Healthcare

Medicare turns 50 this week with a number of substantial challenges in its future, and its overall success may be one of the largest contributing factors. When Medicare was created in 1965, nearly half of all seniors in the United States were uninsured. The program covers 55 million people today, providing medical care to one in every six Americans.

As you know by now, the U.S. Supreme Court issued an opinion yesterday allowing subsidies in states using the federal healthcare exchange. In other words, the decision was a big win for the ACA. Details of the opinion in King v. Burwell are available from many sources, so I won’t rehash them here. I plan to discuss the effects of this ruling in greater detail in a later blog. Today, I would like to offer three brief observations from yesterday’s decision.

I was offered the opportunity recently to observe a medical examination of a child in Guatemala, and I was able to accept because I didn’t have to leave home. The U.S.-based doctor examined the patient with the help of medical personnel in Guatemala, special instruments designed to transmit high-resolution images, and a high-speed internet connection.

Of course, I had heard about advances in telehealth, but until I saw the clarity of the images on the screen and heard the detail in the sound transmission, I really had no idea how much the field had progressed. We could see inside the child’s ear with detail that rivaled an in-person exam. Her heartbeat was loud and distinct. It was as if we were sitting in her local doctor’s office, conferring with a specialist – which, in a way, we were.

In the past several months, I’ve had the opportunity to discuss trends in the healthcare industry with some of the best minds in the business, and one topic keeps coming up – population health. What has surprised me is that everyone I talked to places a different emphasis on aspects of the larger concept. It’s as if there isn’t a universal agreement on the definition of population health.

I think it’s safe to say that the focus of population health is to improve chronic disease management, reduce risk factors and improve gaps in care, but there are a number of strategies available to reach those goals.

It’s a sign of the times – Dr. Phil McGraw attended this year’s Consumer Electronics Show to pitch his new app “Doctor on Demand.” His app allows a patient with a smart phone or tablet to access a board-certified doctor or psychologist for about the cost of an office visit co-pay. DOD has 1,400 physicians and 300 psychologists in its network.

I had the honor of participating in the American Health Lawyers Association’s inaugural Women’s Leadership Institute today. Our keynote speaker was Dr. Antonia Novello, former Surgeon General of the United States. Dr. Novello was the first woman and first Hispanic to serve as Surgeon General, and her talk set the tone for a great day of sharing and learning for those of us committed to inclusion in the workplace.

Her presentation provided practical advice on how women can open doors to opportunity. As I reflect on her words, I realize her 10 key points can help anyone – men, women, black, white, Hispanic – improve their personal brands, and be more effective in their professional and personal relationships.

Healthcare’s Triple Aim – providing better care for individuals, better health for populations and lower costs overall – is closely related to the benefits of clinical integration. In a successfully integrated organization, patients have increased satisfaction, providers benefit from higher reimbursements, and payers recognize lower costs of care. But is integration effective and can it be achieved?

Clinical integration has been part of our discussions since the 1980s. Thirty years ago, the primary aim of integration was to provide the means for hospitals to control costs and improve negotiations with payers. We witnessed a move toward larger organizations in the 1990s as hospitals initiated a record number of institutional mergers and practice buyouts. Merely merging or expanding, however, has not necessarily proved effective. 

If I had to pinpoint the key to healthcare reform, I would use one word – quality. If I had to identify the focus of our efforts, it would be patients. And if I had to construct a timeline for action, it would begin today. We have no time to waste in creating a sustainable model for delivering high-quality care.

Quality care involves providing appropriate care in the appropriate setting so that we can improve the health of entire communities using available resources. We must develop an economically sustainable healthcare model.

If you are hoping that you can survive the changes in the healthcare industry by maintaining your current business model and waiting for the rules to change, you may regret your delay. Status quo simply is NOT an option. You need to start taking action now in order to remain viable in the future.

My advice is to abandon survival mode and begin to design and implement proactive strategies to help your stakeholders thrive in the new environment. 

Whether you are a healthcare provider or a patient, it can be challenging to be away from family and friends at such a celebratory time of the year. But the lengths that hospitals and other healthcare facilities will go to spread holiday cheer for patients and staff is truly inspiring. We reached out to some area hospitals and asked them to share their stories.
 

Join our own Thomas Prewitt, M.D., director of the HORNE Healthcare Delivery Institute, for plain talk about how we’ve reached critical mass in health care by buying into unnecessary care. Dr. Prewitt walks us through memorable examples of how unnecessary tests and procedures put patients at risk and drive up costs.

• The challenges physicians face to stop “over-treating” patients
• What we as patients need to do to take ownership of our personal health care
• How our healthcare focus needs to shift from rescue-care to overall patient health

To see Dr. Prewitt’s TEDx event talk, click here:

Leaders in the hospital field are already pursuing integration to improve patient outcomes and reduce the ballooning cost of health care. The Centers of Medicare and Medicaid Services' quality initiatives, and now the Affordable Care Act, demand a new health care model that brings hospitals and physicians together to coordinate the continuum of care for improved patient care. One emerging trend to enhance care coordination is clinically integrated networks, or CIN.