Maryland hospitals targeting HEALTH

[Greenbeard]

For decades Maryland has been setting reimbursement rates for its hospitals. This year, however, they've started a bold new experiment that grew out of that experience: putting hospitals on a fixed budget.

By letting hospitals know upfront at the start of the year how much revenue they've got to work with (and holding them accountable for quality outcomes) the normal incentive structure has been turned on its head.

Global budgets pushing Maryland hospitals to target population health

The new clinic is one example of innovative strategies Maryland hospitals are employing to improve population health and reduce costs under their state's unique new global budget revenue, or GBR, program. State officials negotiated the program with the CMS Innovation Center and launched it last January, moving the state toward paying healthcare providers based on improving population health rather than on volume of services. Other hospitals are launching similar initiatives to keep their patient populations healthier. . .

“It has literally, overnight, changed the hospital business model 180 degrees,” said Carmela Coyle, CEO of the Maryland Hospital Association. “It is now in the hospitals' economic interest to keep people well and out of the hospital.”

The GBR system has led to more collaboration and trust between hospitals and insurers because their financial incentives now are aligned, said Scott Furniss, senior vice president and chief financial officer at St. Agnes Hospital in Baltimore.

“There's a whole new level of opportunity,” he said. Now, when insurance officials propose strategies for reducing utilization, the hospital will invite them over to discuss it. “Historically, I would have thought, 'What are they up to? Probably less revenue for me,' ” Furniss said.

Hospitals have started changing the way they do business to better impact the total health of their patients--not just when those patients show up in inpatient settings but when they're out in their communities as well. One of the examples they give in that article is a hospital that built a small clinic on-site at a low-income apartment complex full of hospital "frequent fliers" so to speak.

By helping those patients manage their conditions at home and shifting low-intensity care they may need to a more appropriate (and cheaper) setting, the hospital's investment will pay off for it under Maryland's new system.

Ultimately, it's a whole new way of doing business:

Providers increasingly are looking at community-based initiatives to improve health. The Bon Secours Community Works program in West Baltimore, sponsored by the Bon Secours Baltimore Health System, addresses social determinants of health. Projects include economic revitalization, parenting classes, job training, pre-school classes, community vegetable gardens and eviction-prevention workshops. “Our approach has been holistic,” said Sister Patricia Dowling, president of the Community Works board of directors. “The need in the community drives what happens—like when the only bank in the area left, we brought in a credit union.” . . .

The hospital association's Coyle said the state's health information exchange system, the Chesapeake Regional Information System for our Patients, known as CRISP, is aiding population health-management efforts. All 46 of Maryland's acute-care hospitals participate in the exchange, as do more than 150 medical practices. “If you want to manage the health of a population, you have to know who your superusers are, where they live and what they need.”

St. Agnes has made a number of care-delivery changes in response to the new GBR system. It has hired navigators to work with patients before and after discharge to make sure they see a primary-care doctor within seven days and fill their prescriptions. The hospital is working on delivering patients' medications to their bedside prior to discharge. Even though the hospital is not paid for these care-coordination services, this could save the hospital money by reducing readmissions.

Doctors Community Hospital, in Lanham, Md., has identified patients who frequently needed emergency care and opened facilities tailored to them. It launched free clinics for congestive heart failure and COPD patients, offering four-week educational programs to teach them how to manage their conditions. There is also a clinic for sickle-cell anemia patients—a population with a high readmission rate. Camille Bash, the hospital's chief financial officer, said the readmission rate for sickle-cell patients has dropped from about 33% to 10% or less. . .

“Reimbursement was volume-driven,” she said. “We have swung back because we have shifted the focus to doing the right things.”

 

[JumpinJack]

For decades Maryland has been setting reimbursement rates for its hospitals. This year, however, they've started a bold new experiment that grew out of that experience: putting hospitals on a fixed budget.

By letting hospitals know upfront at the start of the year how much revenue they've got to work with (and holding them accountable for quality outcomes) the normal incentive structure has been turned on its head.

Global budgets pushing Maryland hospitals to target population health


Hospitals have started changing the way they do business to better impact the total health of their patients--not just when those patients show up in inpatient settings but when they're out in their communities as well. One of the examples they give in that article is a hospital that built a small clinic on-site at a low-income apartment complex full of hospital "frequent fliers" so to speak.

By helping those patients manage their conditions at home and shifting low-intensity care they may need to a more appropriate (and cheaper) setting, the hospital's investment will pay off for it under Maryland's new system.

Ultimately, it's a whole new way of doing business:

I have often thought that one thing that is needed for health care in America is an advertising campaign tailored to promote a healthy lifestyle. Advertising works. That's why corporations do it. They could be governmental public policy ads (like the "Just Say No" campaign years ago).

The ads could pop up on tv periodically about...eating vegetables. Then about moderate exercise, showing people walking or biking. Then about eating fruits and fish. Then about maintaining normal weight. Then about eating less or smaller portions. Then about stress control. And so on.

As for for-profit hospitals getting together with insurance companies for the purpose of keeping people out of the hospitals.....I'm suspicious. Could be good. But it could be not good. We've been burned on health care reform. You know what they say:

 

[blaxshep]

As for for-profit hospitals getting together with insurance companies for the purpose of keeping people out of the hospitals.....I'm suspicious.

What could go wrong?

 

[Greenbeard]

I have often thought that one thing that is needed for health care in America is an advertising campaign tailored to promote a healthy lifestyle. Advertising works. That's why corporations do it. They could be governmental public policy ads (like the "Just Say No" campaign years ago).

There's an old health policy adage called Roemer's law: "in an insured population, a hospital bed built is a filled bed." In other words, the health system finds a way to use its excess capacity, regardless of whether it's really needed.

A financial model based on filling hospital beds is ultimately at odds with the picture of a healthier population that your advertising campaign envisions. And that's because the health system as it's been constituted is based on churning out an endless stream of health widgets--a test, a procedure, a service. The more, the better. The financial incentive baked into it is to produce those health widgets, not produce long-term health for the populations it serves. And, in fact, a healthier population--one that needed few inpatient hospital stays, for instance--would be a bad thing under that model, as it would threaten the financial viability of key players with a stake in that system.

I'm not sure your ad campaign has much of a chance when you've got a $2 trillion industry with a stake in it failing.

That's why you've got to turn the model on its head--make health the product the health care system is expected to produce, make healthier populations more profitable for the system than the alternative. Then hospitals, doctors, community partners, etc all become allies in not just advertising healthier living but helping people to make it a reality.

This is what Maryland is trying to achieve, on a scale nobody's come anywhere close to before.

 

[JumpinJack]

There's an old health policy adage called Roemer's law: "in an insured population, a hospital bed built is a filled bed." In other words, the health system finds a way to use its excess capacity, regardless of whether it's really needed.

A financial model based on filling hospital beds is ultimately at odds with the picture of a healthier population that your advertising campaign envisions. And that's because the health system as it's been constituted is based on churning out an endless stream of health widgets--a test, a procedure, a service. The more, the better. The financial incentive baked into it is to produce those health widgets, not produce long-term health for the populations it serves. And, in fact, a healthier population--one that needed few inpatient hospital stays, for instance--would be a bad thing under that model, as it would threaten the financial viability of key players with a stake in that system.

I'm not sure your ad campaign has much of a chance when you've got a $2 trillion industry with a stake in it failing.

That's why you've got to turn the model on its head--make health the product the health care system is expected to produce, make healthier populations more profitable for the system than the alternative. Then hospitals, doctors, community partners, etc all become allies in not just advertising healthier living but helping people to make it a reality.

This is what Maryland is trying to achieve, on a scale nobody's come anywhere close to before.

I would agree with most of what you say. As for what Maryland is trying to do....the proof will ultimately be seen. I am suspicious when mega-corporations get together to try to, essentially, not pay claims. I suspect that some people who should be hospitalized won't be. I have learned to be skeptical of our system. I know that the companies involved aren't in the business of health and cures. They would like you not to turn in claims, that's for sure. But that's totally different from you being healthier.