Published in South Florida Hospital News –
We certainly have our share of challenges in the health care industry these days. In fact, I am hard-pressed to remember a time in my career when the issues are more daunting and pressing than they are today. Never mind the ambiguity associated with the bumpy roll-out of the Affordable Care Act or the ever-constant reimbursement pressures brought about by governmental and private payers alike. Now we have true public health challenges like the diagnosis, treatment and containment of Ebola and the alarming incidence of the D68 enterovirus (EV-D68) among children, along with our more long-term, chronic issues like the growing prevalence of obesity (particularly among children), chronic diabetes, heart disease and cancer. Some of these issues are the result of the inevitability of our demographics: an ever-aging population combined with a growing shortage of primary care physicians, nurses and other skilled caregivers.
Although certain trends seem to be moderating somewhat—like the cost of lifesaving pharmaceuticals and technology and the lack of financial and geographic access for the underserved—we are not out of the woods yet. In fact, many governmental and private payers are now trying to shift patients out of an inpatient status into an outpatient status, essentially paying hospitals less for providing the same care and using the same resources. Add to that the increasing competition in the healthcare provider industry from traditional players (to wit, Ambulatory Surgery Centers, Diagnostic Imaging Centers and Urgent Care Centers) as well as surprising and even disruptive players (like Walgreens, CVS and even insurance companies). And, unfortunately, our industry is plagued by the historical inability and/or unwillingness to communicate (electronically or otherwise) among the disparate members of the health care continuum, including physicians, hospitals and other mental health and ambulatory providers. Together, these challenges present a tsunami of unprecedented proportions which we, as health care providers and stewards of our communities, need to address pragmatically and collaboratively.
We do have new models and constructs for addressing some of the challenges facing us. Think about it. We now have the emergence of a new breed of health plan (accountable care organizations), value-based purchasing of care by insurers, clinical integration initiatives among providers, the development of electronic health insurance exchanges to facilitate greater access, and new care coordination models with health care extenders acting as personal navigators between patient and providers. And we have new tools in our arsenal: telemedicine, patient engagement portals, performance improvement methodologies (Lean, Six Sigma), electronic health records with improving interoperability among systems, quality and utilization monitoring software to improve the quality and the access of the care we provide. We are supported by our professional societies and organizations, like the “Choosing Wisely” campaign endorsed by over 60 medical societies and organizations to encourage candid conversations between providers and patients about the best course of care for the patient’s condition, and the “Partnership for Patients” campaign endorsed by the Hospital Engagement Network, with a goal of reducing patient harm by 40% and readmissions by 20% over a two-year period. These new tools, models and intersocietal support will help us achieve our community and institutional goals of better health, more popularly known today as “population health,” manifested in a reduction in hospital readmissions, the minimizing of hospital-acquired infections, the optimization of core “process” measures (doing the right thing at the right time to the right patient, every time) and the eventual improvement in community public health indicators.
But one of the fundamental changes that need to occur in the health care continuum is the breaking down of the silos in our health care delivery system. We need to work with the state and federal government to develop and align the incentives of providers as we change our model of care. We need meaningful conversations, not just among providers, but with the financiers of care; that is, governmental payers, commercial payers, and, yes, even with business leaders and employers, who are often the ultimate payers of care. Especially in today’s information age of emails, texting, social media and impersonal mass media, we need face-to-face discussions with one another and with our key stakeholders and customers on how to improve the health of our community. We need the development of partnerships and affiliations based on mutual trust and a shared vision. As we do so, let’s not forget the central element in all of our discussions, the patient and his or her family support system, and let’s be deliberate about educating them on their roles on the health care team and including them in our brainstorming and our planning for the future. This will require bold action and innovation by us, as health care executives, to demonstrate leadership, commitment, open-mindedness, a healthy dose of humility and perhaps a bit of sacrifice. This is our real challenge and, hopefully, our pathway to better health.