Hospital Impact: Trump administration should stay the course on transition to value-based care

http://www.fiercehealthcare.com/hospitals/hospital-impact-it-s-vital-to-stay-course-value-based-care?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTWpVM05HSm1PR0ZoTnpFMiIsInQiOiJUYjRHejhMZWNReUgrWjZDN1N6ZHhzU3NVSXlrZ2UrTk1lQWtiU1g2TFlBSHdXcHhwXC9sdFo4bFMwaklKaFRKSnZqMmNoV0I1dnNoT0czRDA4QWNoekNCeGZiV2JFYUZVdkdvWkY2UVVjYWFGTTRGOXhzSUlcL2xldkgzYzhoTWVOIn0%3D

Signs saying healthcare reform

As a practicing physician for more than 30 years, I have seen a number of changes occur in the healthcare industry. None of these changes have been as significant as the current transition from fee-for-service to value-based care.

It is no secret that with the price tag and inefficiencies, the current U.S. healthcare system is unsustainable. The traditional fee-for-service model, which focuses on treating acute conditions and rewards providers based on the number of services they provide, no longer works. Fortunately, the industry is shifting toward value-based care, which focuses on prevention and wellness and rewards providers for keeping people well and out of the hospital.

Major health systems like Greenville Health System (GHS), of which I am a part, are slowly but surely making the transition from volume- to value-based care. This type of transition is a huge undertaking and further complicated by the fact that the industry as a whole has not made the transition yet.

It’s as if we have one foot in the canoe and the other on shore. We are preparing for a future that has not fully arrived, but it is one that we are betting on because we believe it will have a tremendous impact on the health of our nation.

 

Five-year decline in hospital-acquired conditions leads to $28B in savings

http://www.fiercehealthcare.com/healthcare/five-year-decline-hospital-acquired-conditions-leads-to-28b-savings

Fewer patients have died due to hospital-acquired conditions over the past five years and hospitals saved more than $28 billion in healthcare costs during the same time period, according to a new federal government report.

The U.S. Department of Health and Human Services credits the 21 percent decline in hospital-acquired conditions in part to the provisions of the Affordable Care Act.

“The Affordable Care Act gave us tools to build a better healthcare system that protects patients, improves quality, and makes the most of our healthcare dollars and those tools are generating results,” said HHS Secretary Sylvia M. Burwell in the announcement. “Today’s report shows us hundreds of thousands of Americans have been spared from deadly hospital-acquired conditions, resulting in thousands of lives saved and billions of dollars saved.”

Indeed, the report, “National Scorecard on Rates of Hospital-Acquired Conditions,” by the Agency for Healthcare Research and Quality, finds that roughly 125,000 fewer patients died during 2010 to 2015. In total, hospital patients experienced more than 3 million fewer hospital-acquired conditions, such as adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers and surgical site infections, during that time period.

Q&A: Cleveland Clinic CEO to Join Trump Advisory Panel

http://www.healthleadersmedia.com/leadership/qa-cleveland-clinic-ceo-join-trump-advisory-panel?spMailingID=10066722&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1061461419&spReportId=MTA2MTQ2MTQxOQS2

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Toby Cosgrove, MD, discusses his concerns about the regulatory burdens on healthcare providers ahead of serving on the president-elect’s “strategic and policy forum.”

This is the first in of a series covering the Shaping of Healthcare’s Future in the Trump era. As the new administration prepares to take office, HealthLeaders Media will continue to talk with healthcare leaders about the challenges and opportunities for the industry that lie ahead.

The single voice representing healthcare on President-elect Donald Trump’s “strategic and policy” forum belongs to Delos “Toby” Cosgrove, MD, president and CEO of the Cleveland Clinic.

Although details about what the group will discuss in its monthly in-person meetings are not yet known, Cosgrove says he’s honored by the selection and humbled that he will be able to represent healthcare to the president.

Forum members are charged with offering insights on how government policy impacts economic growth, job creation and productivity. The 19-member group will bring together leaders from business, finance, and technology and is scheduled to start its meetings in February, after the inauguration.

Following is a lightly edited transcript of a conversation between Cosgrove and HealthLeaders Media on his thoughts about the group and its purpose.

Nonacute Care: The New Frontier

http://www.healthleadersmedia.com/leadership/nonacute-care-new-frontier?spMailingID=10066722&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1061461419&spReportId=MTA2MTQ2MTQxOQS2

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What happens outside the hospital is increasingly important to success, so healthcare leaders need to influence or control care across the continuum.

If you’re running a hospital, one irony in the transformation toward value in healthcare is that your future success will be determined by care decisions that take place largely outside your four walls. If you’re running a health system with a variety of care sites and business entities other than acute care, the hospital’s importance is critical, but its place at the top of the healthcare economic chain is in jeopardy.

Certainly, the hospital is the most expensive site of care, so hospital care is still critically important in a business sense, no matter the payment model. But if it’s true that demonstrating value in healthcare will ensure long-term success—a notion that is frustratingly still debatable—nonacute care is where the action is.

For the purposes of developing and executing strategy, one has to assume that healthcare eventually will conform to the laws of economics—that is, that higher costs will discourage consumption at some level. That means delivering value is a worthy goal in itself despite the short-term financial pain it will cause—never mind the moral imperative to efficiently spend limited healthcare dollars.

So no longer can hospitals exist in an ivory tower of fee-for-service. Unquestionably, outcomes are becoming a bigger part of the reimbursement calculus, which means hospitals and health systems need a strategy to ensure their long-term relevance. They can do that as the main cog in the value chain, shepherding the healthcare experience, a preferable position; but physicians, health plans, and others are also vying for that role. Even if hospitals or health systems can engineer such a leadership role, acute care is high cost and to be discouraged when possible.

Catholic Health Initiatives pulls out of insurance business

http://www.fiercehealthcare.com/healthcare/catholic-health-initiatives-pulls-out-insurance-business?utm_medium=nl&utm_source=internal&mkt_tok=eyJpIjoiTmprM1ptSXlNVEE0WWpCaCIsInQiOiJJd24rWE1HUTl5THZuZTRuaHJMOVViMlI2MFJwcSs4Q0hyaXFlcVJHc2J5WWhucGdmVkRQem9jM1dcL2NrVitKQStmdFZSeXVvMkp1S21qNWE4bHVcLzB6akJCOVAxRzROV2JcL3ZNbFFveVI5R2owbGRHdncwemtOWUpaaG8xVHhXMyJ9

Executive looking out window

As more hospitals across the country consider launching their own health insurance plans, one big hospital operator is pulling out of the business.

Catholic Health Initiatives (CHI), a large nonprofit health system based in Colorado, no longer plans to develop a “wholly owned and nationally driven” insurance business, according to The Wall Street Journal. Instead, it’s going to sell portions of the health insurance business.

The provider, which operates 103 hospitals in 18 states, lost nearly $110 million during the last fiscal year, according to the article.

Dean Swindle, chief financial officer and president of its enterprise business lines for CHI, didn’t agree to an interview for the latest news,  but told the publication in April that “it’s tough in the health plan business. You lose money. You make mistakes. You plow forward. It takes cash.”

Why Catholic Health is bowing out of the insurance field

http://www.healthcaredive.com/news/why-catholic-health-is-bowing-out-of-the-insurance-field/421923/

Dive Brief:

  • Tired of steep losses, Catholic Health Initiatives is looking to sell its health plan subsidiary, Modern Healthcare reported.
  • QualChoice Health, previously known as Prominence Health, sells Medicare Advantage and commercial plans to employers in six states.
  • CHI began buying up health plans three years ago as a way to adhere to the Affordable Care Act and compete with other carriers.

Uncertainty. Opportunity. It’ll all be there for healthcare in 2017, PwC says

http://www.healthcaredive.com/news/uncertainty-opportunity-itll-all-be-there-for-healthcare-in-2017-pwc-sa/432384/

You reap what you sow. The idea is the push behind countless movie plots and rock songs but it’s also a central theme to PricewaterhouseCooper’s (PwC) Health Research Institute’s (HRI) new report on healthcare trends to watch out for in 2017. The seeds for next year were planted in 2007, according to the new report.

There will be certain uncertainty over the fate of the Affordable Care Act next year. However, many of the trends that should be on top-of-mind for hospital administrators next year will relate to value-based care, Trine Tsouderos, PwC’s Health Research Institute director, told Healthcare Dive. “If you think about the political changes as the waves on the surface of the ocean, there’s a very strong current underneath that is the shift to value-based care,” she said. “We do not see that changing. We see the shift continuing industry-wide despite any changes in Washington, DC.”

For example, only 90 or so retail clinics were in operation and about one in 10 consumers have been to one in 2016. Today, more than 3,000 such clinics have been propped up across the U.S. with one in three consumers having visited one. This drift highlights the continued move to more convenience in healthcare access as well as price transparency for patients.

Sticking with the nautical theme, Tsouderos likened the healthcare industry to a battleship in explaining why ideas from 10 years ago are now coming to fruition. It takes a long time to change the course of such a large and complex ship. “You can’t turn [the industry] on a dime,” she said.

What emerging trends administrators should know for 2017

https://www.pwc.com/us/en/health-industries/top-health-industry-issues.html

 

Trend to watch: Payer-provider joint ventures

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/trend-watch-payer-provider-joint-ventures?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=14122016

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Joint ventures are gaining steam as plans and providers look for ways to work together to provide higher-value care.

Anthem and Aurora Health, Anthem’s Vivity, Aetna’s Inova, Presbyterian Health Services in New Mexico, and now Aetna and Texas Health Resources—all of these organizations and partnerships combine the strongest skills of a payer and a provider.

These partnerships allow providers to lean on the analytical and actuarial power of the payers, while focusing on improving health outcomes.

CopelandAbout 13% of all U.S. health systems offer health plans, covering about 18 million members—or 8% of insured lives. according to a report from McKinsey & Company. Also according to the company, the number of provider-owned health plans is increasing about 6% each year.

Bill Copeland, vice chairman of Deloitte and leader of the company’s U.S. Life Sciences & Health Care industry group, says payers aren’t usually as effective as providers at working with patients, and providers don’t have the necessary capital to fully invest in high-value care. Joint ventures that marry the strengths of both parties have mutual benefit and should result in lower overall costs with better patient outcomes.

Building A System That Works: The Future Of Health Care

http://healthaffairs.org/blog/2016/12/12/building-a-system-that-works-the-future-of-health-care/?utm_source=RealClearHealth+Morning+Scan&utm_campaign=4e312288c8-EMAIL_CAMPAIGN_2016_12_12&utm_medium=email&utm_term=0_b4baf6b587-4e312288c8-84752421

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Nearly a century after Theodore Roosevelt’s Bull Moose Party first called for health insurance reform, the United States has made major advances in access, quality, and affordability.

In the six years since President Obama signed the Affordable Care Act (ACA) into law, 20 million more people have health insurance, and, for the first time in our history, more than nine out of every 10 Americans are insured. Growth in both premiums for employer coverage and overall Medicare spending has also slowed. The Centers for Medicare and Medicaid Services’ Actuaries now project that we are on track to spend $2.6 trillion less over the ACA’s first decade than was projected without the ACA back in 2010.

Even with this slow down, any increase in costs can be challenging for businesses monitoring expenses or families working through their budgets. That’s why stakeholders nationwide have been coming together to reshape the future of health care. Using new advancements in data, medicine, and the tools and resources provided by the Affordable Care Act, institutions across the country are building a health care system that works better for all Americans.

This work has gone on steadily for years — through political turmoil and challenges in the courts. Yet through each challenge, these reforms have endured.

They must continue to endure. The 20 million Americans who gained coverage cannot lose it again. The more than 129 million people with pre-existing conditions do not want to go back to a time when insurers could discriminate against them, or block them from coverage. Eleven million Medicare Part D beneficiaries cannot afford to lose the $2,000 they have each saved, on average, from the law’s work to begin closing the “donut hole.” The American people do not want to turn back our nation’s progress. Improvements need to be made, but they need to build on progress and not take us backwards in terms of access (the number of insured), affordability (costs to individuals, businesses, and taxpayers), and quality (the benefits that are being provided).

As the Obama Administration comes to a close, this piece lays out my vision for the future of health care. I share the steps we have taken to change how we pay for health care, incentivize coordination, and unlock health care data. This is the path forward—a system where innovative actors are putting the patient at the center—and, despite differences in health care, I firmly believe it is a vision on which we can all agree.

Pence says Trump plans to repeal ACA right ‘out of the gate’

http://www.beckershospitalreview.com/hospital-management-administration/pence-says-trump-plans-to-repeal-aca-right-out-of-the-gate.html

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President-elect Donald Trump has decided repealing the ACA will officially be among his top priorities when he takes office, Vice President-elect Mike Pence told Chris Wallace on Fox News Sunday.

“Decisions have been made by the President-elect that he wants to focus out of the gate on repealing Obamacare and beginning the process of replacing Obamacare with the kind of free market solutions that he campaigned on,” Mr. Pence said on Fox News.

The Trump-Pence transition team has been working with congressional leaders from both political parties to move Mr. Trump’s “aggressive policy agenda” forward, Mr. Pence said. This weekend Mr. Pence met with Senate Minority Leader Chuck Schumer, D-N.Y., Senate Majority Leader Mitch McConnell, R-Ky., House Minority Leader Nancy Pelosi, D-Calif., and House Speaker Paul Ryan, R-Wis., according to the interview.

Later on the show, Fox News spoke with Sen. Schumer, who said the ACA is one of the issues on which Democrats plan to “oppose [Mr. Trump] tooth and nail.” Sen. Schumer said Mr. Trump would not be successful in his efforts to repeal the healthcare reform law.

“He won’t be able to do it, because now even he, after his meeting with President Obama, said, ‘Oh, I want to keep the good things.’ Well, you can’t keep the good things without keeping [the] ACA,” Sen. Schumer told Fox News.

Scott Becker, publisher of Becker’s Hospital Review, says it is still unclear if Mr. Trump can or will be able to push through an ACA repeal. “It’s a fascinating statement because it’s not clear Republicans have the votes to repeal this without making complicated accommodations on a few levels, particularly for preexisting conditions and some funding issues,” Mr. Becker says.