The Times They Are A-Changin'




Health Care Reform supporters and protesters gather
outside the U.S. Supreme Court. 
Courtesy of the Christian Science Monitor

 

I decided to start this blog on healthcare to share the perspective of a small community hospital’s Chief Executive Officer. This seems especially relevant now because of the unprecedented rate of change in healthcare. Each day brings a new revelation. The Affordable Care Act is dead one day and alive the next; virtually every hospital in our small state has either joined a larger hospital system or is considering it; two out of eleven hospitals in Rhode Island are in receivership and others teeter on the edge; and doctors are being hired by hospitals in ever larger numbers. Here, in the smallest state, six hospitals and system CEOs have turned over in the last four years; one only lasted six months in his position. In our state, we also have a new CEO of the dominant commercial health insurer (Blue Cross) and he is aggressively trying to alter the relationship with providers in ways that encourage less utilization of hospital services. It isn’t so much the direction of change that is staggering, but the pace of change. In fact, I embrace the direction of change because I believe it will result in a healthier population and reduce healthcare costs, making it more affordable for individuals and businesses. Along with others watching these changes, I’m hopeful they will improve the business climate in RI and free up dollars that could be better spent on early childhood education and the underlying causes of poverty.

There are already some signs of positive change. For one, more than 40 percent of RI’s primary care practices are now designated as Patient Centered Medical Homes (PCMH) by the National Committee on Quality Assurance.  PCMH-designated practices must demonstrate that they have organized their resources around trying to achieve the best health outcomes for their patients. You might ask, isn’t that the goal of all primary care doctors? It is, but they haven’t necessarily organized their practice around that goal. PCMH practices take a team approach to care, meaning everyone, from receptionists to doctors, knows the patients and is expected to contribute to improving their health. For example, PCMH practices track the results attained by their patients with chronic diseases such as diabetes. They review these results with the team and try to figure out what they can do to help patients who aren’t controlling their blood sugar or blood pressure. These practices share results with colleagues from other PCMH practices to learn which techniques have been successful in improving outcomes.

The jury is still out on whether the PCMH movement has reduced the utilization of expensive services such as emergency room visits and avoidable hospitalizations, but the preliminary evidence is promising. In other countries, there is a well-documented direct correlation between the number of primary care physicians per capita and the overall cost of care, as well as healthier populations and better quality of life.  Let’s hope we see the same results here, and more young doctors choose primary care over historically better paying specialties. This is healthcare reform at the local level where it counts the most.

Each week I’ll try to focus on a different aspect of change in the healthcare delivery and financing system. In the meantime, I’d appreciate your feedback. --Lou Giancola