The US Supreme Court’s decision will accelerate the momentum that healthcare providers have already made to move the reform agenda forward. As one of the largest healthcare networks in the US with nearly $7 billion in annual revenue, the North Shore-LIJ Health System and many other hospital systems have made significant progress in:
• Reducing unnecessary utilization of inpatient care and specialty services that are driving up healthcare costs. More and more healthcare will continue to be delivered in outpatient settings, which helps reduce expenses and improve patients’ ability to access care.
• Implementing disease prevention and wellness initiatives — part of an effort to better manage people’s overall health (accountable care) rather than simply treating them when they get sick.
• Continuing to be more transparent in sharing clinical outcomes, which is in keeping with the public’s demand for greater accountable for the performance of hospitals, physicians and other providers.
• Working more closely with insurance carriers by moving forward with “pay-for-performance” incentives in which providers receive higher reimbursement for delivering higher-quality outcomes, and lower reimbursements when they deliver poor-quality care. We can achieve better results when we work collaboratively with insurers. As a result, I think you’ll see greater integration between providers and insurance payers in the years ahead.
• For instance, North Shore-LIJ has begun to transition to capitation or so-called “risk” contracts with insurance payers, in which they make “bundled” payments to us for managing the health of their members – such as Medicare or Medicaid recipients – instead of traditional “fee-for-service” payments in which we get paid every time we treat a patient. Restructuring the payment system gives providers greater incentive to focus their efforts on delivering preventive medicine and wellness services to their patients. The bottom line is if you want to be in the healthcare business, you can’t just be in the illness business.
• Forging more alliances with primary care practices to increase access for underserved communities, which will hopefully reduce reliance on hospital emergency rooms for routine medical problems.
• Hiring “care coordinators” and developing medical management capabilities that will enable us to improve the coordination of care, which will make it easier for patients to access the appropriate medical provider at the appropriate time.
• Integrating electronic health records (EHR) and other IT initiatives that improve the quality of care. For instance, North Shore-LIJ is investing up to $400 million to automate inpatient and outpatient records in all medical settings, including 13 hospitals. As part of this initiative, North Shore-LIJ is subsidizing up to 85 percent of the cost of implementing and operating an electronic health records system in the offices of thousands of community-based physicians in New York City and Long Island.
This is an exciting time to be in healthcare. Rightfully so, we’re being challenged like never before. We need to deliver a better product that results in better outcomes. Even if the mandate was not upheld, the bottom line is the reform agenda has already left the station.