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It’s been one busy week! As director of the newly launched Optum Institute for Sustainable Health, I’ve been presenting our first set of findings at the The World Congress 2nd Annual Leadership Summit on Accountable Care Organizations (ACOs) in San Diego, flying all over the country to meet with providers, and on the phone with health care reporters who’ve been interested in our study – everyone from HealthLeaders to Healthcare Finance News to USA Today. Who needs sleep, right??
In my more than 20 years in health care, the Optum Institute is the most exciting organization I’ve been lucky enough to lead. As someone with a true passion for health care, I’m like a kid in a candy store. Our job is to be an authoritative source of information on trends in the marketplace – especially new collaborative care models – and a resource for folks who are working to make healthcare sustainable. We’ll do that by conducting research, monitoring trends, working with leading experts around the industry to keep a finger on the pulse of all things accountable care, evaluating what works and what doesn’t, and helping develop best practices to propel our industry forward in the development of Sustainable Health Communities.
To kick things off right, we went big, surveying 1,000 US-based physicians, 400 hospital executives, and 2,000 health care consumers to get a sense for how each group views this inevitable evolution of care, and to identify the most immediate opportunities for positive change. Some of the results surprised us and others were in line with our expectations, but here my favorite highlights:
This week’s guest post comes from Justin Chang, M.D., chief of emergency services, Kaiser Permanente, Colorado, and medical director, Exempla St. Joseph Hospital Emergency Department. A proponent of collaboration and enhanced coordination of care, Dr. Chang makes the case for a new model of healthcare delivery as defined March 31 by the Centers for Medicare & Medicaid Services (CMS) in its proposed ruling on Accountable Care Organizations (ACOs).
I think we can all agree — physician, payer, provider, patient, etc. — that the ultimate goal of regulations and reform should be to improve the delivery of healthcare, lowering costs and ultimately, making patients healthier and more satisfied. Coupled with driving toward the results defined by CMS, this requires some fairly significant changes in how healthcare providers operate — changes which may rightfully make some providers uneasy. But what many of us may not realize is that hospitals, physicians and payers across the country are already becoming advocates for the types of changes ACOs will require, supporting a shift away from the fee-for-service and silo-type models, even before the regulations go into effect.
As the discussion of Sustainable Health Communities continues, we welcome to Healthcare-Exchange Joel Hoffman, Senior Vice President with OptumInsight Consulting, who sheds light on the payer perspective.
Football season may be over for the year. But for payers, the idea that “as goes the quarterback so goes the team” has never resonated as loudly as it does now — and will in the future — in the new world of Sustainable Health Communities.
Historically, payers have had an important, yet somewhat fundamental role: to select and manage risk, to negotiate favorable provider contracts, ensure its network is comprehensive, design appropriate benefit plans, manage care and provide appropriate customer service. Now, as we enter the era of Sustainable Health Communities, payers take on a new and even more critical function as the enabler — the head coach of the team where the primary care physician (PCP) is the “quarterback” in the local health care delivery system.
This week, Dr. Shari Medina – Senior Director of Clinical Informatics at Picis, Inc. – discusses the evolving role of physicians within Sustainable Health Communities.
It’s no secret that healthcare’s inevitable move toward sustainable health communities (SHC) has many physicians feeling a bit…nervous. Admittedly, most physicians are creatures of habit who fiercely defend their individual approach to patient care, focus on cures not cost, and dread the concept of “cookbook medicine.” And under the SHC model, physicians are going to, without a doubt, be expected to move out of their comfort zones. But while SHCs will put new pressures on physicians to observe and adhere to evidence-based best practices, they will also allow physicians to preserve and deeply embrace the “art of medicine,” as well as enhance physicians’ skills and help improve outcomes by enabling them to spend more quality time with patients.
This week we’re excited to introduce Sharon Giarrizzo-Wilson MS RN, CNOR, Informatics Nurse Specialist with the Association of periOperative Registered Nurses (AORN) as our guest blogger.
Not since Florence Nightingale has nursing been viewed as a key agent in changing the delivery of healthcare. The landmark report recently released by the Institute of Medicine (IOM), in collaboration with the Robert Woods Johnson Foundation (RWJF), The Future of Nursing: Leading Change, Advancing Health, urges strategic nursing opportunities to transform the healthcare in the United States. The report from this joint partnership made several recommendations based on the challenges the nursing workforce faces as contributors in national healthcare reform and public health access. The collective recommendations call for a stronger nursing voice in redesigning the healthcare system.
It’s not news to most that with increasing regulations, an aging population, rising healthcare costs and dwindling numbers of nurses and certain medical specialists, U.S. hospitals are finding themselves scrambling to do more with less. Most hospitals today are focused on trying to meet Meaningful Use requirements, to avoid penalties and secure financial incentives. But many are missing the bigger, longer term picture of this country’s financial situation: how half a trillion (or more) in Medicare cuts over the next 10 years will impact the industry.
Pam Matthews, RN, MBA, CPHIMS, FHIMSS
Pam Matthews, RN, MBA, CPHIMS, FHIMSS, serves as the Senior Director of Regional Affairs at HIMSS, a cause-based, not-for-profit organization exclusively focused on providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare. We are pleased to introduce her as this week’s guest blogger on Healthcare-Exchange.
We can all agree that great strides are taking place today to enable Health Information Exchanges (HIEs), as evidenced by the great work being done across the country at both the state and regional levels. For example, projects in Northern Virginia and Nebraska have taken off and are already providing real value to all participating constituencies.
Those of you who read my previous posts on health care reform know where I stand – that while its creators had the best of intentions, the bill ultimately failed to accomplish two key goals: increase quality and decrease costs. The most critical pieces that legislators missed include tort reform, competitive insurance across state lines and much more aggressive pay-for-performance measures and disease management-based incentives. With these additions, health care reform would have been viewed as much more cost-conscious and quality-focused. Instead, we’re now left with a “Frankenstein” system that was cobbled together with, in many ways, the best of the worst – one that’s expensive to maintain and challenging for physicians, providers and ultimately patients.
Karyn Buxman, RN, MSN, CSP, CPAE
We’re thrilled to welcome former ED, ICU and OR nurse and internationally recognized expert in applied and therapeutic humor Karyn Buxman, RN, MSN, CSP, CPAE as a Healthcare-Exchange.com guest blogger this week. If this gives you a laugh, you can hear more from Karyn at The Journal of Nursing Jocularity!
Last week comedian Stephen Colbert, host of Comedy Central’s hugely popular show, The Colbert Report, testified, in character, before Congress. Facing the House Judiciary Committee, Colbert shared his ‘vast experience’ about the plight of migrant farm workers. In the process, he shared three lessons about communication that are vital for any of us who are in healthcare to learn and incorporate in our daily practice.
At this year’s Picis Exchange meeting in Miami, FL, I had a chance to sit down with Tommy G. Thompson, whose resume will take up half of this blog post – former secretary of Health & Human Services, four-term governor of Wisconsin, member of Picis’ board of directors and a personal friend and resource – to talk about where today’s healthcare system is headed.
The most compelling part of our discussion was his take on President Obama’s approach to healthcare reform and his direct advice on next steps.
Let us know if you agree or disagree with his advice – and what yours might be? And stay tuned for more from our discussion in the weeks ahead!
- Todd Cozzens
