With the Affordable Care Act now the law of the land, a value-based healthcare regime where hospitals are rewarded for keeping patients well, for being efficient and cost conscious is the path we are on. Instead of growing nostalgic for an easier time – never a recipe for success — hospitals need to review their operations, both clinical and business.
Here are the five New Year resolutions that any hospital or health system eager to secure their future in 2013 and beyond should adopt.
- Get over the distrust of payers and take some risk
Payer/provider integration is a trend that is becoming a reality around the country. Keeping all the old biases alive will hamstring this important collaboration. “Historically under a volume-based system, [payers and providers were used] to sitting across the table negotiating rates. It’s been ‘I’ll show you my data, if you show me your data on how well you are doing,’” said Ed Giniat, U.S. sector leader for Healthcare and Pharmaceuticals as well as industry account executive for several hospitals and health plans at KPMG. “Now we are moving to these new kinds of arrangements where they are saying ‘Let’s combine our data and see how we can improve care.’” Giniat believes that it is incumbent on hospitals to collaborate with payers because they know which patients are going to require what kind of care. In other words, hospitals need to take on some risk. “Hospitals need to share the risk, both upside and downside; that is what the whole accountable care movement is all about,” Giniat said.
- Align with physicians
Hospitals have been acquiring physicians groups as they realized that the reimbursement system is moving away from episodic care to paying for care across the continuum — before patients come to the hospital and after they leave. That makes working more closely with primary physicians critical. “Aligning with physicians doesn’t mean you need to acquire the physicians and make them employees, but it means you need to extend the continuum of care,” Giniat explained. Hospitals may take apage out of the pilot program that integrated health system HealthPartners conducted in 2011 toreduce ER admissions and hospital readmissions. HealthPartners, which operates as a health plan as well as providing primary care service through clinics and running hospitals, targeted 27 patients. The program increased each individual’s access to primary and specialty care physicians. At the same time, the care plan for each patient was integrated into electronic medical records and flagged so that providers and staff at all five HealthPartners’ hospitals and 25 medical clinics could view it.That and other measures helped to bring about a marked change — two months before the roll out, ER admissions among these patients numbered 121; two months later, it was down to 53. In hospital admissions, the number fell from 57 to nine.The reduction had a real impact on HealthPartners financials too, with an estimated cost savings of $511,000.
- Use technology wisely and not just to roll out EMRs
When it comes to healthcare technology, nothing has gotten more attention than electronic medical records for which the American Recovery and Reinvestment Act put aside nearly $20 billion. But there are all kinds of low-hanging tech fruit yet to pick. For instance, staff scheduling software that provides real time insight into staffing needs of a hospital or other care provider and can reduce overtime costs. And then there are software solutions that speed up patient registration and discharge as well.A huge opportunity is clinical decision support, said Gunter Wessels, partner and healthcare practice principal at consulting firm Total Innovations Group Inc. Wessels pointed to a software vendor called InVivoLink whose technology helps orthopedic surgeons pick the right joint for surgery, match it with clinical characteristics of patients and order it from the supplier in time for the procedure. “Their solution is a great example of clinical decision support systems/supply chain/supplier interaction that works, all powered by IT,” Wessels said.
- Redesign the clinical care process
To do so, hospitals and health systems need to adopt Six Sigma principles, Giniat said.Flexible scheduling in the emergency room is one method of redesigning the clinical care process. Another example comes from the Mayo Clinic, which has experimented with having a doctor visit at least one older patient at his home, given a history of accessing care in the most expensive manner — at the emergency room.
- Hire new talent to build up a different expertise
If hospitals take more risk, they need to hirenew talent — especially people adept at predictive modeling and actuarial tasks. Historically, these types of people are found more on the payer side. Now hospitals can leverage their relationships with payers to access that talent, Giniat said, but that likely is not enough. There have to be people within hospitals and health systems who understand that language.And with the advent of big data, reading it, crunching it and analyzing it to answer important questions means that hospitals need to create and fill data analysis positions. As these jobs gain in prominence, one department in particular will need to transform completely to be relevant in the future — the billing office.
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