It's been a busy couple of weeks for me, on the road at three meetings to better understand all the forces coming at us, and to ensure we are prepared for the future environment.
I thought it might be helpful to summarize for all of us what I have learned. I also want to encourage continued dialogue across the organization on what it means for us: sponsors, board members, medical staff and leaders need to be aligned in our thinking. It's also important for the community to also understand there is a fundamental restructuring going on in health care that also will impact how each of us seeks and receives care in the future.
The American Hospital Association was at St. Joseph's to present the Carolyn Boone Lewis Living the Vision Award for our work in the community. This represented that they see our community engagement to be the first key step in this transformation. Community health starts before the delivery of health services by creating good schools, jobs, healthy environments and community engagement. This goes to the move towards improving the health of our population, rather than just treating illness.
After the award, Rich Umbestock, their CEO, presented to regional CEOs the need to create a new road map, one that moves us from volume based care to a second curve called value based care, essentially moving from fee for services to value based purchasing: tying payment to quality and cost. To read the full report, click here.
The must do strategies he cited for us:
1. Align hospitals, physicians and other providers across the continuum of care
2. Utilize evidence based practices to improve quality and patient safety
3. Improve efficiency through productivity and financial management
4. Develop integrated information systems
5. Joining and growing integrated networks and care systems
6. Educating and engaging employees and physicians to create leaders
7. Strengthening finances to facilitate reinvestment and innovation
8. Partnering with payers
9. Advancing an organization through scenario based strategic, financial and operational planning
10. Seeking population health improvement through the "Triple Aim" (improve the health of the population, improve the patient experience, reduce the costs per case)
Next up was the Hospital Association of New York State where we spent time discussing leadership in this new environment, and what the state is doing to drive change.
The state data clearly is demonstrating that NYS hospitals are at the bottom of state comparisons for margin and strength. Nationally hospitals have a five percent margin; NYS hospitals have less than .5 percent . This is significant because it impacts the ability of an organization to invest in the changes it needs to make for this new world including IT systems, care management and physician models.
The NYS experience is suggesting to go forward:
1. Size and breadth matter, alignment and integration to access capital will be needed
2. Outcomes will be more important
3. Payer mix will impact success in the short term
4. Market size and specialization matter
At the Iroquois Association which represents upstate hospitals we discussed state initiatives that are driving change including: regional health planning, creating vital access provider designations for rural funding, the creation of regional quality collaboratives and launching state innovation models to create analytics and information flow.
Clearly federal policy is impacting state policy which is driving change in our region. So how do we measure up? Generally that can be evaluated in four areas:
Financial Strength: days cash on hand, profitability, capital structure, physical plant. While not at national averages, we score among the best in NYS hospitals however clearly that is not enough for the future environment.
Size and Volume: we will need further alignment to be able to compete in the new marketplace.
Quality Metrics and Evidenced-Based Care: while not where we want to be, our move to a scorecard and accountability on outcomes is driving us all to focus in the right areas. We are making improvement.
The Patient Experience: we have a culture that is patient focused, and working to improve what we do every day. The creation of the Office of the Patient Experience will take us to the next level.
I came home energized that we are focused on the right things and that we will be challenged to go faster and do better. If any organization can be successful in responding to this new environment, it's the incredible team at St. Joseph's!