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St. Joseph's Hospital Health Center

Advancing Excellence

Jan 20 2014
Financing Health Care
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The New York Times has another lead story this morning on the cost of health care. The theme continues to be that we cost too much. The writer suggests we maximize charges to benefit providers and organizations, and not what's best for patient care.


We are organized as a health system to respond to payers and regulators. If we can't be reimbursed for care, we can't provide it. So it's easy to blame providers, but we reflect the way the system is organized. That's about to change.


Medicare, New York State Medicaid and private insurers are moving us all toward the value proposition -- high quality, coordinated care at a set price.


The implications are clear:


  • A strong information system must be in place to coordinate care, reduce repeat and unnecessary tests and reduce the overall cost of care.
  • Patient satisfaction, patient centered care and patient input into care must be central.
  • Quality and safety are key, and evidenced-based care is the foundation of this new system. Basic assumptions on how to manage chronic disease must be followed. As airline pilots learned, there must be common standards followed every day in every plane to fly properly. Health care must also adopt evidenced-based guidelines.
  • Care management, connecting all the pieces of care, to ensure good outcomes goes hand in hand with health care reform.What happens overall is affected by the level of education and coordination received in the primary care office, hospital or nursing home.





While the cost of care is not declining, reimbursement will and we must reconcile these two trends.


It will happen by reducing unnecessary care, repeat tests, readmissions, improving quality and safety, and providing care in the right setting. The point of the Times article this morning is we have shifted care to higher cost settings that must now be reversed. The consequences are substantial to the finances of providers and systems. But there is a way through this.


This week at the opening of the St. Joseph's Primary Care Center - West, a few moms came up to me and said, "Does this mean I won't have to call a Medicaid taxi and then go to the emergency room for care? I will be able to access care nights and weekends in my own community?" Yes. We have co-located primary care, mental health, pediatrics, obstetrics, lab and radiology in the community. Why? To provide the right care at the right time in the right place. It will shift care from the emergency room to the community. 


This all works only of we can actually make these changes. It will for a period of time put great pressure on all systems to make investments to change the way care is provided, while reducing overall costs of care. It will require us to fundamentally rethink how providers and institutions engage in this work.


St. Joseph's is fully engaged in this future vision by investing in a new information system, establishing navigators and health home case managers, expanding primary care and engaging with our medical staff, Excellus, and New York State to develop a new model of financing. 



It won't be easy, but others have gone before us and we will learn from those experiences. Interesting work ahead!


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