Health care system rated unhealthy at Aspen Ideas Festival
A panel of medical experts said last week that the financial realties of the health care system are so bleak that widespread change must happen.
“What I worry about is that the U.S. can’t afford its health care,” said Ken Davis, CEO and president of Mount Sinai Health System, at the Spotlight Health panel discussion titled “Health Systems for the Future” as part of Aspen Ideas Festival. “Whether it’s employees, or whether it’s employers, or whether it’s the government, federal or state, everyone knows we are on a course of catastrophe economically.”
That’s why industry leaders say the approach to health care has to change so that it’s a continuum of care that focuses on preventative measures.
Hospitals are no longer just buildings where people are treated and released, said Jonathan Perlin, president of clinical services and chief medical officer of HCA Healthcare.
“We have to get beyond the thinking of the bricks and mortar because what’s really exciting is the data mash-up that comes from consumer and patient outcomes that create a data ecosystem,” he said. “We really have the opportunity for a new health ecosystem that can embrace the continuity between health and wellness, as well as acute care and sickness.”
That point was echoed by Diane Holder, executive vice president of the University of Pittsburgh Medical Center. She also is president of UPMC Insurance Services Division and president of UPMC Health Plan.
“It’s a whole new world right now,” she said, adding that technology is allowing more connectivity among patients and doctors.
UPMC has built a robust set of insurance companies within its system. With a $16 billion budget, half of the revenue comes from clinical services and the other half comes from insurance, Holder said.
“It’s not because we wanted to be in the insurance business,” she said. “What we really cared about was trying to figure out, how do you line up incentives? What’s broken is that there’s no alignment between clinical delivery and what people want and what’s being paid for.
“We’ve already broke the bank and we know it’s not sustainable,” Holder continued. “How do you get upstream with the dollars?”
Dave Ressler, CEO of Aspen Valley Hospital, who did not speak on the panel but agrees with the overall sentiment of the panelists, said changes are afoot in health care.
“We are part of what I hope is a big shift in the industry,” he said. “Right now health care is based on a fee-for-service model, but how do we shift to be a system of care and we take responsibility of management of an overall population?”
Davis said the Mount Sinai system operates on a risk model, which accepts all the risk on every patient contract.
“Our top-line revenues have to come down,” he said. “It will never be growing as fast as our expenses.”
Meanwhile, health care providers still have to operate with their core value of providing care, Davis noted, adding that Mount Sinai loses 33 cents on the dollar with Medicare patients.
AVH is part of what’s known as an Accountable Care Organization, which represents Medicare beneficiaries in rural communities in the state. There are two ACOs in Colorado, which Ressler helped form.
The idea is to reduce costs within that population through a Medicare shared savings program.
“If you can reduce those costs, then it helps everyone,” Ressler said. “But you don’t have value by just reducing costs; you also have to have quality, so I think that is part of the solution.”
Perlin predicted that Medicare will be insolvent by 2026, and an unhealthy population is driving up health care costs.
Ressler said 70 percent of the costs of health care are related to chronic conditions like diabetes or COPD.
AVH is part of a nonprofit called the Valley Health Alliance that is comprised of the area’s six largest self-insured companies. It’s focused on reducing costs through population health management and improving access to health care.
Ressler also points to AVH’s health fairs that are free or at a minimal cost to the public as another example of preventive care.
AVH also is working with Anthem, the valley’s only insurance provider, to reduce costs.
“We consider Anthem to be a partner,” Ressler said, adding that AVH’s efforts don’t move the needle on issues surrounding the larger health care system but it’s a start. “I think this process of transformation starts at the community level and it’s our responsibility to be part of the change and part of the solution.”
It’s been about a decade since health care providers have been expanding the continuum of care on a national level. Ressler said a lot of forward thinking and innovation is happening but much more work needs to be done before the health care system has been revolutionized.
“I think this is ultimately going to take generations,” he said.
“And I think it happens at a grassroots level.”
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