Healthcare Reform After the Supreme Court: Where Do We Go Now

This June, following much anticipation from those in the healthcare industry and consumers alike, the Supreme Court announced its decision to uphold nearly all of the Patient Protection and Affordable Care Act, including the individual mandate. The law impacts various sectors of the healthcare industry differently, but for hospitals, the Court's decision — even if it had decided to reject the mandate — wouldn't have changed the course on which many health systems are embarking. A reversal of the individual mandate would have meant less paying customers and continued increases in charity care, but most hospitals have long realized the current healthcare delivery system is unsustainable, and many, including Mercy, have started to make changes to welcome a new type of delivery system.

Within Mercy, we have been on this journey for some time to prepare for population health management and to redesign and retool how we provide care along the continuum for our patients and our community. We believe in this notion because, first, it is the right thing to do for the people we care for, and secondly, it is part of the fabric of our Mercy mission. It became clear to us that irrespective of what happened with the healthcare law, from a philosophical perspective, we were going to continue down our path of greater value for our patients, by emphasizing quality over volume, reducing costs in a systematic manner and improving access for our community.

How we'll do it

Managing the health of a population required a new mind set, new operational and clinical models and a new emphasis on things like coordination, care management, integration, communication, analytics and informed decision-making based on those clinical and business level insights. Even before that, we have been preparing the foundation by creating a broad network of physicians with the capability of taking care of our community with primary health and preventative medicine as well as in complex medical and surgical care. We are rapidly moving to certify all our primary care practices as Patient Centered Medical Homes, which we believe, will be the fundamental foundation of an integrated delivery model.

As we have prepared for this over the last several years, on the hospital side, we've implemented an entire transformation process to improve throughput, quality and coordination with the overall goal of becoming more efficient, effective and integrated in our clinical and logistics of healthcare delivery. As such, this has had a significant impact on our quality and safety outcomes as well as the experience our patients have when they are being cared for at one of our hospitals. We have deployed several innovative methodologies and processes that have been significant accelerators in this journey.

Because of this innovative approach, technology needs to be utilized strategically as a connector of all the pieces of care. One of the ways Mercy has utilized technology is to enable a concept of one patient, one chart. By doing so, we are enabled to seamlessly follow the care of our patients across the continuum, give our physicians and other providers that data and the analytics to provide superior quality of care and enable our patients to engage with us in a meaningful way electronically to improve their health and wellbeing.

Additionally, one of our hospitals has applied for Medicare's Bundled Payments for Care Improvement program to begin testing bundled payments for cardiac care, through the Center for Medicare and Medicaid Innovation. This again is a key example of leading innovation and testing new models of care delivery that will become great tools as we move toward healthcare reform. All of these separate innovations will create the basis from which we will continuously learn and innovate new models of care today and in the future, allowing us to be ready to provide the highest quality, highest experience and highest reliability of care in the most personalized manner, thus fulfilling our mission to our community.

What's holding us back

While Mercy and many other organizations have begun to move in the right direction to improve healthcare quality and bend the cost curve, there are challenges ahead — and much more to be done. For one, with this magnitude of transformation, mindsets can be difficult to change. We've lived in a certain environment for a very long period of time and to move to a new one is not easy. Constant education, communication and articulating the value of change, is critical to shifting mindsets.

There is also the constant issue of living in two worlds, as the fee-for-service world and the pay-for-performance world currently coexist. Move too fast and actually reduce volume and improve health, and you don't get paid for it. Move too slow and you won't be ready once the shift happens. You have to captain two boats simultaneously; you don't want to over accelerate, but at the same time, you can't be too slow. As you're doing the right thing, you also have to make sure you're financially viable, so you can continue to deliver on your mission.

What's next

While the changes health systems are making to integrate and coordinate care and the Supreme Court's decision to uphold the PPACA are promising indicators that significant change in our healthcare delivery system can be achieved, we must continue to move in the right direction — toward the triple aim of higher quality, lower costs and improved health. Is there more that can be done? I think so.

Most of us in the industry know that doing nothing is not an option — it's not an option for people out there looking for care, and it's not a sustainable option for our delivery system. We've started the conversation and movement in the right direction, but we have to keep moving forward. For example, the PPACA did not address malpractice reform and what role that could potentially play in how physicians practice, how healthcare is delivered and the cost of care. Second, a great deal of our current efforts to reform is predicated on healthcare systems doing certain things; there are not a lot of incentives for patients' role in achieving healthy behaviors.

Even without the PPACA, and regardless of the political outcomes of the November election, these changes have to occur. Certain things are known: We have to provide higher quality care; we have to provide it at a lower cost; and we have to have access at the appropriate level of care. Whatever strategy hospitals select to pursue to achieve this — network development, ACOs, bundled payments, etc. — isn't as important as starting somewhere, starting anywhere. Whatever you do will be a building block to wherever you, and our delivery system, ultimately end up.

Imran Andrabi, MD, serves as senior vice president and chief physician executive officer for Toledo, Ohio-based Mercy, part of Catholic Health Partners. He previously served as president and CEO of Mercy St. Vincent Medical Center in Toledo.. He is a diplomat of the American Board of Family Medicine and the American Board of Managed Care Medicine.

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