Mass. safety net hospitals on cutting edge of reform implementation
Six years after Massachusetts’ historic healthcare reform legislation, the state provides a window into healthcare reform for the rest of the states, even as the exact shape reform will take is under debate. Long a mecca of medicine, we are accustomed to attention of this sort, and our healthcare community—physicians, hospital leadership, academicians—has always contributed a wealth of knowledge and innovation to the industry. As the media, industry and policy analysts continue to monitor the implementation of healthcare reform, there is much to learn in how safety net institutions such as Boston Medical Center—those providers that deliver care and other health-related services to Medicaid, uninsured and other vulnerable populations—are handling reform.
The notion of safety net hospitals being role models of healthcare reform may seem farfetched to some who view these critical institutions as a last resort for care. In fact, safety net hospitals are increasingly recognized as highquality and low-cost healthcare providers.
At BMC, our 2011 patient-safety performance as measured by the Leapfrog Group is equal to or better than that of the other Boston teaching hospitals. Meanwhile, a 2009 state attorney general’s report found that BMC is the lowest-priced teaching hospital in Boston. Yet many people assume that safety net hospitals are operationally unprepared to take on the new world of accountable care organizations. In fact, safety net hospitals like BMC are ahead of the curve—because they have long needed to be— in providing comprehensive, coordinated care to patients with complex needs.
Conventional wisdom also suggests that safety net hospitals will play a more limited role in our national healthcare landscape moving forward because low-income patients will be able to get care at any hospital. But implementation of healthcare reform in Massachusetts has proven this false.
Today, more low-income patients than ever opt to receive care at BMC and other safety net hospitals despite being able to go anywhere. What keeps them coming? In addition to satisfaction with BMC’S services and staff, we believe it’s the unique infrastructure to treat the patient’s physical issues and also the range of factors critical to good health.
We have long made it a priority to provide services such as transportation, translation and navigators for patients with complex diseases and have focused on developing care delivery models that improve health outcomes and are cost-effective. In fact, much of our funding is now explicitly tied to such transformational programs, such as our homegrown Project RED initiative, which has been selected as a national model by the federal Medicare program for reducing costly hospital readmissions. The effort, which stands for Re-engineered Discharge, aims to reduce re-hospitalization rates.
Despite the inherent funding challenges of safety net hospitals, where care is reimbursed by public payers, these institutions are well-positioned to lead the way in healthcare reform and transition to effective and efficient ACOS that can shift care to the most appropriate location—whether it be doctor’s offices, ambulatory centers or community health centers.
At BMC and many of the larger urban safety net hospitals, we provide access to a number of clinical services, including a strong primarycare component, and our care model organizes these services around the patient. We have a health insurance plan, work closely with a network of community health centers and tie it together with electronic medical records.
As payment reform discussions continue in Massachusetts and broader healthcare reform is considered nationwide, there is consensus in the industry that more emphasis will be put on delivering the right care in the right setting. At BMC, we have already seen significant improvement in lowering the rate of stay through care coordination with our community health center partners and an intense focus on hand-off and discharge planning.
Safety net hospitals will continue to be bellwethers for industry and policy leaders in treating the newly insured and addressing the complex issues these patients face in terms of their health and the socioeconomic barriers that stand in the way of them receiving care and staying healthier.
And while safety nets will ultimately face competition for the newly insured, they are considerably further ahead on the curve than most realize—and they possess a skill set that is attractive not only to low-income patients, but for a growing number of consumers in a healthcare marketplace that increasingly puts a premium on high quality, affordable and integrated care. While competition will only challenge us to work harder and be more efficient and innovative in our programs, services and delivery of care, the end result will be lessons with broad application throughout our healthcare system.