It’s powered by the notion that getting more people into care sooner will catch health problems earlier and reduce the cost of treating chronic illness in the long run.
“There’s a ton of uncertainty right now,” and “there will be bumps in the road on how it’s implemented,” said Hiltz. “But I think most health care systems are beginning to believe that health care transformation is under way.”
Dr. James Duffee, founder of the Rocking Horse Community Center, provided a for instance: The case of a woman whose cancer is identified and treated early on a pap smear rather than, through lack of access to care, being discovered in an advanced stage in an emergency room visit.
“All the costs and suffering of cervical cancer is eliminated by a simple procedure early on,” he said.
In Duffee’s view, the access to care provided by an expansion of Medicaid “would mean that we take people from the emergency departments and move them into a less costly, more efficient point of care.”
Duffee said Rocking Horse is frustrated because it added a new building to take care of patients anticipating the expansion that hasn’t yet happened.
“We’re ready. We’d like to take care of these people. We’d like to improve the health of the community, (and) offload the burden on the emergency room,” Duffee said. “But we need the legislators to do their jobs.”
Hiltz echoes Duffee in identifying fundamental question in the industry is: “How do we keep people out of high-cost health care?
Although Hiltz said he, too, supports the expansion of Medicaid because caring for all is part of the hospital’s mission, it’s not just care for the poor that’s driving the change.
“The business community and consumers are demanding a new way of doing it,” he said, “a shift from volume to value.”
Hiltz said the changes will require not only early identification of chronic illness but better management of those illnesses — something that also will require a rethinking of health insurance plans.
He said an experiment taken on by a Mercy Health hospital in the Cincinnati area discovered that just by having that person coordinate care for a group of patients whose chronic illness required continual care, “at the end of a year, we found a 30 percent reduction in hospital days and a 50 percent reduction in emergency room visits.”
Despite improving health care outcomes, he said, the approach cost the care system money because of outmoded reimbursement schemes.
Not only did Mercy Health spend $60,000 on a health care manager, it lost money it would have received under the system for the emergency room visits and hospital stays.
“We’re living with one foot in today’s (reimbursement) world and one foot in the future,” he said.
That’s one reason Catholic Health Partners, with which SRMC is associated, acquired Kaiser Permanente in Cleveland and over the next year plans to create an insurance plan that supports the new approach.
Another element of the transformation, he said, is developing and improving of shared electronic medical records systems that puts doctors, hospitals and long-term care and rehabilitation facilities on the same page with one another, and developing cooperative relationships to ensure there is a “smooth hand-off” as patient care shifts from one to the other.
Mercy Health is pursuing all these under its structure as an Accountable Care Organization that seeks to bring as many players in patient treatment into a single network to coordinate that care.
Hiltz said that however the ACA and Medicaid debates turn out, “We’re going to take care of people, period.”
Duffee is adamant that the poor not be left out of the programs that would encourage them to seek appropriate care.
Under the current system, “If you’re poor, you’re sick, you have less access to care and you die earlier,” he said. “That’s it.”
He said that’s the reason he supports both Medicaid expansion and the Affordable Care Act.
“Is it a perfect plan? No.”
But he argued it’s “not only ethically right, morally right, it’s fiscally right” and “moves us toward what I think is the standard of ethical care in all Western developed nations.”
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