hospitals in Western New York because it improved its Surgical Quality of Care Composite score from 91.53% to 95.87%. The composite measures the organization’s effectiveness in implementing eight evidence based measures in Surgical Care Improvement. Such measures include use of Beta-Blocker therapy during surgery when indicated; use of preventative antibiotics in a timely manner and discontinuance of those antibiotics at the appropriate time; urinary catheter removal promptly following surgery (within the first two days from the date of surgery); use of venous thromboembolism prevention strategies on all surgical patients when indicated; and others.

United Memorial increased this composite score over a period of one year through multiple strategies including physician engagement, staff education, and standardization of clinical practices. This award follows closely on the opening of the new Surgical Center in 2011 which provided state-of-the-art surgical facilities and processes to the Genesee County region.

“Participation in initiatives to improve quality of care demonstrates United Memorial’s commitment to continuously improve the healthcare of our community,” stated CEO Mark Schoell. “It furthers our promise of delivering quality care, right at home.”

Friday, May 3, 2013 at 2:11 pm

UMMC recognizes volunteers at annual awards dinner

post by Howard Owens in announcements, batavia, business, UMMC

Press release:

United Memorial Medical Center held a dinner on May 2, 2013 at Bohn’s restaurant to recognize volunteer service within the organization. Their gifts of time were spent filing records in Human Resources, assisting visitors, comforting family members waiting for a loved one in surgery, stuffing envelopes in the Foundation, helping patients on Hope Haven, serving coffee at the refreshment kiosks at the Hospital and at the Jerome Center, and helping someone choose just the right item in the gift shop.

Their dedication and compassion assists United Memorial in caring for patients and visitors every day. Volunteers are part of our team and part of our UMMC family. We depend on them and turn to them when we need a helping hand with a daily task or need their input on a large project.

Each year, United Memorial and our auxiliaries, the UMMC League and St. Jerome Guild, Inc. honor volunteers who have reached milestones in the cumulative number of hours they have volunteered. This year Guild members Priscilla Dirisio, Jean Havens and Rosemarie Monachino received pins commemorating 100 hours of service. Debbie Pellegrino, Marge Rimmer, Judy Thrasher, and Fran Wigton were honored for 1,000 hours; Betty Luperino received her 2,000 hour pin; and Mary Grace Demarse was honored for 3,000 hours.

Dorothy Baker, the 2011 Genesee County Health and Humanitarian honoree, received her 20,000 hour pin; the equivalent of more than 10 years of full time employment. Dorothy volunteers at the Jerome Center Gift Shop and Refreshment Kiosk and organizes the annual poinsettia and spring flower sales.

League members who were honored include Kathy Hoerbelt and Norma Meyers for 300 hours; Lil Irrera and Carol Smith for 500 hours; Anne Barone and Tim Weatherbee received pins for 700 hours; Doris Lindebauer reached the 1,000 hour milestone; Kay Benton the 1,500 hour; and Linda Pembroke, 3,500.

Augustine Fleming, has volunteered at United Memorial’s Hope Haven unit for over 7,000 hours. Her dedicated volunteer hours to patients recovering from addiction would equal nearly four years of full time employment.

Last year, 79 individuals volunteered 14,689 hours to United Memorial; over 20 months of time compressed into one year.   United Memorial measures the time they have donated since their true gifts of compassion, empathy and care they each bring to the lives of our patients, visitors and colleagues is immeasurable.

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