Becker's Hospital Review

Becker's Hospital Review CEO Strategy Roundtable There are few physicians who are going to see those patients. Now you tell a person they have coverage, but no one will take them. So now they will come to our ER, which is the most expensive place to receive care. We have a residency clinic adjacent to the ER, so we have a place to send them for follow-up visits even if the patients do [end up] in our ER. Lynn Nicholas: We saw a big influx of volume in our ERs in Massachusetts [after enacting statewide healthcare reform]. It wasn't Medicaid patients, but people who had coverage for the first time. It was mostly young people who didn't have primary care physicians. Hospitals weren't hurt too badly because they had coverage, [but] it wasn't great payment, because many picked bronze plans. Alan Channing: By way of framing it, we are also a safety-net hospital. We recently took on [Holy Cross Hospital], about five miles away on the west side of Chicago, where there were a million and a half people in our overlapping service area. Medicaid is 60 percent of our business, and our uninsured is 15 percent. So we like healthcare reform. Larry Goldberg:  There are some things you endure and you take a loss on. There's a bigger fundamental issue here. It's somewhat political. All this stuff is incremental. The big issue, in Chicago, is we're 40 percent overbedded. We don't let hospitals close. Rates need to be rationalized, but then what happens when places can't afford to exist? We keep perpetuating this. Russell Sullivan:  The ACA is going to stay in place for the next three years. There will be some changes [via] executive order. The environment for legislating changes in the healthcare space is toxic right now. The terms of the ACA were premised on the fact that 50 states would take Medicaid expansion. Many millions of people would sign on for insurance. The legislation did not include adjustments if those assumptions did not come to fruition. On innovation Catherine Jacobson: We sponsor the largest multisystem ACO in Wisconsin with the largest number of lives under management — Quality Health Solutions. We have five separate independent health systems and the Medical College of Wisconsin. We are clinically integrated, so we can represent ourselves to the market. We just received a shared savings contract from UnitedHealthcare. It took about three years to put all that together. We're very proud of what we've been able to achieve. Larry Goldberg:  We're doing lots of things and positioning, but the biggest message I'm trying to send is, "Let's focus on fundamentals." There's a lot of noise and anxiety and projects and experiments happening, but it's…about the patient experience. It is quality. It is access. It is getting our cost structure in line. Stick to the fundamentals. Our quality scores, financial performance, patient satisfaction scores — none of that was impacted by this outside noise. Keep the focus on doing the right thing. What's all this stuff about? This is what we should have been doing before. We can overcomplicate this. Michael Sachs:  We need to reimagine what the service is [at hospitals]. It doesn't mean coming to see a physician, getting a test scheduled three days later and getting a report seven days later. That's not service. The patient should come in, get a diagnosis, get a treatment plan and treatment should begin. Every [pause] in the care process costs money and outcomes. When we reorganize and take time out of the system, we'll lower costs and get better outcomes. On their outlook for 2014 and beyond Michael Sachs:  The world of innovation in healthcare, both in delivery and on the IT-side, is going to substantially change how care is delivered. Quint Studer:  The [new] payment system, on purpose, is meant to disrupt the status quo. Phil Kambic: Is this glass half empty or half full? I ask my staff all the time. I think there's a ton of opportunity, and you have to be bold.   José Sánchez: The changes in last 20 years or so — from managed care to basically consolidation to evidence-based medicine — and many of these incremental changes we have seen, like EMRs, have been really focused on cost control. The question is if those have added value to patients. Lynn Nicholas: Genetics account for about 50 percent of determinants of care, 40 percent are societal issues and 10 percent is what we do every day [in healthcare]. Payment reform and moving into global budgets as fast as we can unleashes enormous potential to be creative in that 10 percent and drop for the first time into the 40 percent. Science, remarkably, is going to begin to influence the genetic part quite a bit. Ninety percent of the scientists in the world who have ever lived are alive today. While we struggle with what affects the 10 percent, there's enormous potential 25 for what will happen. It's very exciting. Alan Channing: I've not been in many conversations where somebody doesn't raise the question about whether patients have skin in the game. As a safety-net provider, I look at my patients and say, "How can I help you do that?" The language that comes to my mind is: "How are we making ourselves more essential to the community? How are we engaging with the community and with the patients through a variety of mechanisms?" Dr. Paul Summerside: I'm super excited. I still get up every day pretty excited…[I recommend you] get up every morning and think about operations. Think about just, "What can I do today? What can I do today to make things run a little better?" That wears off on everyone else. If you do those things, you're just going to kick butt in this industry right now. Dr. Diana Hendel:  I'm excited, and it was great spending the day with you. I'm reminded of a Barbara Kingsolver quote: "The changes we dread most may contain our salvation." We are the generation changing our health system. Russell Sullivan:  The proliferation of mergers, acquisitions, ACOs, joint ventures and loose affiliations will produce better outcomes at a lower cost, just as Congress hoped. Catherine Jacobson: I'm also one of those optimists. I've been in healthcare almost 30 years. In the 1990s, we fought change…but now we have more data than we've ever had before. Larry Goldberg: What we're talking about right now isn't going to happen as fast as we feel. But directionally, this [era] is pretty exciting. Joe Fifer:  I don't think we're talking about the right thing. We had this whole conversation today. Per-month per-member came up at one point, but it was not even fully developed. The total cost of care never came up. What we're focused on are individual successes within this whole continuum. But it feels like we're playing whack-a-mole. As long as we continue to do this, we won't succeed. n Chuck Lauer speaks to (from left) Joe Fifer, Larry Goldberg, Catherine Jacobson, Russel Sullivan and Diana Hendel.

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