When it comes to sharing, large systems have an edge
over their smaller peers: They have a lot to offer, and supply and demand will allow them to reap the rewards for those resources.
One example: Systems such as Adventist have access to data—and lots of it. The system plans to connect community physicians to its own private health information exchange. Down the road, it will likely connect with state databases.
“There’s a lot of power in that information,” says Reiner. “Our plan right now is to really just use and leverage our eight or so contributing systems and standardize some of the data.” The end goal is not only to have a goldmine of data at its disposal, but to use that data to engage and build loyalty among community physicians. “If they want to have access to our private HIE, we’ll put a device in their office and they can communicate with our private HIE. Then we will connect to the regional extensions in our various markets,” he says. “We’ll connect to whatever shakes out.”
Regardless of size, specialty, or location, there is one thing that all healthcare organizations have in common: They depend on payers for survival. And building more mutually beneficial relationships with payers will be a key strategy for the hospital of the future.
Under healthcare reform, most hospitals will see volume grow as more people gain insurance coverage. Of course, that volume will be paid at Medicare/Medicaid rates. “Given the surging budget deficits and huge price tag that will accompany reform, it is not a big leap to assume that over the next decade those reimbursement rates will head only in one direction—down. And private payers are sure to follow,” says Rob Reilly, general manager of the GE Healthcare Performance Solutions.
The traditional response to Medicare/Medicaid reimbursement issues has been to offset shortfalls via the commercial payers. But those days are numbered, Reilly says.
“While politicians and many in the industry vilify the insurance companies to justify the cost shift, the reality is that there are many real companies on the other side of that equation that are the true payers,” Reilly says. As with their other vendors,
businesses want to build relationships with healthcare providers that supply the best-quality goods and services at the best prices.
“Employers looking to keep their workforces healthy and productive are another opportunity for health systems,” he says. “Those that aggressively drive productivity measures, rigorously manage capacity, and continuously improve quality will be able to differentiate themselves with employers looking to do business with health systems that provide the highest-value equation.”
Adventist, for example, is tackling readmission rates and length of stay by merging clinical information and revenue cycle management, says Reiner. “We’re doing some work in the care management and utilization review space to try to make that more of an integrated part of the clinical and the revenue cycle …
You don’t want Medicare patients staying too long, and the payers like United, they have [utilization review] nurses, too. They want to control the cost as well. So we have to make sure that people are meeting criteria and they’re really sick enough to be in the hospital.”