From caring for our aging population to ensuring the affordability of healthcare to the masses, the rising costs and complexities of administering healthcare are among the nation's biggest concerns.
The general health of our overweight and aging population, advances in medical equipment, training and technology and the cost of prescription medicines have all played a role in the increasing costs of our collective well-being.
In fact, recent estimates from the Centers for Medicare & Medicaid Services show Americans spent over $3.2 trillion on healthcare in 2015. With estimated growth rates of 5.6 percent annually this means the average American will spend more than $10,000 this year on personal healthcare and that figure is widely expected to increase through the year 2025.
According to a recent WalletHub study, the state of Texas ranks at the very bottom in the country when it comes to statewide access to healthcare. The research firm's Best & Worst States for Health Care in 2017 ranked Texas 51st in access and 41st overall. The study, which included the District of Colombia, utilized 35 different measures of cost, accessibility and outcomes to determine their list.
However, the Metroplex stands apart from many of the underserved areas of the Lone Star State with a reputable network of high-performing hospitals. According to US News and World Report five of the best 11 hospitals in the entire state are in the Dallas-Fort Worth area.
Closer to home, residents in and around Southlake enjoy access to an ever-expanding network of locally-based retail healthcare ranging from free-standing emergency rooms, health clinics and outpatient specialty hospitals.
To help provide some insight on the state of healthcare on a national and local scale, we posed several questions to the presidents of three of the area's top hospitals. The presidents of Texas Health Harris Hospital Southlake, Baylor Scott and White Grapevine and Methodist Southlake were kind enough to lend their opinions. Collectively these three presidents offer decades of industry experience and just as importantly, an understanding of what's going on right in our own backyards.
1. What are the overarching trends that are transforming the U.S. healthcare market?
Steven R. Newton, President Baylor Scott & White: There are many trends of note today, including regulatory uncertainty, the rise of consumerism, the focus on “well care” in addition to “sick care,” and industry disruption by Amazon and mega mergers by surprising partners like the proposed CVS and Aetna deal. One of the most interesting trends affecting healthcare today is development of new technology that (1) helps consumers monitor and change their health and wellness behaviors, (2) helps patients have shorter and safer hospital stays, and (3) helps patients connect with doctors and other providers via computer and smart phone.
Traci Bernard, President Texas Health Harris Methodist Hospital Southlake: Telemedicine/Telehealth services such as video-conferencing are becoming cost effective ways to complement local health services. It is particularly beneficial to those living in rural, regional and remote communities and requiring regular access to medical specialists.
The payment landscape is shifting under the U.S. health care industry. Traditional fee-for-service payments are being replaced with a financial incentive framework that rewards for improved quality, outcomes and costs. This shift to value-based reimbursement models creates a new paradigm in which care is delivered by an entire coordinated care community sharing in the responsibility. While the law directly impacts only Medicare payments today, it lays the groundwork and provides strong incentives for other payers to move in the same direction.
John McGreevy, President Methodist Southlake Hospital: Without a doubt, the Affordable Care Act has brought a major transformation since the late 1980’s. This has contributed to consolidation (mergers and acquisition) of healthcare in the United States between health systems and hospitals, drug companies, health plans, device manufactures and other healthcare entities. It is the general consensus that health systems and hospitals needed to become larger in order to effectively manage large populations through the exchanges and fewer health plans.
2. In today's high-priced healthcare market, how can hospitals and physicians provide consumers with the best possible value?
SN: All of us must be committed to delivering health care at the lowest achievable cost and the highest quality. These goals go hand in hand if managed carefully. For example, it is essential that doctors and hospitals work together to provide care based on clinical evidence, collaborate to eliminate unnecessary services and reduce delays in care and other forms of waste, and become accountable for the outcomes of care.
TB: As trends collide, they create challenges for the industry stakeholders as well as opportunities for innovation. There is a shift in the spectrum of care from hospitals to lower cost sites. Texas Health Resources is committed to wellness and preventative care; shifting disease management from reactive to preventative. We are committed to personalized care and shifting offerings from mass generalization to mass customization and precision. Finally, there is a shift on the management of the aging, chronic and end of life care. This requires a shift in focus from institutionalized based care to community-supported aging, and leveraging big data and personalizing to manage chronic conditions.
JM: Improving access at the right place and the right time with the continued focus on quality, demonstrated through reporting of standards. Generally speaking, this will require the inclusion of the healthcare consumer for the purpose of making an informed decision. Idealistically, this will require steering patients away from hospitals, which is most costly for the healthcare consumer. The common practice today is to work with chronically ill patients through a healthcare navigator program to seek proactive management of such afflictions as diabetes, chronic pulmonary disease, heart disease and more. The continued collaboration between hospitals, physicians and insurance plans is required for this model to succeed.
3. How is the delivery of health care by hospitals going to change over the next few years?
SN: Hospitals will always have a vital role in the healthcare ecosystem. Caring for the critically ill and injured and those with advanced illnesses like cancer and heart disease will always require a team of highly-qualified experts to be ready and able 24 hours a day. Increasingly, though, many elective procedures that used to be done in the inpatient setting will be done as in an outpatient environment, as this can be safe and less costly thanks to innovation in care delivery.
TB: The healthcare landscape has shifted, moving toward consumer centric care and overall population health management. Adapting to the needs and wants of the consumer (convenience, timeliness, quality) has created opportunities for improved coordination of care, which has led to increased quality and decreased cost. Additionally, we saw a retail health and wellness convergence amongst retail clinics, urgent care centers and the like, causing more of a collaboration between these two industries.
JM: One constant about healthcare has been the change brought about by the federal government through regulations in Medicare and Medicaid. Hospitals tend to be driven by the enactment of rules and regulations governing the Medicare program. We have witnessed a paradigm shift with the proliferation of “retail” healthcare like freestanding emergency centers and ambulatory surgical centers. The “Amazonation” of driving the healthcare consumer to outpatient centers will continue for ease of access, resulting in further migration away from tertiary care health centers. Furthermore, health insurance companies are beginning to increase the scrutiny of healthcare costs through resisting the use of hospital-based services for their beneficiaries.
TB: There is also an increase in privately insured adults enrolling in Consumer Driven Health Plans (CDHP) with health savings accounts or other reimbursement arrangements. Others are also enrolling in high-deductible plans (HDHP) not linked to a health saving plan or a health reimbursement plan. It is common for employers to contribute to a Health Savings Account. Individuals in these types of plans were more likely to exhibit cost conscious behaviors. They are also remaining in these plans for extended periods of time. The viability of these plans has increased, as has employer contributions. Which ultimately points towards higher rates of wellness program availability and participation.
4. Describe how value-based reimbursement is impacting hospitals:
SN: Value-based reimbursement simply links payment to outcomes. Medicare, for example, withholds payment from hospitals if too many patients are readmitted within 30 days of discharge. In healthcare, like other industries, innovation often follows funding changes. As a result, new readmission avoidance programs are being implemented to help patients stay healthy after they leave the hospital. In this situation, everybody wins.
TB: The payment landscape is shifting under the U.S. health care industry. With the volume-to-value transformation, traditional fee-for-service payments are being replaced with a financial incentive framework that rewards for improved quality, outcomes and costs. This shift to value-based reimbursement models creates a new paradigm in which care is delivered by an entire coordinated care community sharing in the responsibility—and risk—of outcomes and costs, touching almost every part of health care delivery operations.
JM: The impact has been minimal, as the costs to implement this system compared with the overall benefits to the consumer have not been in line. National healthcare statistics reflect that less than 20 percent of hospitals nationwide have a concerted-effort on value based payment models. Statistics aside, hospitals and health systems will continue to pursue the value-based models while experimenting with other alternatives.
5. How is your hospital investing to meet the needs of the community?
SN: Our hospital has long been committed to listening to community needs and responding with exceptional programs. Recently, for instance, we became the only level 2 trauma program in Northeast Tarrant County and opened a new inpatient rehabilitation unit. Our community said “We want advanced trauma and rehab care right here in our neighborhood,” and we delivered. We are always looking for ways to reach more, do more, serve more. It’s who we are.
TB: The specialty hospital model is part of the shift in care from the traditional hospital model to a lower-cost site. Our focus is on surgery and the necessary support services. With a focus on doing one thing, we are able to provide a high level of care and service more efficiently and effectively. We have been committed to investing in the latest technology to maintain our current service lines. Strategically, we continuously monitor the growing needs within our community, while responding by adapting appropriately.
JM: Investments have been predominantly two-fold. One: retail healthcare centers, joint ventures with physicians, and innovative healthcare services that are mainstream in other industries; and two: major investment in Enterprise-wide electronic health records (EHR). They provide the hospital staff, physicians and other healthcare providers to practice medicine in an incredibly efficient manner through the electronic sharing of clinical records, which reduces the overall work effort. In addition, web-based portals allow patient access to their records for improved transparency.
Steven R. Newton
President, West Region
Baylor Scott & White Health
· 13+ years as President within the Baylor Healthcare System
· Holds a Masters Of Public Health (MPH) – Yale School of Public Health
Traci Bernard
President
Texas Health Harris Methodist Hospital Southlake
· 12+ years as acting president
· 20+ years of clinical and management experience
John McGreevy, CPA, FHFMA
President
Methodist Southlake Hospital
· 8+ years as a hospital CEO
· Member of the American College of Healthcare Executives