Facing the Care Coordination Challenge

Jacobsen prefers to look at the challenge from a more positive perspective.

"Events happen which lead to an outcome. Your response is your only variable in that equation," he says. "We've got to be a part of the solution, and the government can't do that for us—they don't know enough."

Finally, among other interesting data, 60% of CEOs thought that quality would improve by increasing the scope of care of nurses within their organizations. Typically, physicians are seen as resisters to this type of change, but Jacobsen says that is going away as physician shortages bite into productivity.

"Advance practice nurses do an awesome job and we need more," he says. "The U.S. is opening new medical schools, but we still don't expect to produce enough physicians to meet our needs."

Jacobsen argues that much of the problems that bedevil senior executives hinge on better population health, which requires much more intensive work with the patient on variables that lie far outside clinical challenges. Hospitals aren't used to responsibility for such work, but they recognize the need to become more proficient.

"I had a Medicaid patient last year who used my ED 66 times," Jacobsen laments. "What we're dealing with here is that this person is disabled, and there's huge access issues around other sites of care. If they had access to the behavioral health they needed, transportation, and primary care, they would not do this."

This article appears in the February 2012 issue of HealthLeaders magazine.