A Bottom-Line Diagnosis

A Bottom-Line Diagnosis

Martha Sylvia, PhD, MBA, RN, calls herself an “interdisciplinarian,” bringing together her nursing and business education, public health influence, and DNP expertise to translate the best evidence into practice.

Heck, she wrote the textbook on it: Clinical Analytics and Data Management for the DNP. Sylvia’s South Carolina company, ForestVue Healthcare Solutions, works with providers who are challenged to straighten out the bottom line while streamlining patient care.

 The doctorally prepared Sylvia is eminently and perhaps overly qualified to diagnose a provider’s problems and offer recommendations for survival in a value-based care system, a model in which such providers are paid based on patient outcomes rather than simply services performed. It is a more holistic approach, and one that Sylvia believes in wholeheartedly. But it upends established ways of doing business. Providers must adapt or vanish.

“Especially now on the provider side or the health care delivery side, revenue is at risk,” explains Sylvia. “It is a whole different paradigm on how you survive and thrive as a health care delivery organization. When you think about, ‘My revenue is no longer fully coming from the amount of services I provide. It is coming from how I provide care and the ways in which I can assess what patients need and link them to what the care they need, but no more and no less.’ What you’re talking about is efficiency. They have limited resources. ‘How do I spend them wisely?’ ”

Sylvia credits her mentors at JHSON, and particularly Professor Emerita Kathi White, with cementing her love of data, analytics, and population health management. It was while she earned an MSN/MBA that “I really began to put together my understanding of the business of health care with my clinical understanding of care delivery as a nurse.”

White helped Sylvia get an internship as the first-ever data analyst in the Care Management Department at Johns Hopkins HealthCare, “doing the stuff I was learning in her class. That was amazing. And that’s where I really started to latch on to doing this work.” Other mentors at JHSON and the Bloomberg School of Public Health “helped me understand what it means to deliver care or design interventions for large groups of people, and to do that ethically and in a way that is true to our principles as nurses. I carry that with me always.”

After her PhD, Sylvia joined the JHSON faculty while keeping up her clinical work. “I never thought I would leave Johns Hopkins, but then an opportunity in Charleston, SC, came up that I was really excited about. I thought it might be time to spread my wings, to try something different, and personally, for a move closer to the ocean.” The position, as a director of population health and analytics at the Medical University of South Carolina, was a great springboard to spreading her wings. She loved Charleston, and from there she began working with health care organizations “pushing the agenda of value-based care” in population health management. Soon, Sylvia decided to start her own company. “That first year as an entrepreneur and starting your own business is kind of scary,” she admits. “I thought, ‘Well, I can do this for a year and see how it works out.’ That was 2017.”

Her services at first consisted of consulting only as Sylvia began developing a “roadmap” for struggling companies as ForestVue’s own roadmap took shape. She added products and services as she went, “driven by where people are at in their journey to value-based care and moving them incrementally along.”

Again, this is where her nursing skills—listening and understanding as well as data analysis—became crucial. “It’s difficult to get people to understand if they’re not ready for it. The magic happens when they are ready for it, and open to it, and we do this process together.”

“I pull from everything I ever learned as a nurse.”

In her faculty role, she guides students who are working to provide care within the pockets of need throughout her state. “South Carolina has some of the highest health disparities in the country and our students work diligently to address this need through their DNP projects, improving care in the settings where people live and seek healthcare.” My role is to guide students so that they can implement the best systems to improve health disparities. In some ways, addressing health disparities in Baltimore and the Johns Hopkins Medical Campus was different but just as challenging. “I still feel very connected to Baltimore,” Sylvia says. “It will always have a special place in my heart.”

As for her DNP book, Sylvia says she decided to write the textbook as she observed nursing executives in the field shying away from difficult discussions about finances and the business of healthcare for lack of confidence and experience in those areas. She likened situations she observed to “a nurse receiving a list of patients from the business to put on their case load. The business says, ‘Here are the highest-cost patients.’ Nurses say, ‘They might be the highest cost, but the intervention may not be right for them.’ ”

“Seeing that nurses needed the language and the confidence to challenge that paradigm, to have those conversations, building  confidence around data and analytics was needed”  

Sylvia has since written a second book, Population Health Analytics, which “brings it all together” for a broader health care audience without watering down the impact of the DNP textbook.

Meanwhile, work continues to find her and ForestVue, says Sylvia, also an associate professor at the Medical University of South Carolina.

When it all gets to be too much—and even when it doesn’t, truth be told—Sylvia and her husband board their cruising trawler, the Bonnie Doon. “We can be on the water all year round. We are always out on our boat on the Charleston waterways, in nature, loving the wildlife, being out there as much as we can.”

The boat is named for an idyllic Australian village at the heart of the film The Castle. Sylvia and her husband have never been there. They love the idea of a little paradise a half a world away, but the data and analytics don’t lie: Why go there when Charleston is right here? — Steve St. Angelo

Click here to learn more about the programs at the Johns Hopkins School of Nursing.

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