We are hearing quite a bit about the transformation of health care, but what does that really mean?
If you are Donald Trump, the presumptive Republican presidential nominee, it is the complete repeal of the Affordable Care Act. If you are the Democratic front-runner, Hillary Clinton, it is modifying the existing platform. Regardless of the interpretation, we are a long way from implementation of any significant policy shifts.
We simply shouldn't delay tackling the challenges right in front of us while the presidential campaign drags on and a new administration sets up shop.
The health-care community has agreed that transformation means improving the quality of the care provided to patients; making wellness and disease management - population health - a priority; and reducing the cost of providing care.
But the old system and rules governing health care will not work with this new health-care model. Meaningful change requires a major shift in approach by all parties involved. Traditional roles and professional boundaries are blurring. Hospitals, physicians, nurses, and other leaders in health care are going to have to embrace new and often threatening strategies that will upset the status quo.
Instead of driving up inpatient admissions, hospitals must successfully drive them down and move more care to outpatient and community settings. Physicians must adapt to new health-care teams that fully recognize the training and authority of other clinical professionals. Nurses must embrace the flexibility in staffing that is essential to ensure timely responses to patient needs. Insurers need to jump on the transparency bandwagon and provide the timely data that can inform crucial care decisions.
The Hospital and Healthsystem Association of Pennsylvania (HAP) has been part of a state initiative, led by the Department of Health, to promote positive health-care changes. This initiative is being called the Health Innovation in Pennsylvania Plan.
HAP and hospital leaders have been working side by side with provider and consumer groups, state agencies, and insurers to address:
Price and quality transparency
Health information technology
We applaud Dr. Karen Murphy, the state health secretary, for her leadership in bringing stakeholders together with policymakers to identify the path to meaningful health-care transformation.
The most complex part of the process is the move from a national system that has historically paid for volume, or the number of patients getting care, to a system that pays for value. Value is determined by quality patient outcomes, appropriate use of medical best practices, and lower health-care costs.
To be successful, we need policies and processes that are coordinated, flexible, and streamlined. We must emphasize the importance of timely data and transparency. We need to modernize the laws and regulations attached to the old delivery system so we can thrive in the new system.
HAP's policy recommendations to transform care focus on five key issues:
Align quality-of-care measures among state, federal, and commercial payers.
Ensure provider access to timely data and information so they can assume risk and manage population health.
Develop alternative value-based programs for rural health-care providers.
Support expansion of tele-health services.
Determine and implement opportunities to integrate physical and behavioral health services.
Holding on to old ways is not an option. Business models, relationships, and agreements developed before the Accountable Care Act (prior to 2010) must be reworked to be responsive in the new world.
Regardless of whether our next president looks to eliminate the current system or modify it, his or her plans will not come to fruition quickly. In the meantime, neither consumers nor the economy can wait. We must own the transformation.
HAP is committed to taking the crucial next steps in the transformation process now. We look forward to working with all stakeholders and state leaders to make the leap to a value-based payment environment, one that improves the quality of care provided to patients; makes wellness and disease management a priority; and reduces the cost of providing care.