BLOOMINGTON — Health care systems are evolving from a focus on treating sick people in the hospital to managing peoples’ health.
It’s not just the right thing to do. They are following the money.
Under the Affordable Care Act, health care providers may be rewarded if they demonstrate better health outcomes at lower costs.
OSF HealthCare, Advocate Health Care, and Hospital Sisters Health System (HSHS) have been transitioning to the new model for several years.
“Long before the law was passed (and before incentives to coordinate care), we’ve been active in changing how care is delivered,” said Tim Eckels, an HSHS vice president. HSHS includes St. Mary’s Hospital in Decatur, St. Anthony’s in Effingham and St. John’s in Springfield.
“The key to keeping patients out of the hospital is a good thing,” he said.
“We’ve been working on the Affordable Care Act goals with our partners,” said Colleen Kannaday, president of Advocate BroMenn Medical Center in Normal and Advocate Eureka Hospital in Eureka.
“When the act passed in 2010, we didn’t wait,” she said. “Our perspective was, ‘We’re going to embrace this and create a model.’”
A step in that direction by Advocate has been creating an Accountable Care Organization (ACO) in partnership with Blue Cross.
OSF’s Pioneer ACO has been in cooperation with the Centers for Medicare & Medicaid Services. Goals are to provide more coordinated care for Medicare beneficiaries.
OSF reported recently that — after the first year of its ACO — care for patients with chronic medical conditions included in the ACO had improved while costs decreased 1 percent.
“As we have more success, we will have a healthier population,” said Ken Natzke, CEO for OSF’s Bloomington-based Eastern Region.
“In the old world, doctors and hospitals were paid more if they did more,” said Kannaday. In the new model, doctors and hospitals that demonstrate they are providing quality care at a lower cost are rewarded financially, she said.
Health care systems are operating in both worlds.
Advocate Physician Partners — which includes Advocate Medical Group doctors and some independent physicians — have joined Advocate hospitals in initiatives focused on keeping people healthy. Included are: reserving some physician appointment times for same-day appointments; expanding hours for doctors’ offices; encouraging doctors to prescribe generic medicines; and adding case managers in some larger offices who stay in contact with patients with multiple diagnoses to ensure they are on top of their health and another in the BroMenn emergency department who helps coordinate care for patients who need special help after being discharged.
OSF also has initiatives — such as flexible scheduling — to improve access to primary care physicians, Natzke said.
Results have been improved health and more cost-efficient health care, administrators said.
“If you can reduce emergency department visits, admissions and re-admissions, you can reduce the cost of providing care,” Kannaday said. “We have demonstrated that for the last three years.”
Acute care in hospitals won’t go away. But as the focus continues to shift to outpatient services, so too will health care systems’ employment base.
“We built at the right time,” Kannaday said of Advocate BroMenn’s addition that opened in 2012. “Going forward, we will see less investment nationwide in the inpatient setting.”
However, Advocate Eureka is planning to replace its two operating rooms and to provide private rooms for all inpatients, she said.
Marketplace impact
Decatur Memorial Hospital isn’t expecting major immediate changes as the Health Insurance Marketplace opens on Tuesday and coverage under the exchange and expanded Medicaid begins Jan. 1, said CEO and President Ken Smithmier.
The hospital, which has about 2,000 employees, has cut about 300 positions in recent years, but Smithmier isn’t anticipating more staff reductions.
Kannaday and Eckels also aren’t expecting significant changes for their hospitals in 2014, but gradual change over the next few years.
Natzke estimated OSFSt.JosephMedicalCenter will experience a 10 percent ($1 million) decline in charity care and bad debt with more patients on Medicaid and the exchanges. The hospital’s yearly operating budget is about $300 million.
“But the big unknown is what will happen Jan. 1 when people wake up with insurance for the first time,” Natzke said. “I don’t think we’ll see any massive change in peoples’ (health care) behavior overnight. People are getting health care now, whether it’s paid for or not.”
“We’re not expecting a huge rush,” Eckels agreed. “There will be a lot of confusion for a while. We think enrollment will be fairly gradual, allowing us to manage as it happens.”
Natzke said, “As we get more embedded in population management, we anticipate a lower demand on the emergency department. Hopefully, most of our newly covered individuals will get lined up with good primary care coverage.”
Eckels also anticipates fewer people using the emergency department as more people get health care before their illnesses become acute.
At Decatur Memorial, Smithmier isn’t expecting a decline in emergency department visits, saying, “I don’t see that changing.”
Advocate and OSF medical groups’ offices accept patients on Medicaid and, with the Affordable Care Act, the number of people on Medicaid will increase. Advocate, OSF and HSHS Physician Group have been adding primary care physicians.
People will turn more to doctors’ offices and clinics, putting more pressure on those services, Eckels said.
“It’s something we’ll have to manage,” he said.
“Patients have been getting care,” Kannaday said. “Our hope is that more of them will find a medical home and their care will be better managed.”
“The health care system clearly was not sustainable,” she added. “By partnering with physicians and hospitals and payers, we can create a health care system to propel us the right way into the future.”
Source: pantagraph.com