My perspective is shifting slightly on the issue of health care reform, and what’s possible and not possible, perhaps because a few weeks ago the Urban Land Institute held an event I attended at which Peter Fine, the CEO of Banner Health , was the featured speaker. While I was familiar with some of the things he said because I’ve been writing at UsHealthCrisis.com for a few years, his “spin” was new, because I’ve only heard one industry speaker recently — and that was a thought leader from Kaiser Permanente.
Let’s begin with the commonly accepted numbers. Right now, there are 37 million Americans over 65. By 2030, that number swells to 75 million, thanks to the Boomers.
An additional 37 million are uninsured, and soon to be covered by Obama’s reforms in one way or another. I suspect there will be quite a bit of shifting and juggling as insurance companies try to make this work. One has already left our area, and another has entered the market. For patients, that’s scary and confusing, and sounds like they won’t be able to “keep what they have” if they like it, because the company may decide to exit the market. California has already become the first state to offer an exchange similar to what all states must have by 2014.
What does this mean for the hospital system? Well, one of the goals of reform is to keep people OUT of hospitals, through prevention, less expensive treatment protocols, and comparative effectiveness research.
Health care people, at least those who manage large systems like Banner, must all be futurists. They are not unlike utility company executives: their role is to project out into the future and bet huge amounts of capital, and the risk of decision making in health care has just grown exponentially.
Banner is making its investments in some interesting areas — primary care and electronic health records (EHRs). Fine told us that his investment in EHRs in intensive care have actually reduced mortality 23%. When you think about how seriously ill most people are when they’re in intensive care, that’s a big number. They’re far down the road in health information technology, but now the financial risks are being put on hospitals to keep patients out of the hospital, which means a great emphasis on the outpatient environment. What will have to expand? Non-hospital ambulatory care facilities.
What will also have to expand? The primary care physician base that feeds into the hospitals. Although Arizona has a surplus of hospital beds, like every other state it has a shortage of primary care physicians, physician offices, and medical office space. In the future, physicians will have to closely align with hospitals — or be employed by them — because payments will be “bundled.” What does that mean?
Well, insofar as anyone knows, it means that health plans will pay for the patient, and everyone who cares for him/her will share. The hospital, the primary care doctor, the specialist, and the radiologist may get a lump sum to split proportionately. Depending on how the patient fares.
When you think of it, that’s a shocking change. In the future, the finger pointing will have to stop. Who missed the diagnosis? Who forgot to comply with the treatment plan? Who exposed the patient to an infection he didn’t have when he came in — that’a all going to be accounted for. Banner will start developing medical office space for its “captive”physicians in the communities where patients live, instead of making them come to the campus around the hospital, as we all do now.
This would be a big change. Communities now lag behind in physician offices, and are also having trouble attracting physicians. However, the availability of health care services is one of the first questions people ask when they buy a home, and health care is increasingly seen as a driver of economic development. Not to mention the imperatives of new legislation.
Given all the givens, we think the future will see more diagnostics, more primary care, more collaboration, and fewer “hospitals.” That’s a good thing; no one likes hospitals anyway:-)