Mak­ing the dif­fer­ence

Taven­ner tells Women Lead­ers in Health­care at­ten­dees they can help make re­form work

Modern Healthcare - - THE WEEK IN HEALTHCARE - Beth Kutscher

With the com­pli­cated state health in­sur­ance ex­changes go­ing live in Oc­to­ber, CMS Ad­min­is­tra­tor Mar­i­lyn Taven­ner has a lot to think about at the end of the day. “What keeps me up at night is, how do we get the mes­sage across to this coun­try about the im­por­tance of health in­sur­ance and the im­por­tance of preven­tive care?” she told at­ten­dees last week at Mod­ern Health­care’s Women Lead­ers in Health­care Con­fer­ence in Nashville. “For many peo­ple, that’s not some­thing they un­der­stand un­til they have per­sonal ex­pe­ri­ence. And that’s where women lead­ers make the dif­fer­ence.”

In a key­note ad­dress to some 250 health­care ex­ec­u­tives, Taven­ner ex­plained that the pub­lic ed­u­ca­tion process to en­roll peo­ple in ex­change plans will fo­cus ini­tially on in­di­vid­u­als and small busi­nesses. It will in­volve nav­i­ga­tors, who will guide peo­ple through the en­roll­ment process and will start train­ing at the end of this month. It also will in­volve agents and bro­kers, who re­cently started their train­ing.

She said there’s a sig­nif­i­cant role for health­care ex­ec­u­tives in help­ing the ex­change roll­out run smoothly.

Taven­ner urged at­ten­dees to help ed­u­cate their friends, fam­ily, pa­tients and col­leagues about the in­sur­ance ex­changes, where peo­ple with in­comes un­der 400% of the poverty level can buy sub­si­dized cov­er­age and oth­ers will be able to sign up for ex­panded Med­i­caid cov­er­age. With women mak­ing 80% of health­care de­ci­sions, “I think this is an easy mis­sion for all of us,” she said.

But she added that while half the fo­cus of the Pa­tient Pro­tec­tion and Af­ford­able Care Act is on ex­pand­ing health cov­er­age, the other half is on con­trol­ling health­care costs. “One of the crit­i­cisms of Mas­sachusetts (which es­tab­lished an Oba­macare-style sys­tem in 2006) is that they did a great job with ac­cess, but they didn’t deal with the cost,” she said. She ac­knowl­edged that Medi­care has seen the low­est cost trends of the past 50 years, but added, “We will have to stay fo­cused on costs.”

Re­duc­ing cost growth was also one of themes of a panel on blend­ing cul­tures af­ter a merger or ac­qui­si­tion.

Ju­dith Per­sichilli, in­terim pres­i­dent and CEO of CHE Trin­ity Health, whose merger went live in May, said that op­er­a­tional ef­fi­cien-

“The real sav­ings are in clin­i­cal trans­for­ma­tion.” — Ju­dith Per­sichilli “What keeps me up at night is, how do we get the mes­sage across to this coun­try about the im­por­tance of health in­sur­ance and the im­por­tance of preven­tive care.” — Mar­i­lyn Taven­ner

cies were not where the merged sys­tems saw the most po­ten­tial for sav­ings. “The real sav­ings are in clin­i­cal trans­for­ma­tion,” she said, cit­ing the fo­cus on be­hav­ioral health in the Pitts­burgh mar­ket.

Pan­elist Keith Pitts, vice chair­man of Van­guard Health Sys­tems, which re­cently an­nounced a merger with Tenet Health­care Corp., said providers need to take out 20% of the to­tal cost of care.

He fo­cused on one of Van­guard’s most re­cent takeovers, Detroit Med­i­cal Cen­ter. “Ev­ery­one wants to know: Why would you buy Detroit Med­i­cal Cen­ter?” he said. “Detroit wasn’t a bro­ken health sys­tem from an op­er­at­ing stand­point. But they didn’t have any cap­i­tal. They were scrappy, but they didn’t have any cash.”

That 2010 ac­qui­si­tion al­lowed Van­guard to in­ject fund­ing for de­ferred projects. “If you drive around Detroit, you’ll see cranes up,” he said. “Most of those cranes have our name on them.”

Detroit Med­i­cal Cen­ter, a safety net hos­pi­tal for south­east Michi­gan, also ap­plied and was se­lected to be a Medi­care Pi­o­neer ac­count­able care or­ga­ni­za­tion. “We did save 4.5% the first year so we stayed in a sec­ond year,” he said. “The health sta­tus of Detroit is one of the tough­est in the coun­try. I see a very bright fu­ture in Detroit in be­ing able to ac­com­plish that.”

The event cel­e­brated Mod­ern Health­care’s Top 25 Women in Health­care, a bi­en­nial list of vi­sion­ary fe­male lead­ers in fields in­clud­ing health pol­icy, govern­ment, health sys­tems, pay­ers and medicine.

As the national con­ver­sa­tion fo­cuses on how to get more women to “lean in” to the high­est lev­els of their pro­fes­sion, health­care de­liv­ery is be­ing over­hauled by woman-led teams at the CMS, HHS and Food and Drug Ad­min­is­tra­tion. Women also head the watch­dog group that grades hos­pi­tal per­for­mance as well as in­dus­try groups for physi­cians, nurses and health in­sur­ers.

But while the event cel­e­brated how far women have come, it also ac­knowl­edged the trade­offs.

Su­san DeVore re­called the mo­ment when she knew she had reached an un­sus­tain­able point as a mother and a health­care ex­ec­u­tive. It was late at night, and she was rock­ing her baby son. She stroked his hair and mar­veled at how an­gelic a sick child looks. And then her mind wan­dered to a big pre­sen­ta­tion she was sup­posed to give the next day and she thought: “I’m go­ing to be so tired to­mor­row.”

DeVore is pres­i­dent and CEO of the Pre­mier health­care al­liance, one the coun­try’s largest group pur­chas­ing or­ga­ni­za­tions, and a mother of three. She knew then that roles would have to change. She and her hus­band would have to share the cook­ing and clean­ing more equally. He would have to play dress-up and she would go to base­ball games.

DeVore con­tin­ued: “We also told our kids that they owned the fam­ily’s suc­cess, too— they had to do their part. ... And I think the same thing ap­plies to health­care.”

Just as work­ing moms have made their own rules about mother­hood and lead­er­ship, DeVore said, the health­care in­dus­try is now dis­pos­ing with old no­tions about who should do what. Physi­cians need to work closer with mid-level providers, and pa­tients should be em­pow­ered to take more con­trol of their own health. “I think it’s up to us, col­lab­o­ra­tively, to lis­ten to ideas, no mat­ter where they come from,” she said.



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