‘Too Important to Fail’

While fear-mongering about the ACA’s impact persists, some industry insiders not only believe that clear heads will prevail, they also are providing a strategic roadmap to help corporate America chart a course to better cost-containment and improved healthcare outcomes in a post-healthcare reform environment.

One such example is a cross-section of leaders from high-performance hospitals, clinics and ACOs called the Informed Opinion Leadership Action Group (IOLAG), which recently published a major study of the U.S. workplace suggesting how hospitals and physicians can best prepare for the ACA. The IOLAG – Employer Market Sector employer resource tool entitled, “Necessity Prompts Strategic Adaptation,” was profiled in a 24-page supplement in the January/February 2011 issue of the American Journal of Medical Quality. The group advocates a population health approach to market-based transformation by fixing healthcare on the frontlines.

“The opinions from the national leadership group can be summarized in my view as a clarion call for a renewed commitment to making hard choices that require we abandon the status quo, not just modify it,” said David B. Nash, M.D., MBA, AJMQ’s editor in chief and dean of the Jefferson School of Population Health.

Jason Hwang, MD, MBA, executive director of healthcare at Innosight Institute, praised the IOLAG for offering “motivation and guidance to healthcare leaders who wish to challenge longstanding notions of what comprises a healthcare system and how health services can become convenient and affordable enough such that anyone can access them. ACA is only the latest wakeup call to re-examine our healthcare business models. We cannot afford to hit the snooze button again.”

Dr. Paul H. Keckley, executive director of the Deloitte Center for Health Solutions, perhaps said it best when he noted that “the healthcare industry will thrive because it’s too important to fail.”

A Strategic Vision and Roadmap

America’s employers, hospitals and physicians now face a dramatically different healthcare financing and delivery landscape under the ACA. The U.S. Secretary of Health and Human Services has wide discretion to develop, implement and evaluate new care models that include, but are not limited to, ACOs, a national hospital-physician payment bundling pilot, patient-centered medical homes, reimbursement reductions for “avoidable” readmissions and comparative effectiveness improvements. This effort also includes other criteria for performance excellence execution to improve the economic well-being of companies and achieve value-centric strategic business adaptation alliances.

The ACA will serve as the vehicle by which costs are contained and quality of care is preserved or improved for the estimated 95 percent of Americans who are expected to have health insurance by 2020. Hospitals, of course, are grappling with strategies to determine the best way to care for another 30 million prospective patients who presumably will have access to affordable health insurance. Their response to any overwhelming demand for services will not only affect how care is delivered, but also forever alter the relationship among doctors, hospitals and insurance payers as part of the most sweeping changes in healthcare delivery and financing since the 1960s.

The IOLAG has produced a strategic roadmap to help C-Suite employer executives, physician leaders and various community stakeholders optimize key business and clinical processes that neighborhood hospitals with their physician partners need to redesign for the new delivery and reimbursement environments created by the ACA, including a list of do’s and don’ts.

The IOLAG’s hospital market sector team leader, Dr. James B. Couch, created a set of 17 open-ended questions with the IOLAG’s chairman that were used to obtain input from all co-contributors based on their experiences. The approach was intended to elicit recommendations on how hospitals and physicians would need to change their fundamental way of doing business to evolve, achieve and thrive in the emerging, value-focused group purchasing arrangements and ACO climate created by the ACA.

As healthcare delivery continues to change, one promising path to healthier communities will be through population health improvement tools, techniques and best practices that power “neighborhood cultures of health” and well-being. The IOLAG has suggested that hospitals need to integrate their work with local communities to create these cultures of health through strategic adaptation business alliances and determine how best to meet the highly anticipated increased demand from consumers for their services.

“The aim behind all of this is to reward value instead of volume and intensity by making providers eligible to share in the savings that result if they are able to take steps that reduce overall healthcare costs while maintaining or improving quality of care,” says Dr. Mark McClellan, Director, Engelberg Center for Health Care Reform, The Brookings Institution.

CEOs of hospitals, clinics, health plans and ACOs are at a crossroad. With dramatic opportunities looming on the horizon, leaders are preparing for the uncertainty by understanding how to advance disruptive improvement to ensure lasting success.

The key is to adopt clinical integration criteria strategies to align hospitals’ interests with those of its staff physicians and trusted clinicians to guide insightful decision making and create the most value in a way consumers can use. There is an inextricable link between quality-focused clinical integration criteria and effective healthcare options to help consumers better understand the pros and cons of different interventions in order to make distinctive choices regarding evidence-based treatments in the lifelong continuum of patient-centered care.