Redesign of the U.S. Health Care System

I recently gave a presentation to the Healthcare Financial Management Association (HFMA) about health care reform in the U.S. HFMA is the nation's leading membership organization for healthcare financial management executives and leaders, who consider HFMA a respected thought leader on top trends and issues facing the health care industry.

I know that focus on our country’s broken health care system will only continue to grow in the coming months and years, especially as we approach the impending presidential elections, and thought the rest of you might be interested in my latest thoughts on health care reform as well.

Changing the health care system in the U.S. is a high priority for government, business and patients and their families. As I mentioned above, the new president will have a mandate to facilitate a redesign process, so some change (hopefully positive) is inevitable.

In reality, we know that the U.S. health care system is highly fragmented, and many of us recognize that we are all to blame. It is my belief that many constituencies bear the title of “bad guy” because we have all contributed to the current state of affairs. Bad government, greedy insurers and vendors, arrogant administrators, rich doctors and inept boards have gotten us to the broken system we now must heal. In reality, even the desires and values of many American patients and their families have added to this state. Many patients continue to clamor for independence and the ability to choose when, where and how they receive care, and these desires have a direct effect on the system itself, as it struggles to balance the desires of patients with the realities of the day.

Data from various sources confirms that the constituencies I mentioned have focused on health crisis management instead of managing health. The focus on preventative medicine has been historically lacking, so when chronic conditions are identified, they have generally progressed much farther and done more damage than if they had been caught and managed from an earlier stage.

However, the fact remains that health care reform is far too critical for the welfare of Americans for it to be held hostage by the politically motivated or the profit-minded. This means that all of us must accept the need for some form of national health care, along with a collaborative willingness to pay for the appropriate services in the appropriate settings. This redesigned system must avoid excessive administrative costs and significant control by an ultimately rigid and unwieldy governmental, insurance, industry or vendor bureaucracy.

In light of these realities, we have done our best to respond in complete and proactive ways. For CHRISTUS, these responses include our Journey to Excellence, deliberate and structured futures planning (Futures Task Force I and Futures Task Force II) and our reorganization of our portfolio to one-third acute care, one-third non-acute care and one-third international entities.

Because of our belief that excellent health care is a necessity, not a luxury, CHRISTUS’ goal on our Journey to Excellence has been to develop processes and programs which reach global benchmark performance in clinical quality, service delivery, business literacy and community value. On this Journey, we have learned that:
• We must listen to the voices demanding change
• We must be aware of the signs of failure
• We must embrace outstanding health care governance
• Developing, sharing and rewarding best practices are critical success factors
• Effective teamwork is critical
• We can never be satisfied
• Unlimited optimism is paramount
• Use of a balanced scorecard approach is essential
• A high level of accountability must be sought
• Incremental victories must be identified and celebrated
• Great dreams do not occur overnight—where CHRISTUS is today is no accident
• Our theological and ethical foundations do make a difference
• Future thinking and monitoring of innovations are important
• Change management is difficult, but a required CHRISTUS leadership competency

The completion of Futures Task Force I in 2001 reinforced the value of scenario planning and solidified our belief that the major drivers of change in our industry would include declining reimbursement; disruptive, non-invasive technologies and the healthy aging of seniors. The Task Force’s recommendations also helped CHRISTUS to consider the structure of our system that would provide the highest quality of care at the most affordable cost to as many people as possible, regardless of their ability to pay. This, of course, requires a full understanding and integration of the continuum of care, which we continue to study.

In addition, Futures Task Force II includes learning journeys to New Orleans, Canada and India; technology reviews and tours of innovation centers. It is our belief that the work of this Task Force will allow us to articulate and apply Futures Task Force I’s recommendations more fully as well as develop new recommendations for the next 10 years.

As a result of all this work, CHRISTUS is in a transition of our portfolio to include one-third acute care, one-third non-acute care (including post-acute, community health services, clinics, senior services and retail) and one-third international entities (including robust sharing of best practices and a healthy Medical Travel program).

It is clear to me that change in the U.S. health care delivery system must occur, and CHRISTUS Health desires to embrace those changes and to be at the redesign table to share our learnings and best practices. The new model for health care must be evidence-based, must not let the “physician voice” become overwhelming, and must learn to balance individual vs. community focus.

I firmly believe that a successful redesign of the U.S. health care system is possible if we partake in the process with the central idea that health care is a noble humanitarian tradition of helping those who are suffering. Therefore, the welfare of every person must be of the highest priority.