The Case for Care Transformation

Albert Einstein is credited with a pithy definition that insanity is: “Doing the same thing over and over again and expecting different results.” By that definition, the U.S. health care system has been on an “insane” path for too long. Our fee-for-service payment model has rewarded volume of services over high-quality, coordinated care for decades. The results we get, year after year, are skyrocketing costs totaling $3.8 trillion in spending in 2019 with a growth trajectory to reaching $6.0 trillion by 2027[1]. To put this in perspective, If the U.S. health care were its own country, it would be the 4th largest economy in the world.

We don’t get much for our spending either. We have the 55th highest infant mortality in the world (tied with Serbia)[2], our life expectancy ranks 43rd in the world[1], and we are nearly 3 times more likely to die of coronary heart disease than someone in South Korea.[3]

Perhaps finally taking heed of the famous Einstein quote, policy makers, payers, providers and patients are now looking to do things differently. These efforts are embodied in the concept of care transformation. Care transformation has become a favorite talking point and shared aspiration for a range of health care organizations. In fact, new Chief Clinical Transformation Officer roles are popping up at provider and payer organizations around the country, including organizations such as the Cleveland Clinic and Horizon Blue Cross Blue Shield of NJ.

But what exactly does care transformation actually mean?

I have the chance to see our health care system through multiple lenses, as a researcher, a physician, a father, a patient, and a business owner. In each of these roles, my view of care transformation is pretty straightforward: Care will be transformed when we offer consistent, evidence-based care that achieves the best possible outcomes at the lowest possible cost.

The clear conclusion from my health economics research, done around the world, is that health systems delivering consistent, evidence-based care deliver the highest value care to patients. Access to evidence-based care supported by the best available science is what drives the best outcomes when I see patients in the clinic. Consistently high-quality care is what I hope I receive when my children or I need medical attention. And avoiding low-value, high-cost services are key to keeping premiums low so I’m able to invest in my employees and product.

Care transformation through consistent, evidence-based care can only become a reality when we address what I consider to be a preventable national health crisis – unwarranted care variation. For too many years, we have been working under the same old incentives and training protocols that lead to a wide range of medical practices for the same conditions. This variation, we and others have shown clearly, can’t be explained by the severity of illness or patient preferences. This unwarranted variation is routinely observed between states, zip codes, and even between providers in the same facility.

For example, those visiting a bottom decile hospital more than double their chances of dying compared to a top decile hospital[4]. The incidence of central venous catheter blood stream infection is nearly 20 times higher at a bottom decile hospital[3]. Someone in Idaho Falls is three times more likely to undergo knee replacement surgery than a patient in the Bronx[5].

Variation like this negatively affects outcomes, experience and cost. We can all agree that where you live or which doctor you happen to see should never dictate the level or type of care received, yet the stories of care disparity are endless.

Our research and work in the U.S. indicate that most of this variation is avoidable. While evidence-based guidelines do not cover every potential clinical scenario, there is overwhelming evidence that high-quality guidelines across many common conditions are under-utilized by well-meaning, hardworking, busy clinicians struggling to keep up with the latest guidelines. Collectively, the decisions these providers make every day influence a staggering 80% of all health care spending[6].

There are a number of tools today that seek to address unwarranted variation, such as quality dashboards, EHR clinical decision support and changing incentive models. However, most of these tools have struggled to transform practice at scale through more consistent care. The missing piece, in my opinion, is true clinical collaboration with physicians in this care transformation journey.

Medicine is hard and any attempt to truly transform care, to do things differently, must actively engage providers on the front lines and arm them with the training and tools they need to make the best, most evidence-based decision they can for every patient they see. This is an essential part of getting the different results – high quality, high value – that unites these care transformation efforts.

Whether you have Clinical Transformation in your job title or not, reducing unwarranted variation will be critical to successful care transformation and to succeeding in the new value-based models, such as ACOs and capitated payments, that seek to reward organizations that do things differently to get different results.

If we can successfully bring consistency back to care and reduce unwarranted variance, we will all benefit through higher quality, better outcomes and lower costs.


[1] National Health Expenditure Projections 2018-2027,, Accessed February 2020.

[2] CIA World Fact Book,, Accessed February 2020.

[3] World Health Organization, Age Adjusted Death Rate Estimates: 2017

[4] Rosenberg BL, Kellar JA, Labno A, et al. Quantifying Geographic Variation in Health Care Outcomes in the United States before and after Risk-Adjustment. Plos One. 2016;11(12). doi:10.1371/journal.pone.0166762

[5] The data was obtained from The Dartmouth Atlas, which is funded by the Robert Wood Johnson Foundation and the Dartmouth Clinical and Translational Science Institute, under award number UL1TR001086 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH).

[6] Crosson FJ. Change the microenvironment. Delivery system reform essential to control costs. Mod Healthc. 2009;39(17):20–21.


About The Author

Employee Spotlight: Honey Holman

As a nursing education specialist with Ascend business ATI Nursing Education, Honey Holman creates and revises content for exams, practice exams, tutorials and video scripts for nursing students. The NCLEX test (which students must pass to become a practicing nurse) is updated every three years and many of ATI’s products are updated on the same schedule to help learners and educators stay current with references and practices. Honey also keeps her team’s handbook updated for common processes and tasks, and trains consultants who assist with item review.

When she’s not working, you can find Honey spending time with her family – especially during family nights at her house, which consist of board games, movies and themed meals. She’s also involved with her church and helps with leading and serving there.

Q. What does an average day look like for you and your job?

A. Currently I am helping lead the update of our nursing Skills product. This product includes learning material and videos focused on skills general nurses need to perform on the job, such as inserting and caring for intravenous lines, feeding tubes, vital sign assessment, and airway and oxygen management. Beyond this project, my typical day is split between writing items or learning content and reviewing created content, including meeting other nurse and test developer colleagues to prepare assessments. Essentially, our team produces the “meat” for all the content across our products that nursing students will use.

Q. What is your favorite thing about the business unit or department you support?

A. Our team of nurses is brilliant. We all have different areas of expertise from our varied practice backgrounds. We have good relationships and can collaborate with each other when we need a second opinion or to gain the advice of a peer who has more experience in a certain aspect of nursing.

Q. As a follow up, what is one word that you would use to describe your work team?

A. Resilient. We balance each other well with varied personalities and expertise, and there is a deep commitment to the team. When you practice nursing in a clinical setting, covering each other’s breaks and taking extra shifts when a team member is down becomes second nature and so we apply the same care in this working environment. We work together well and there is great give and take that keeps us moving forward no matter what professional or personal difficulties come up.

Q. What’s the best thing about the city you live in?

A, We live in a small town in Alabama that is also home to the country singing group Alabama, who kindly built a really nice park with a walking trail and exercise equipment where my daughters love to play. We enjoy town parades, festivals and fairs that all give it that nice, homey small-town charm. We also have access to the mountains, and it’s far enough north that we get to experience all four true seasons each year.



Jones & Bartlett Learning Offers Free Online Educational Resource for Mechanical Ventilation Clinicians

In response to the COVID-19 pandemic, Jones and Bartlett Learning announced that they will be providing Essentials of Mechanical Ventilation, a free online educational resource for clinicians as well as important information regarding the more common ventilators they may encounter in hospitals today.

In continued response to the COVID-19 pandemic and the on-going need for mechanical ventilation, Jones and Bartlett Learning, an Ascend Learning Company, announced today that they will be providing Essentials of Mechanical Ventilation, a free online educational resource for clinicians, which outlines the initiation and adjustment of ventilator support, as well as important information regarding the more common ventilators they may encounter in hospitals today.

“As we continue to live in a new reality amongst COVID-19 we thank those in the medical field fighting day and night aiding those in need and advancing our knowledge of the disease” said Cathy Esperti, Director of Product Management, Jones & Bartlett Learning. “We are hopeful that this resource will assist them in the field as they work with COVID-19 patients.”

Essentials of Mechanical Ventilation is a product associated with the award winning text Mechanical Ventilation by David C. Shelledy, PhD, RRT, RPFT, FAARC, FASAHP and Jay I. Peters, MD. The comprehensive guide covers the evaluation and management of critically ill patients requiring mechanical ventilatory support, techniques, and procedures for providing safe and effective mechanical ventilation. This online resource will provide clinicians essential information on when to start a patient on a ventilator and how to initiate and adjust ventilation. Essentials of Mechanical Ventilation also includes a Comprehensive Mechanical Ventilation Synopsis Deck, comprised of 1000 slides in PowerPoint™ format, which provides an overview of various ventilator types arranged by Critical Care Ventilators; High-Frequency Ventilators; Portable, Transport, and Non-invasive Ventilators; and Neonatal Ventilators. Jones and Bartlett Learning also offers a full Respiratory Care Curriculum providing robust resources for hospitals, clinicians, and educators.

“In this era of the COVID-19 pandemic, mechanical ventilation can be a lifesaving intervention when applied properly by skilled clinicians,” said Shelledy. “I am delighted that Jones & Bartlett has made these detailed and up-to-date training materials available to the outstanding clinicians caring for critically ill patients in the ICUs and emergency departments of our hospitals. I hope the materials are useful to them as they seek to provide the very best care to their patients. Godspeed and stay safe!”

About Jones & Bartlett Learning
Jones & Bartlett Learning is a world-leading provider of instructional, assessment, and learning-performance management solutions for the secondary education, post-secondary education, and professional markets. Jones & Bartlett Learning develops educational programs and services that improve learning outcomes and enhance student achievement by combining authoritative content written by respected authors with innovative, proven, and engaging technology applications that meet the diverse needs of today’s instructors, students, and professionals. Learn more at

Ascend Learning Clinical Healthcare offers complimentary access to suite of innovative virtual training and simulated case study exercises

LEAWOOD, Kan.April 27, 2020 /PRNewswire/ — As higher education institutions continue to operate in the world of online learning, students in healthcare fields, like others, are being asked to sharpen professional skills and fulfill practice requirements in non-traditional ways.

To facilitate healthcare professional and student success, Ascend Learning Clinical Healthcare is launching a suite of complimentary, evidence-based clinical training simulations developed by Ascend Learning sister organizations. This series of effective, scalable and data-driven solutions will be available free of charge through May 15.

Insight to Action solutions use assessments and simulated case studies to develop and hone professional skills, specifically around adherence to accepted care guidelines. An up-front baseline assessment helps participants understand their level of knowledge and proficiency, and is followed by a series of short, interactive, practice-focused clinical vignettes, where they are given real-time performance feedback on their care decisions. Participants can see how their care compares to the guidelines and compete with their peers for the top evidence-based scores. Insight to Action, powered by QURE, complimentary case studies include:

  • Opioid Use
  • Low Back Pain

Kognito solutions use evidence-based patient simulations, enabling participants to virtually engage in role-playing conversations with AI-powered virtual humans. Through practice and receiving personalized feedback in a safe environment that is as close as possible to real life, healthcare professionals become adept at leading conversations and patient encounters. Kognito complimentary modules include:

  • Motivational Interviewing Techniques
  • Antibiotics Stewardship
  • Mental Health Risk

NHA TEAM Based Care™ solutions, designed for all members of the care team with modules particularly focused on those working in the clinic environment, deliver a foundational knowledge of a patient-centered care model. Understanding the what, why, and how behind this model of care can benefit early-stage professionals in starting their medical career. TEAM Based Care™ complimentary modules include:

  • Population Health Management
  • Teamwork and Care Coordination
  • Methods and Techniques for putting TEAM-Based Care into Practice

“As we all navigate this ‘new normal,’ it’s more important than ever to successfully leverage the latest learning technologies, particularly in the world of healthcare,” said Dr. Nathan Walts, Vice President, Product Strategy, Ascend Learning Clinical Healthcare. “As a healthcare education innovator, it’s in our mission, especially in today’s current crisis, to ensure access to these best-practice and evidence-based tools. We have been deliberate in selecting areas of care that cross all sectors of healthcare and providing opportunities for a variety of professionals to improve their skills and ultimately patient outcomes in these areas.”

Learn more at

SOURCE Ascend Learning Clinical Healthcare

5-7-5 Haikus from Home

Creativity abounds at Ascend! We recently challenged employees to submit haiku poems to share how they feel about working from home, and a panel of judges selected three winning poems. With almost 50 thoughtful, inspiring and humorous submissions, below is a selection of poems for all to enjoy.  


a capella notes
bark, cry, school zoom, laughs and sighs
work’s new symphony 


Let’s shelter in place
Ah, we’re in it together
Pray, count your blessings 


Sipping warm coffee
Sun shining through my window
countless days start 


Bath time for toddler.
So I can send one e-mail.
New normal is hard. 


Storm rages outside
Tornado of children in
Hover over mute 


Tapping of keyboard
Plays counterpoint to kids songs
Blessed be headphones 


I can’t find my phone
Ring, RING, where the RING is it
Found under the cat 


Believe me today
Tomorrow will be better
Have faith in people 


What even are jeans?
The freedom is so breezy.
I will miss PJs. 


dogs snoring softly.
so many books read! I try
to savor small joys. 


I don’t know what’s next
Hindsight is Twenty/Twenty
Wish this year was too 


A private office
Calls by video, fun pants
Am I Tiger King? 


Plans for the weekend
thousand piece puzzle waits
I need a stiff drink! 


Challenge accepted
Changing lives every day still
Together we win 


birds on my window,
national guard on my block,
sushi on my mind … 


Miss my Finance peeps
Friday Zoom I cannot wait
Online Happy Hour! 


I apologize 
for anything odd, my cat
is on the keyboard 


Hygiene rules have changed
Washed my hands five-hundred times
Laundry? Meh…next week 


My name is Becky
And I love working from home
Anyone agree? 


If you can’t go out
Open the windows and doors
Let the outside in 


We’re in the midst of some true creative writers and are always creating ways for team members to connect virtually during this time. Think about what haiku describes your life right now, and stay safe! 




Chamberlain University and Ascend Learning launch course to help nurses prepare for COVID-19 care

Chamberlain University partners with Ascend Learning’s ATI Nursing Education business to offer a free course in acute care

CHICAGO–(BUSINESS WIRE)–As healthcare organizations continue to respond to the COVID-19 pandemic, hospitals and clinics are calling on nurses from all specialties to fill this critical need. To help those practitioners prepare for direct acute patient care, Chamberlain University, in partnership with Ascend Learning, is offering a free online course for all licensed registered nurses.

“As the COVID-19 pandemic sweeps the country, I am in awe of the nursing community as it steps forward in the face of crisis,” said Karen Cox, Ph.D., RN, FACHE, FAAN, president of Chamberlain University. “Nurses who haven’t practiced in acute care recently want to jump in, and hospital leaders want to equip all of their nurses to work on the front lines. As a nurse and an educator, I am honored to assist these healthcare workers in the face of a crisis.”

Acute Care Readiness is a review course that is not for academic credit. It covers the knowledge and skills nurses need to help them return to safe clinical practice in acute care settings. These skills include patient assessments, medication administration and complex acute care procedures. Ascend Learning will partner with Chamberlain University to provide online educational expertise.

“As the need and call for more qualified frontline nurses continues to grow, we want to help. We are thankful we can offer free resources to support these courageous and selfless healthcare workers through our ATI Nursing Education solutions as they sharpen their critical care skills and respond to the call to help save lives,” said Ascend Learning CEO, Greg Sebasky.

Licensed RNs who may have been working in ambulatory care, long-term care or in non-acute care roles as advanced practice registered nurses (APRNs) would benefit from this course. To learn more about the Acute Care Readiness course, contact Chamberlain University’s director of professional development at [email protected].

This partnership responds to the demand for acute care skills in the U.S. at scale in a manner that can be impactful. This is aligned with Chamberlain University’s parent company, Adtalem Global Education, in its mission to provide workforce solutions and make positive contributions to the global healthcare community. According to the U.S. Department of Education’s most recently published data, Adtalem, through its affiliated schools of Chamberlain University, American University of the Caribbean School of Medicine and Ross University School of Medicine, educates and graduates more doctors and nursing professionals than any other individual school in the U.S. Ascend Learning’s ATI Nursing Education business is a leading provider of online instruction for nursing schools across the United States with 98% of nurse educators naming it a leader in the nursing education industry and 93% claiming ATI’s solutions improved their students’ ability to perform as a new nurse, according to a 2019 research solutions survey.

About Chamberlain University

Chamberlain University is a part of Adtalem Global Education (NYSE: ATGE). Chamberlain University’s mission is to educate, empower and embolden diverse healthcare professionals who advance the health of people, families, communities and nations. Chamberlain University is comprised of the College of Nursing, which offers a three-year Bachelor of Science in Nursing degree program and flexible post-licensure programs such as the RN to BSN online option, Master of Science in Nursing degree program, Doctor of Nursing Practice degree program and graduate certificates, and the College of Health Professions, which offers a Master of Public Health and Master of Social Work degree programs. Chamberlain University is accredited by the Higher Learning Commission, a regional accreditation agency recognized by the U.S. Department of Education. For the most updated accreditation information, visit To learn more, visit

About Adtalem Global Education

The purpose of Adtalem Global Education is to empower students to achieve their goals, find success, and make inspiring contributions to our global community. Adtalem Global Education Inc. (NYSE: ATGE; member S&P MidCap 400 Index) is a leading global education provider and the parent organization of Adtalem Educacional do Brasil (IBMEC, Damásio and Wyden institutions), American University of the Caribbean School of Medicine, Association of Certified Anti-Money Laundering Specialists, Becker Professional Education, Chamberlain University, EduPristine, Ross University School of Medicine and Ross University School of Veterinary Medicine. For more information, please visit and follow us on Twitter (@adtalemglobal) and LinkedIn.

Employee Spotlight: Rob Eredini

As a sales director at Ascend business unit ExamFX, Rob Eredini leads a team of five account managers. His team’s clients are primarily B2B organizations in the insurance and financial industry. He works with his team to implement strategies aimed at strengthening partnerships, growing, and gaining market share within the assigned organizations as well as exploring new opportunities. Every day, Rob’s schedule varies with a mix of 1:1 meetings with his direct reports, strategizing with leadership, collaboration with other departments, and interaction with clients and organizations. When the workday ends, you can find him golfing, grilling and spending time with family.

Q. What have you gained from working at Ascend?

A. I have gained a tremendous amount of knowledge and experience. I have really been guided by our values both professionally and personally. I’ve also developed a ton of friendships.

Q. What’s the greatest piece of advice a mentor has given you?

A. Always try to put yourselves in your client’s shoes. Whether you agree or disagree, you are a much more effective partner if you understand their perspective.

Q. What is one career lesson you’ve learned?

A. Be passionate about what you do. It makes the challenging days tolerable and the good days great. This also makes “passionate” my favorite Ascend value.

Q. What is one goal that you plan to accomplish during your adult lifetime?

A. I hope to visit every baseball stadium.

Q. What’s the best thing about the city you live in?

A. I feel like most times I say I live in Austin, Texas, people have something good to say. The food, the atmosphere, and the people are all top notch. I could do without the heat, though!

Employee Spotlight: Maxwell Dziku

As an instructional designer for MedHub, Maxwell Dziku’s goal is to help people learn better by providing the right tools and resources. As part of his role, he creates learning content and tools for training users of two different platforms (e*Value and MedHub). In addition, he’s also a Walkme solution builder for a new platform and develops Smart Walk-Thrus that offer on-screen step-by-step guidance for users on the platform.

When he’s not at work, Maxwell enjoys spending time with his kids (especially at the park), traveling with family, taking pictures and unwinding with a good novel.

Q. What does an average day look like for you and your job?

A. Depending on the project I am working on at the time, I might be working with a SME (subject matter expert) to obtain or update content, and going through any of the stages of the ADDIE (analysis, design, develop, implement, evaluate) model we use for content development. I might also be in a team meeting or working through projects.

Q. Before working at Ascend, what was the most unusual or interesting job you’ve ever had?

A. I did some missionary work in Ghana where we focused on affordable and transformative education and community building. I also worked at another company for a year or so as a content ingest developer where I built web harvest robots that crawled people’s websites.

Q. What is one goal that you plan to accomplish during your adult lifetime?

A. I would love to travel the world and capture memories with my family. Top on my list are the following: 1. Israel 2. Morocco 3. Kenya 3. Europe….

Q. What’s your favorite Ascend value and why?

A. Embrace Change- I think change is essential in order for any individual or organization to thrive and have fulfillment.


Employee Spotlight: Merideth Tumasz

As a relationship manager for Ascend (primarily supporting Ascend’s Professional Education group), Merideth Tumasz’s primary goal is to support all functional groups, helping them solve the company’s biggest problems. She does this by working with other departments and business units to understand their needs and processes, and what support or resources they need to work more efficiently. Merideth is heavily involved with pipeline planning and awareness, as well as keeping up-to-date on processes and resources all the teams offer. She especially enjoys getting to interact and work with so many different people and departments.

Outside of work, Merideth enjoys hiking with her dog Yogi, being outside, playing floor hockey and watching the Boston Bruins. She also enjoys traveling and photography.

Q. What does an average day look like for you and your job?

A. My day is typically filled with a variety of meetings, which I love. I run status meetings to understand when products will hit the market, attend meetings to help improve workflows and cross-department interactions, and have check-ins with departments and other business units to understand needs and maintain strong communication.

Q. What have you gained from working at Ascend?

A. I’ve gained a plethora of business knowledge and strong relationships from working at Ascend. Everyone welcomes conversation and the open-door policy is such a wonderful aspect of our company. I learn so much about how people work and what our company does from casual conversations that I’ve learned to appreciate the informal meetings just as much as the formal ones.

Q. What’s the greatest piece of advice a mentor has given you?

A. It’s nearly impossible to do anything 100% correctly. Any mis-step should be seen as a learning opportunity and gives you a chance to improve in the future. I’m typically my harshest critic, so understanding that I will not always get it right on the first try (or second, or third) has been really eye-opening for me.

Q. What is one thing that people are surprised to find out about you?

A. I am heavily involved with FIRST and VEX Robotics even though I do not have a STEM background. I have participated in these programs since middle school, and now I volunteer at events all over New England. Last year I was an announcer at VEX Robotics World Championships.

Q. What’s one thing you love that everyone else seems to dislike?

A. I love helping people move! I’ve moved people to Colorado, North Carolina, D.C., Buffalo, as well as local moves across New England. I think I have wires crossed in my brain, but lifting boxes and setting up furniture is such a blast for me.



Employee Spotlight: Kevin Reber

Kevin Reber, team member at Ascend’s National Academy of Sports Medicine (NASM) and Athletics and Fitness Association of America (AFAA), works as the director of retail sales out of the Gilbert, Arizona office. Day-to-day, Kevin’s role is to assist his team in helping others realize their dream of becoming a personal trainer or group fitness instructor. In his four years at Ascend, he believes he has gained appreciation for what a strong culture can do to drive a team’s performance. Kevin enjoys spending his free time golfing, playing ice hockey, hiking and watching his kids play sports.

Q. What’s your favorite Ascend value and why?

A. Passionate – As I have interacted with many employees across Ascend, they are all passionate about the customers we serve. As leaders, we can train people in a lot of different aspects of the job, however, passion has to come from within and it is great to see how well we recruit individuals who bring that passion with them.

Q. What is your favorite thing about the business unit or department you support?

A. I love the culture! Our staff never gives up and is always striving to exceed goals and break records. Our sales staff continually works as a team and never quits!

Q. If you could have a completely different career for a week, what would it be and why?

A. Selling private jets. I love selling and I love flying, so it would be the best of both worlds.