With the future of the
Affordable Care Act more certain, hospitals and health systems should focus on
initiatives that improve the patient experience, enhance population health, and
reduce healthcare costs.
Despite vigorous legal
challenges, last June, the U.S. Supreme Court upheld the constitutionality of
the Affordable Care Act (ACA), a little more than two years after it passed
Congress. And following a long and contentious campaign, President Obama was
elected to a second term in November, thus ending—for all practical purposes—any
threat that the ACA will be repealed.
Now that the future of
the ACA is more certain and reforms are beginning to be implemented, hospitals
and health systems should steer a course toward a healthcare delivery system
that pursues the “triple aim” of improving the patient experience (quality and
satisfaction), improving the health of populations, and reducing the per-capita
cost of health care.
Action Steps for Providers
There are five
innovative ways in which hospitals are preparing for an era of reform.
virtual-care models that enhance access to care. For example,
KentuckyOne Health has developed a community-based “virtual-care model” that
uses physician assistants, nurse practitioners, dietitians, and other
nonphysician providers who are linked through telecommunications to physicians
within the larger system. In Kentucky, half of the state’s counties are
underserved by physicians, and some counties have no physicians at all. This
technology enables the health system to increase access for residents in
communities that are economically challenged, with a large number of uninsured
patients, so that care may be provided locally, says Daniel W. Varga, MD, chief
clinical officer for KentuckyOne Health.
joint arrangements with other health systems to form accountable care
organizations. Interviews with provider executives point to efforts to
develop ACOs and ACO-like entities on the provider side. For example, Glenn
Fosdick, president of Nebraska Medical Center in Omaha, points out that for more
than two years, his facility has been offering an ACO-like arrangement in a
joint project with Methodist Health System.
“We knew there were
going to be market-driven changes regardless of the outcome of the Supreme Court
decision,” says Fosdick. “Reimbursement couldn’t continue the way it had been
structured, so we had to plan to reduce costs while maintaining or improving
quality.” Nebraska Medical Center has done so by aligning physician and
hospital interests for the betterment of both.
internally to improve value, enhance customer satisfaction, and reduce costs.
“We’re working to help our communities understand the implications of
reform, and we’re working internally to improve value, add customer
satisfaction, and reduce costs,” says Michael M. Allen, CFO and treasurer,
Winona Health Services in Minnesota. “We’re doing this to be prepared for
whatever the regulatory scenario happens to be.”
use of standard clinical protocols for certain procedures. Both Fosdick
and Varga promote the use of standard clinical protocols for certain procedures,
and both see management of a population’s health as the key paradigm shift.
“Global capitation is a long way off for us, but what we learn in the interim
will help us when it finally comes,” says Vargas.
initiatives designed to reduce readmissions. In Nebraska, the challenge
in reducing readmissions through improved management of chronic conditions is
not so much poverty as it is access issues, due to the distances involved. “One
of the quality issues we face is to reduce the number of hospital readmissions,”
says Fosdick of Nebraska Medical Center. “When the patient has to travel 100
miles or more to get to a hospital, readmission is a real issue for patient
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