University of Washington Medical Center is one of eight hospitals worldwide testing a surgical checklist unveiled by the World Health Organization. The checklist also includes items from a statewide project, the Surgical Care and Outcomes Assessment Program. With $1.35 million from the state Life Sciences Discovery Fund, UW Medical Center doctors are signing up hospitals to collect and share details about what surgeons do in operating rooms and how patients do afterward, and to use checklists to improve.
Major health groups that had backed California Gov. Arnold Schwarzenegger's effort to extend medical coverage to all state residents have turned against him, saying his proposed budget cuts would swell the number of uninsured people by 1 million. The coalition includes Catholic Healthcare West, the state's largest private hospital chain; the Service Employees International Union; the consumer advocacy groups AARP and Health Access California; and insurers Kaiser Permanente and Health Net. Those groups last year pressed lawmakers to approve a $15-billion insurance expansion plan favored by Schwarzenegger.
My sense is that many of the attendees here are skeptical of that claim viscerally, but their minds—and their heavy attendance at consumer-oriented sessions here at HFMA-ANI—betray them.
Maybe it's just curiosity, but I don't think so. I think they want to know whether this coming horde of consumers is just a bunch of hype or not.
Well, by the time that's clear, it will probably be too late to do much about it. Steve Case, the head of Revolution Health, gave the keynote speech yesterday and despite his admitted lack of knowledge about the inner workings of healthcare, he knows how to market to consumers and to give consumers what they want.
It's important to note history to skeptics about consumerism in healthcare. Consumers have only outsourced their healthcare for the past couple of generations. Prior to Medicare's advent in 1965, if you didn't have employer-based healthcare, you paid for it out of pocket. Healthcare is complicated, but perhaps not so complicated that the forces of the free market can't have a big impact. Healthcare, Case says, will be one of the last industries to shift to a business model by which the consumer will shape winners and losers in the future.
For now, consumers are nibbling around the edges, but it won't always be so. Another conference presenter, Paul Keckley, executive director of the Deloitte Center for Health Solutions, has done reams of research into what consumers want in healthcare and he's convinced that healthcare is a consumer market now. Maybe not for procedures, but in terms of wellness and other "integrated" medicine, it's already there. Are you managing to yesterday's model, he asks? More is spent on so-called "alternative medicine" than on primary care. That's striking, and it's a big missed opportunity if you're not trying to figure out how you're going to tap into that market.
It's a hard transition to make. Yesterday's model says your hospital should be managing to a system that ensures you're going to be paid for the procedures you currently do. For instance, Keckley says, no hospital gets paid to tell an orthopedist not to do a hip replacement. Hospitals get paid to help an orthopedist do a hip well that maybe should not have been done.
But that model isn't the only way to do it anymore. Capital allocation is perhaps the most fraught with danger. Should a hospital or system spend $100 million on a new patient tower or should it spend that huge capital allocation on research and development in consumer-oriented care systems? To many of you, the answer is obvious. You're going to get paid tomorrow under today's model for that investment in stuff like the new patient tower. But will that be true in 10 years? Or 20 or 30? That's how long it takes to pay off that new patient tower. It might be the right answer today but it may not be the right answer forever. Allina, in Minnesota, for instance, is spending on consumer R&D. That means that money isn't available to be spent on some project that boasts a lot of cranes and bricks and mortar.
I don't pretend to know what the right answer is for you and your hospital. But your consumers do. You should get to know them. They're getting to know you, whether you like it or not.
The Southwest has the lowest rate of health insurance coverage in the United States, with 30% of non-elderly adults and 18% of children uninsured, according a study by the Centers for Disease Control and Prevention. One expert theorized that the trend likely comes from a combination of factors, including state policy decisions and the fact that many jobs in the Southwest are service, construction or other jobs without good health benefits. New England has the largest proportion of its population covered, the study found.
WellPoint Inc. employees earned a bump in their annual bonuses this year thanks to its Member Health Index program, which monitors care for the health insurer's patients. WellPoint met or surpassed most goals for improvement in the first year of the program that measures whether more members were receiving recommended care in 20 clinical areas. WellPoint set goals for each clinical area and then decided that the numbers it saw had to increase at least 5% toward those goals for their employees to earn a higher bonus. The company hit or surpassed that targeted increase in 17 of the 20 areas.
An increasing number of Americans, many with health insurance, are delaying or forgoing medical care because of concern about cost, according to a report from the Center for Studying Health System Change. A 2007 survey of 18,000 people found that 20% of the respondents said that they had put off or gone without needed medical treatment at some point in the prior year, up from 14% in a 2003 survey. Of those who said in the 2007 survey they had put off care, 69% cited concern about cost as a reason.