Rounds: Will Health Systems Do Anything About Health?

Should health systems care about health? What do they plan to do about it? These questions are not as snarky as they may seem. The real strategic choice facing hospitals and health systems over the next decade is whether they will evolve their mission from its focus on sick care to health care.

I posed this question last week to a number of chief financial officers from across the country who gathered for two days of idea exchange at our annual HealthLeaders Media CFO Exchange. The 29 CFOs represented a diverse group of health systems, from community and rural hospitals all the way to regional health systems. They were also diverse in terms of their physician alignment, degree of payer/provider integration, and experience with risk-bearing contacts and capitation.

None of the CFOs disputed that their organizations need to make many changes to meet demands for more coordinated, cost-effective care. They said they will work diligently to improve overall health.

Investments in electronic health record systems, for example, that will be able to identify gaps in care, foster evidence-based medicine, and, hopefully, improve physician-to-physician and physician-to-patient communication.

But providers may only be willing to step so far into the realm of "health" care, which includes a range of services from more robust prevention programs and significant investments in primary care. When it comes down to whether American hospitals will fully evolve into organizations that seek to lead people toward healthy lives, there are many barriers. A few, which I have paraphrased, are:

• Incentives are still not aligned for health systems and hospitals to lead the march.
• Physicians and other community pillars are better positioned and experienced to lead.
• The demand for acute/inpatient care and outpatient procedures is also expected to grow rapidly in the next decade, and that is the demand hospitals must meet.

The health systems that may be the true test cases may be physician-led, integrated systems with experience at capitation, patient-centered medical homes, and multispecialty practice. I moderated a Healthleaders Roundtable a couple of years back and still recall what Dean Health CEO Craig Samitt, MD, said about how his Madison, WI-based health system views growth.

"The ideal growth scenario for us is five years from now [is] we have triple the number of patients, each generating half the number of prior services that they generated previously," Samitt said.

The healthcare organization that is the furthest along in the "health" continuum to date may well be Kaiser Permanente, with nine million members, 37 hospitals, and more than 16,000 physicians. It has the structural advantages of being integrated with the health plan. And its scale affords certain other tools, such as an integrated electronic health record system that combines provider tools with member tools for managing health and communicating with the care team.

"The most direct way to think about it is how a person defines health rather than how a medical system defines health. If you ask people about their health, they talk not just about fear of disease," says Raymond J. Baxter, PhD, Kaiser Permanente's senior vice president, community benefit, research and health policy. "They don't draw the boundaries that [healthcare] professionals draw around that."

KP has taken an approach to take on the spectrum of levers that can influence a person's health. It does not constrain itself to the management of chronic disease and prevention, but has interest in community-based programs.

For example, a typical provider may prescribe an overweight patient to lose weight by eating healthier food and getting more exercise. But what is the health system doing to provide those resources? Some health systems will embrace KP's idea of supporting community walking trails, adding farmers' markets for local produce in urban food deserts, or working with schools to build healthier lunch menus.

Other health systems across the country are working on similar programs to various degrees, but whether they will place their hands on the steering wheel of overall "health" to drive down costs is an open question.

To learn more about Kaiser Permanente's Model for building community health and patient engagement, register for the HealthLeaders Media Rounds live/simulcast Kaiser Permanente's Model for Total Health from Washington, DC on October 16.