In Tarrytown, home health care advocate Joanne Cunningham had two words to describe the nation”™s health care industry in this time of transition. “Chaos and anxiety,” she said.
Cunningham, president of the Home Care Association of New York State, was a panelist at the Westchester County Association”™s recent annual health care reform summit, which looked at how the industry is managing reforms driven by the federal Affordable Care Act of 2010 and at how employers can reduce their costs for health care as public insurance exchanges are due to open by 2014.
Cunningham”™s opening comment drew knowing nods and smiles from some in the audience. Other speakers described the unfolding shifts in health care delivery, insurance coverage and pay models as both a “challenge” and “opportunity” to care providers, insurers, employers and employees. Many emphasized a need to focus on wellness and prevention programs that reward and make individuals personally responsible for their health and healthy behavior.
In the effort to improve health and cut medical costs, “We have to figure out ways to meaningfully engage the patient and the patient”™s family,” said keynote speaker Emme Deland, senior vice president for strategy at New York-Presbyterian Hospital. The patient”™s role is important in curbing diseases and treatment related to obesity, smoking, drinking, bad diet and lack of exercise, she said.
“We can”™t talk about obesity too much,” said Joel Seligman, president and CEO of Northern Westchester Hospital. “This is a nightmare that we”™re paying for.” He and other speakers cited a recent report indicating that more than half of Americans could be obese by 2030, resulting in millions of new cases of disease that could cost the U.S. up to $66 billion in treatment and more than $500 billion in lost economic productivity.
“The challenge is getting people to participate in these (wellness) programs,” said John Caby, vice president of provider engagement and contracting at New York Empire BlueCross BlueShield, which is ready to roll out its new patient-centered care model for small physician practices in New York. He said employers and insurers need to “incent” health plan subscribers to pay attention to their well-being.
Caby noted that health care expenses total about $2.7 trillion annually in the U.S., of which an estimated $900 million is wasteful spending. “We need to lower the cost of health care,” he said. “That”™s the challenge that we have and that”™s the opportunity that we have. We”™re at the tipping point, and the tipping point can go either way. The challenge is to transform this system into a collaborative system. That means change in every aspect.”
To improve quality of care and reduce spending, Caby said Empire BlueCross Blue Shield is willing to share data on plan members with physicians and wants to combine its clinical and laboratory data with clinicians”™ electronic medical records for patients. He said “relationships” must be forged between insurance carriers and care providers.
A global leader in employee health care, IBM Corp. “views health as a differentiator” that distinguishes the company from competitors when recruiting top employees, said Kyu Rhee, vice president of integrated health services at IBM. The company spends $2.5 billion to $3 billion annually in health benefits design services, focusing on quality, cost and innovation, he said.
Offering financial incentives to U.S. employees for the last 10 years, Rhee said 90 percent of employees take part in the company”™s wellness initiatives.
On a global scale, “We”™re pushing the marketplace to be investing in primary care and prevention,” said Rhee. “There”™s a lot of unnecessary waste and repeat procedures and malpractice issues that go away” if attention is paid to primary care.
But the increased demand for primary care physicians has not been met by an increased supply of lower-paid doctors from medical schools.
“I can”™t find talented primary care doctors anymore,” said Dr. Scott Hayworth, president and CEO of the 280-physician Mount Kisco Medical Group. The multispecialty practice is offering signing bonuses to primary care doctors, he said.
“I think that”™s going to be a real problem for America, that there just are not enough primary care doctors,” said Hayworth.
Voicing a view shared by several speakers, Hayworth predicted the transition from a health care payment system based on fees for services provided and capitation rates to value-based pay “is going to be tough. We have to figure out how to take care of more patients with less money. It”™s going to be a challenge.”
Hayworth said the high costs of medical malpractice insurance and malpractice lawsuits must be addressed. “Unless we get liability in this country under control, there”™s no way we”™re going to save money,” he said.
Michael Irwin, managing director of health care investment banking at Citigroup Inc., said the “enormously challenging” transition already has begun to drive consolidations among hospital and health systems, physician and medical groups and managed care companies. Across the health care industry, “There are a lot of very strange new partnerships,” he said, and private equity “plays a huge role in all of that.”
“Increasingly I think you”™re going to be looking at national players,” said Irwin. “What impact that will have on Westchester and the area is a very good question.”
Kevin Dahill, president and CEO of the Northern Metropolitan Hospital Association and the Nassau-Suffolk Hospital Council, said more hospital consolidations in New York and the entry of national for-profit hospitals into the state likely are “inevitable.” But he warned that “one size doesn”™t fit all” in the region”™s diverse suburban communities.
“It”™s not so easy to reposition your organization without giving strong consideration to your local community,” Dahill said. With consolidation, “We have to remain responsible to those communities at the same time.”
Amid the talk of the many challenges ahead, Citigroup”™s Irwin sounded a note of optimism. “I”™m very confident that enlightened self-interest will get us to where we need to be at the end of the day,” he said.
