Top 10 Integrated Care Headlines for 2015

Innovation and transformation of our healthcare system continues at a frenetic pace. In case you missed them, here are, in our opinions, the top 10 most important integrated care headlines for 2015, in ascending order of importance.

10. Boeing Negotiates Directly With More Health Systems

With support from the Catalyst for Payment Reform, Boeing takes the bold step of foregoing the insurance process and directly contracting with an ACO in a shared-risk contract for Boeing’s 49,000 benefit-eligible employees and retirees.

Notable quote: “Boeing approached health systems looking to contract and successfully pushed for ‘very detailed’ performance targets, said Donn Sorensen, president of Mercy’s operations in eastern Missouri. ‘If they can do one thing, they can procure,’ he said. ‘They are very data-driven.'”

Source: Melanie Evans, Modern Healthcare, August 4, 2015

9. Assuring Hospital Emergency Care Without Crippling Competition

Author Christopher Pope opines how restructuring of the economic model for ED care inadequately ensures the provision of emergency capacity and care for the uninsured, while undermining the ability of specialty hospitals and physician offices to compete for the provision of elective care.

Notable quote: “By consolidating…subsidies into lump sum budgets for indigent emergency care at each facility, it would be possible to reward hospitals for efficiently meeting their critical infrastructure and uncompensated care responsibilities, without hampering competition in the market for elective services."

Source: Christopher Pope, Health Affairs, July 6, 2015

8. Humana Explores Sale That Would Shake Up Health Insurance Industry

In the first of many reports of payer merger and acquisition activity, this piece details how this proposed sale is structured and what it could mean to payers and providers alike.

Notable quote: “Aetna and Cigna have both stated they want to increase their Medicare membership. Jeffrey Loo, an equity analyst at S&P Capital IQ, said he would include Anthem in the mix of suitors as well.”

Source: Bob Herman, Modern Healthcare, May 29, 2015

7. Paramedics Steer Non-Emergency Patients Away From ERs

USA Today and Kaiser report on the Healthcare Innovation Award grant to Reno’s Regional Emergency Medical Services Authority community health program.

Notable quote: “Ramsdell and others…spent 150 hours in the classroom and with clinicians learning how to provide ongoing care for patients. Before the grant, Carter said the only option for intoxicated patients was the emergency room or jail.”

Source: Anna Gorman, USA Today and Kaiser Health News, May 18, 2015 

6. Overkill

Prominent physician Atul Gawande chronicles the results from the IOM report analyzing 2010 healthcare spending data and identifying $750 billion the U.S. spent in wasteful care.

Notable quote: “Right now we’re so wildly over the boundary line…that it’s hard to see how we could accept leaving healthcare the way it is.”

Source: Atul Gawande, The New Yorker, May 11, 2015

5. 2016 IPPS Proposed Rule: 10 Points to Know

Ellison highlights the main provisions of the 1,500-page CMS proposed rules for the Inpatient Prospective Payment System, which also includes rules for long-term acute care hospitals.

Notable quote: “In the proposed rule, CMS recommended adding eight new measures (five clinical episode-based payment measures, one patient safety measure, and two coordination-of-care measures) for the FY 2018 Inpatient Quality Reporting program and subsequent years.”

Source: Ayla Ellison, Becker’s Hospital Review—Finance, April 20, 2015

4. Change From the Inside Out—Healthcare Leaders Taking the Helm

In this JAMA editorial, Dr. Don Berwick and colleagues announce the creation of the Healthcare Leadership Alliance and express that it’s time to look beyond the ACA to the next phase of reform in the U.S. healthcare system.

Notable quote: “Innovations in delivery mature at a far faster pace than laws and regulations evolve, even in far less contentious political times than today’s. For example, productive new healthcare roles…emerge at a rate that legal requirements and reimbursement policies simply do not match.”

Source: Donald M. Berwick, JAMA, March 26, 2015

3. Make Way for Payment Reform in the ER

Charles Reese, MD, blogs about the shift from fee-for-service in the emergency department to better health outcomes and spending dollars more wisely.

Notable quote: “In the new world, less will be more. So after decades of your C-suite asking for more growth, more patients, don’t be surprised if suddenly they ask for less. Fewer ED visits and admissions are suddenly a really good thing, financially.”

Source: Charles Reese, MD, Emergency Physicians Monthly, February 14, 2015

2. It’s Time to Rebuild Healthcare’s Business Model

Joe Flower explains there are no winners in the fee-for-service healthcare game and outlines the key strategies for providers, health plans and consumers. He references the classic 1983 film War Games, where the supercomputer, Joshua, learns that the best way to win at tic-tac-toe is not to play.

Notable quote: “How can hospitals and health networks win this game? Only by imitating Joshua: Find a different game to play. Stop thinking of payers as your customers. They are financial organizations that stand between you and your customers. If they are not helping you move beyond the default model, they truly do not have the best interests of either you or your customers at heart.”

Source: Joe Flower, Hospitals & Health Networks, January 20, 2015

1. CEOs Weigh in on Emerging Healthcare Trends for 2015

In an interview with major health systems CEOs, Ilene MacDonald outlines the three megatrends to watch:

• Greater hospital-physician integration;
• Continued shift to value-based care delivery;
• Consolidation with former competitors.

Notable quote: “Hospitals and providers will continue to develop models of integrated organizational design, in which both will participate in shared savings, shared risk and shared gain, says Raymond Hino, CEO of the California-based Palm Drive Healthcare Foundation. These new models of shared risk and reward will motivate many physicians to reverse the trend of employment in large medical groups and hospitals, and to partner with hospitals to create centers of excellence in which the physician providers themselves will have a seat at the table and a say in the design of new programs and services.”

Source: Ilene MacDonald, Fierce Healthcare, January 9, 2015