Health­care lead­ers must live in to­day’s world and plan for to­mor­row’s

Modern Healthcare - - COMMENT - By James H. Hin­ton

We are in a his­toric time in health­care. At hos­pi­tals and health sys­tems across the coun­try, we have spent years pre­par­ing for and pro­vok­ing change. While the Pa­tient Pro­tec­tion and Af­ford­able Care Act serves as our cur­rent cat­a­lyst for change, the change im­per­a­tive evolved long be­fore the ACA was signed into law.

Times of his­toric chal­lenge re­veal the best in each of us and I be­lieve there has never been a gen­er­a­tion of health­care lead­ers given an op­por­tu­nity like we have to­day.

Each day in our or­ga­ni­za­tions, we see tal­ented pro­fes­sion­als pro­vid­ing high-qual­ity health­care at rea­son­able cost. You also find the op­po­site— high-cost, lower-qual­ity care and pa­tients who fear the com­plex­ity of the sys­tem as much as their ill­ness. We know that progress in spe­cial­iza­tion and tech­nol­ogy has led to pa­tients deal­ing with hun­dreds of care­givers, mul­ti­ple lo­ca­tions and con­fus­ing billing sys­tems. Of­ten, the only com­mon de­nom­i­na­tor is the pa­tient.

At the same time, fewer pa­tients need to visit hos­pi­tals, and they have shorter stays. Hos­pi­tals to­day are in­creas­ingly fo­cus­ing on vis­its to physi­cian of­fices, am­bu­la­tory imag­ing and sur­gi­cal cen­ters. A pa­tient “visit” of­ten looks more like Face Time on our iPhones than a face-to-face in­ter­ac­tion in a doc­tor’s of­fice.

In­creas­ingly, hos­pi­tals in Amer­ica are defin­ing suc­cess as be­ing more than a crane on their site and work­ers scur­ry­ing to build new pa­tient tow­ers with more in­pa­tient beds. Pro­gres­sive sys­tems are in­vest­ing in tech­nol­ogy and am­bu­la­tory cen­ters, and are reach­ing out to pub­lic health de­part­ments to patch holes in our health­care safety net. We are in the midst of dra­matic, un­equiv­o­cal change. The very na­ture of health­care de­liv­ery is be­ing rapidly re­de­fined.

This means health­care lead­ers must live in to­day’s world and plan for to­mor­row’s. And they are very dif­fer­ent—one is built on the vol­ume of ser­vices we pro­vide. The other will be built on the value we of­fer pa­tients.

We know that our health­care sys­tem over­spends on high tech­nol­ogy and un­der­spends on so­cial, be­hav­ioral and en­vi­ron­men­tal sup­port for pa­tients. For ex­am­ple, our fee-forser­vice sys­tem puts up bar­ri­ers to di­a­bet­ics who need rou­tine foot care such as sim­ply hav­ing their nails trimmed. But we pay gen­er­ously to am­pu­tate that foot af­ter lack of ba­sic pre­ven­tive care leads to se­vere con­se­quences. Like­wise, our sys­tem re­wards back surgery, even though study af­ter study shows that our un­der­val­ued phys­i­cal ther­apy ser­vices can pre­vent most of those same surg­eries.

Sto­ries like these are too fre­quent and too painful. We must make them un­ac­cept­able. We can no longer af­ford even a sin­gle high-cost in­ter­ven­tion for which there is un­clear ev­i­dence of pa­tient ben­e­fit.

In some coun­tries, in­di­vid­u­als see it as their pa­tri­otic duty to take re­spon­si­bil­ity for their health. Amer­i­cans are as pa­tri­otic as any­one else and we love our free­dom too. All too of­ten, our free­dom to choose has re­sulted in obe­sity, seden­tary life­styles, smok­ing and sub­stance abuse. Our health­care sys­tem can­not re­pair a life­time of abuse or lack of at­ten­tion to our own health and well-be­ing.

So there is a gi­ant equa­tion at play. One per­son’s free­dom to live an undis­ci­plined life gets paid for by some­one else, or in­creas­ingly, it di­rectly de­prives some­one of life-sav­ing treat­ment. And that just isn’t right. En­gag­ing Amer­i­cans in a se­ri­ous dis­cus­sion about their re­spon­si­bil­ity for their own health must be part of any so­lu­tion set in health­care.

Our health­care field is an im­pres­sive lab­o­ra­tory for in­no­va­tion and ex­per­i­men­ta­tion. Each day we ex­pe­ri­ence pock­ets of bril­liance. Com­mit­ted boards, lead­er­ship teams and their or­ga­ni­za­tions are see­ing the changes in re­im­burse­ment as a su­per­high­way to im­prove­ment and ul­ti­mately, mak­ing care bet­ter.

As more health sys­tems tran­si­tion from fee-for-ser­vice to mod­els that share sav­ings based on true value, the in­ge­nu­ity of our in­dus­try is on dis­play. We know of sys­tems that are tai­lor­ing pro­grams to el­derly, chron­i­cally ill pa­tients and im­prov­ing their lives for a frac­tion of the cost. We know of com­mu­ni­ties that have banded to­gether to ad­dress prob­lems such as teen preg­nancy or child abuse. We know of physi­cian groups that have re­designed care for pa­tients with lower back pain and re­duced surg­eries by 80% with hap­pier, pain-free pa­tients.

I am very op­ti­mistic about the fu­ture. No gen­er­a­tion has a bet­ter op­por­tu­nity than ours. Let’s take the best ideas from sys­tems around the coun­try to im­prove the pa­tient ex­pe­ri­ence, im­prove pop­u­la­tion health and re­duce the cost of care. We must har­ness our po­ten­tial and be­come an even more pro­duc­tive lab­o­ra­tory for in­no­va­tion. Change is here. It is not slow­ing down. Nei­ther should we.

James H. Hin­ton is board chair­man of the Amer­i­can Hospi­tal As­so­ci­a­tion and pres­i­dent and CEO of Pres­by­te­rian Health­care Ser­vices, Al­bu­querque.

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