"When I translate our payer mix into cash, roughly 75% of the cash we receive comes from the state," he says. "That makes us the state's largest partner for hospital services, and they're very cognizant of that." Still, he can't afford to sit on his haunches as healthcare reform marches forward to eventually convert his payer mix.
Sinai has installed Lean manufacturing processes and has empowered about a dozen Six Sigma teams looking at efficiencies that can be gained in registration to pharmacy distribution.
"If we're going to survive and be a player in the new world, we have to be in position to take advantage of the pay-for-performance activity, so over the last couple of years, we've worked to distinguish ourselves from a quality perspective," Channing says.
As healthcare coverage for the uninsured ramps up, Sinai is preparing for better cash flow, based largely on the fact that about half to two-thirds of the uninsured that make up 13% of its payer mix right now will get coverage.
Sinai sees its future in carving out specialty areas of excellence in a crowded healthcare marketplace. It's already partnered with several federally qualified health centers, which should help it in integrating primary and inpatient care protocols for the sickest patients.
Sinai is also working on a project that will incentivize physicians to help transition from an episodic to a holistic model of patient care.
"If you think about how primary care gets used, it's still pretty episodic because the physician is still incentivized to see a lot of patients in a day's time," Channing says.
Through leadership on possible Medicare demonstration projects, he hopes to position Sinai as a national leader in what he calls "pre-primary care," which involves heavy counseling and tracking of patients to address chronic conditions like diabetes or asthma.
"What we have done is position ourselves to be the hub of an ACO. We've done that by creating an integrated delivery system with the employed physician group, with our partnership with the FQHCs, and the community-based work outside the hospital environment," he says. "We've described it focusing on having a medical home for everyone."