Role mod­els

Mass. safety net hos­pi­tals on cut­ting edge of re­form im­ple­men­ta­tion

Modern Healthcare - - OPINIONS COMMENTARY -

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.

Safety net hos­pi­tals will con­tinue to be bell­wethers for in­dus­try and pol­icy lead­ers ...

Kate Walsh is CEO of Bos­ton Med­i­cal Cen­ter.

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