ACOs or Clinical Integration?

On numerous occasions you have read here that the high cost and low quality of some health care in the U.S. is due to overuse or misuse of many therapies and the lack of coordination of care among various delivery points, causing duplication of services. If ACOs do what they are supposed to do, they will hold providers truly accountable for a patient’s care through its entirety by creating meaningful clinical collaboration between physicians and hospitals, utilizing clinical evidence-based treatment plans proven to result in higher quality and lower care.

Although there are major challenges to overcome, including connecting hospitals and physicians with electronic data and determining how ACO reimbursement will be distributed, CHRISTUS Health recognizes opportunity and supports the concept of ACOs, but more importantly, the idea of clinical integration, which is the basis of our strategy. This position provides an aligned approach to care management that allows hospitals and physicians to collaborate to provide coordinated, lower cost and higher quality care. The significant differences between ACOs and the Clinical Integration model are:

• ACOs are Medicare-only and are still based on a fee-for-service model (which limits their effectiveness in the short term, but they will likely migrate to capitation);
• Clinical integration requires an alignment between physicians and hospitals based on the desire to improve the cost/quality equation. That is the primary focus of the alignment.
• Clinical integration requires a governance structure that holds all parties accountable for evidence-based protocols that will ensure high quality and minimal "waste" in the care delivery process.
• Clinical integration requires data integration across the continuum, but with little specificity about how that occurs. In fact, some of the greatest success stories in clinical integration have been operating with little more than a data repository for years, but have been able to achieve significant improvements in clinical outcomes and cost.

While the challenges outlined by some industry analysts are valid, the concept of ACOs is a sound one if all parties are truly committed to improving the cost/quality equation; however, current legislation does little to actually hold all parties accountable and responsible to each other. Clinical integration, on the other hand, is not legally mandated, but is more of a business management model designed to reduce utilization, standardize care, manage care (via a medical home) and improve quality - while at the same time lowering overall cost. The most important benefit of doing so is that physicians and hospitals can co-negotiate for managed care contracts and can command higher payments from private payers on the front end for demonstrated superior quality.

Reform Repeal Vote

As I’m sure you are aware, the U. S. House of Representatives will be holding a vote today on H.R.2, “Repealing the Job-Killing Health Care Law Act."

As a health care entity still subject to the requirements of the Accountable Care Act, CHRISTUS will move forward with implementing the provisions of health care reform in accordance with the law. We will also continue to advocate for additional legislative measures that expand access, reform payment mechanisms and address social justice issues. We are aggressively sharing knowledge and best practices across our ministry to reduce costs and speed implementation while improving quality and patient satisfaction.

CHRISTUS Health will continue our commitment to “Putting Care Within Reach” of all those who need us, and will remain focused on providing high quality, compassionate care each and every day.

A New Era for Hospital-Physician Alignment

There is no denying that we live in an era of rising health care costs. As a result, we have seen many strategies like health care reform to reduce these costs and ensure that everyone in our country has access to the care they need. It is clear that our shared goals of higher quality care at a lower cost can only be achieved through collaboration. This means collaboration between hospitals and physicians as well as providers across the continuum of care (long-term care, home care, clinics, etc.) and patients themselves.

I was recently interviewed for an educational report compiled and distributed by the healthcare financial management association on the topic of hospital-physician alignment, which covers why it is important now, and how health care systems can foster and support alignment with physicians (as well as the much-noted ACO model). I’m admittedly somewhat biased, but I believe it is a thorough, well-written report, and I suggest you pause to read it and share it with your teams.

Any Illness is Not Good Medicine!

I was overcome with disbelief when I saw an article yesterday morning in The Dallas Morning News claiming that flu cases are good medicine for hospitals. Why?

First and foremost, it’s hard to imagine that any illness could be good medicine for anyone, including hospitals. Yes, we know that the “good medicine” referred to in the headline was the “good financial outcome” for the hospital that an increased influx of flu cases would cause. However, that would be the ultimate cause of some of the poorest medicine delivered in the U.S. today: Do whatever you can as a provider, providing services that even may not be necessary, to increase revenue and bottom line profitability.

Second, having flu patients in a hospital is actually bad medicine for the inpatient setting, since it would make the spread of flu more likely and increase the likelihood of a patient flu “epidemic” within the hospital. Clearly, the goal of any health care team should be to keep as many flu patients and flu symptom visitors away from the hospital campus as possible.

Third, flu cases do not generate any operating income for hospitals, which the article got close to right; a hospital analyst reported that “Higher flu activity is likely to increase medical costs. . .However, unless the flu activity increases dramatically, we expect a limited impact on company earnings.”

Fourth, indicating that the absence of a flu season is the cause of flat year-over-year inpatient volumes holds little truth. We have had minimal flu season volume increases for multiple years, and there are many other more valid reasons to volume declines, including the global economic crisis, which caused more patients to cancel elective procedures, and new technologies permitting more procedures to be done safely in outpatient settings.

Fifth, and most importantly, preventing flu through prevention and education should be health care providers’ primary focus, not encouraging more flu cases so as to cause bad medicine for hospitals.