As the leader of NCH Healthcare System in Naples, FL, Allen Weiss, MD, would like to see fewer people using his hospitals for care.
In theory, so would we all. Hospitals, in a generic sense, are more than ever, for serious illnesses. They're also expensive, and as many hospital safety reports in recent years have shown us, often deadly.
Hospital and health system executives who realize that the unsustainable cost trajectory of healthcare threatens their continued existence are many. Just witness the ever-increasing number of merger announcements in recent months.
But even among that group, you'll find a few who think spending is likely to level out sooner rather than later. These are the early adopters of new ways to create incentives for healthcare organizations to keep people healthy.
Count Alan Weiss among them.
An aim of keeping people out of the hospital is not the kind of thing a hospital CEO with 75% of his local market share is expected to say, even in this enlightened time. Yet Weiss is convinced that his health system's future lies in finding ways to keep his beds empty. And unlike many others, he's taking steps to make sure that happens sooner rather than later.
But a couple of things have to happen first.
One is innovative collaboration with commercial payers. Weiss announced an interesting one right before the holidays, with Blue Cross and Blue Shield of Florida. Weiss calls it the "first step towards a revolutionary accountable care organization."
It's a bold, but savvy bet, Weiss says. The deal involves lots of sharing of data and a good deal of trust, but it's trust borne out of about a decade of work building from what Weiss calls "a competitive and professionally distant relationship" between the payer and the health system.
"We were bickering over price, not value, which made no sense," he says.
Seeking a better way, Weiss and the CEO of the health plan met in Jacksonville last year. This followed early discussions that suggested the insurer would like to steer more patients toward NCH because of its high quality scores and better than average record of value—especially compared to its competitors.
"We have room for improvement, but the whole industry is just so off in terms of waste, any little improvement we have looks better than you can imagine," Weiss says. "[Blue Cross Blue Shield] started the conversation, but we were poised to come to the same conclusion: What can we do to improve ourselves?"
Sharing of claims data was a good starting point, and the exercise revealed that even though NCH physicians were doing a pretty good job of eliminating waste, a combination of resources could make real-time interventions on physician decision-making based on evidence possible. That would eliminate so-called hidden waste.
"Just getting a seamless exchange of information among the clinicians is an early objective and knowing who's doing what among the physicians, almost in real time, makes a huge difference," Weiss says.
As the collaboration begins to develop in 2013, electronic-assisted connections with the insurer will provide "almost real-time feedback" that NCH's physician medical director will be sharing with physicians.
For example, it turns out that NCH physicians had been ordering quite a bit of thyroid testing, particularly with patients who had already been admitted.
"You can't check them then because it's a bad time to measure," says Weiss.
So the system, based partially on data from the insurer, developed a new educational piece on how best perform thyroid testing.
"It's easy to do and makes sense so we don't do unnecessary tests," he says.
For another example, radiology is the single biggest cost outside the hospital and evidence shows that one third of them should not be done, says Weiss.
"For every 250 X-Rays performed, somebody gets cancer," he says. "These initiatives just encourage physicians to think of appropriateness," which many have never been trained to do.
Egos, he says, took a backseat in the work.
"We were past deciding who were the leaders and followers in this business relationship," he says. Instead, it was a question of exploring how we can use both of our resources together. They're expert at handling claims; they knew more about us via claims than sometimes we do. We know about quality. Together we filled in the blanks."
That doesn't mean there aren't future issues to iron out in such a partnership. Outcomes need work, Weiss says, but they're attacking processes first. "This is not rocket science."
To learn how to do this right, Weiss says, the open-ended collaboration with Blue Cross Blue Shield allows for limited downside risk for not meeting its targets, he says, which are multiple.
"One good thing about this relationship is that with limited downside risk, it's like learning day at the casino," he says. "We're playing cards, but in a sense, we're not playing for real money. Later, it's the real deal. Right now, we don't have a downside risk."
Except that keeping people out of the hospital has its own serious costs.
With other payers, a hospital visit can be lucrative, as it can be with Medicare, as long as its limited quality targets, such as preventing 30-day readmissions for the same condition, are met. As the relationship develops with Florida Blue Cross Blue Shield and other payers—"This is not a monogamous relationship. We are going to get better at this," Weiss says—he hopes that payers will recognize a need to share their profit margin with providers.
"We have to get Florida Blue and others to understand if we can keep everyone healthy, they need to share with us their profit margin," Weiss says.
"If we can get to that point we have it made. We'll be like the Maytag repair guy, which gets them away from paying us for sickness. That's the tragedy of the current system. We can't afford to continue to do what we've done."
Philip Betbeze is the senior leadership editor at HealthLeaders.