“There will be a lot of research and fine-tuning of each process of care, but it will make you figure out how to make a course of care work financially and that’s where our IT investments will give us a competitive advantage,” Fine says.
West Johnson, vice president for Wellspring+Stockamp, Huron Consulting Group, headquartered in Chicago, says health systems would do well to adopt a process-manufacturing model to treat patients with similar ailments.
“Every patient has unique needs, but the notion of treating them all as absolutely unique is not going to work,” he says. “The ability for individual physician decision-making will go down, because what today is largely independent will be tightly linked.”
Currently, and for a few years yet, physicians and hospitals bill separately for each piece of service done during a patient’s course of care. But a game-changer is on the horizon, as bundled payment demonstration projects take off. Such a payment would in theory cover all treatments of the episode of care from its inception to 30 days after, says Johnson. “Modeling yourself after the Geisingers is somewhat myopic—those that are already in the clinic model have an early mover advantage in integration between physician hospital operations, but that doesn’t mean they will be the leaders in developing the next generation of clinical protocols that will be effective and efficient,” he says. “Those that have developed protocols over the years can also be pretty hidebound and slow to change. You’ll see people who are nimble and will cast aside the prior status quo.”
In addition to its physician-owned medical group, Henry Ford deals heavily with about 2,000 private physicians.
“We’re working hard to create an attractive opportunity so they can be more aligned with us,” Schlichting says. “We want them to have the tools and support activities that our Henry Ford group has.” She and her executive team are exploring the creation of centers of excellence in tertiary and high-tech areas that would involve private physicians.
Though the federal government has not yet specified that hospitals would be in charge of distributing reimbursement under a bundled payment regime, Banner’s Fine is hoping it will be, “because it’s the ideal place in most cases to coordinate care and the most expensive services are provided there.”