How Big, How Soon?
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"We're looking at different IT systems that can pull demographic data from our communities, data on diagnoses to evaluate the health of the community and the risk of disease," she says. Like many others, the St. John's management infrastructure focuses on service lines. The twist is that the service line directors are responsible not only for acute care, but also for prevention and rehab.
"That way our entire hospital focuses on those risk factors," she says.
But from a capital standpoint, bricks and mortar for new clinics doesn't appear to be as necessary as the IT solutions needed to tie together all of these facilities working outside the hospital, both clinically and financially.
"Capital is getting tighter and tighter as reimbursement per patient is going down. We realize that Medicare and Medi-Cal, California's version of Medicaid, is going down," she says. "In the future when these patients roll into the exchange, reimbursement for them will be similar to the Medi-Cal population."
With declining reimbursement as the backdrop, the biggest change in the entire CHW system, she says, is related to population management.
"We're investing in ways to work on the front end with people in the community to keep them healthy, offer preventive treatments, incentivizing for healthy lifestyles. On the long-term side, we're coordinating the type of care they receive after discharge, skilled nursing, at home. The idea is to stay out of the hospital. But, if one is needed, it should be one that is integrated with the patient's physicians and offers efficient high-quality care."
This article appears in the January 2012 issue of HealthLeaders magazine.
Philip Betbeze is senior leadership editor with HealthLeaders Media.
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