Fall CEO/Trustee Luncheon

Healthcare providers are focused on their patient care mission 24/7-365. Healthcare reform is just beginning to creep in. The awareness of preparation for change is upon us.

Attendees of the Council Fall CEO/Trustee luncheon held September 15th now have a better perception and possible game plan on certain facets of what’s to come.

The topic was “Health Care Reform: Taking Action Amid the Uncertainty”. Maria Finarelli, a Principal with Health Strategies & Solutions, holding an MBA from Duke and armed with over 15 years health care consulting focused upon the horizon. The major coverage options go into effect in 2014. Here’s a summary of her presentation for those who were unable to attend.

Ms. Finarelli used a PowerPoint presentation to describe today’s health care system that almost all agree is broken. Specifically, she reviewed evidence that our current system leaves millions uninsured; is too expensive, is inefficient; and rewards the quantity, not the quality, of the services provided. Furthermore, in the absence of meaningful reform, the current trajectory is unsustainable.

Next, she outlined the short-term and long-term elements of the health reform legislation, focusing on four aspects: access, quality, cost and coordination of care. However, progress along each of these four dimensions will not only be slow, it will be largely ineffective without the fifth and most essential element of health reform -- payment reform. In order to bend the cost curve and create incentives for efficient, coordinated care, payment reform will be necessary.

Ms. Finarelli then summarized several compelling arguments for a major shift away from the current fee-for-service reimbursement system. The impact of 2006 legislation in Massachusetts that combined near universal coverage with fee-for-service medicine (what the current legislation will do on a national scale) was also described. Gains were achieved in access to care, but spending grew more than expected in the first two years.

The next section of the presentation began with an in-depth discussion about bundled payments, which will be the focus of numerous pilot studies in the next five years. A detailed profile of one approach based on bundled budgets, coordinated care, and shared economic risk was presented. The Prometheus Payment model is currently being tested at four pilot sites in Pennsylvania, Minnesota, Michigan and Illinois.

The final portion of Ms. Finarelli’s presentation identified actions that hospital and health system leaders should be taking now to prepare for the major changes ahead. The strategies were grouped into three categories:

Information systems: investment in information systems that not only integrate clinical data and cost data, but that also provide real time access to both types of information throughout the entire continuum for care

Physicians: develop a shared (hospital and physician) vision and values and the same high level of commitment to provide high quality, efficient, integrated care; behave like true partners, and have a high level of trust in one another

Culture: create and maintain a culture that places the highest value on quality and outcomes; promote teamwork, encourage innovation, and reward excellence, because they will be the keys to future success

While the specifics of reform are still uncertain, the direction is clear and providers should begin to take action.

Ms. Finarelli had a lively question and answer session.