Molpus: How are you transitioning your physicians away from the fee-for-service mentality?
Brooks: Well, that's the dual imperative and that's part of the challenge. The good news is we've integrated all these health systems. The bad news is we've integrated the health system. So as these primary care physicians help manage healthcare utilization and healthcare costs, guess where a lot of those excess ED visits are coming out of? Now if we switch the financial mechanisms so that the health delivery system gets rewarded for that, not just the payer, we share part of the spoils, so to speak, in that regard, then we can take those resources and help retool the health system, right? But if we don't do that and we're still paid incrementally and we reduce the amount of increments that we're producing, the numbers aren't going to pan out and we're going to have a big problem on our hands.
Halfen: I think we as physicians need to realize that the best way to reduce expenses is by increasing the health of that patient so that they do not need to come into the emergency room or go into the hospital. That's the major reduction. Whether the doctor orders more laboratory tests—some of my partners order more tests than others—is the big determinant. You're not going to reduce costs very much by changing that. You're going to reduce the costs more by improving their health.
Jeffries: From the hospital perspective on volumes, those are negative things. I think the opportunity for health systems involved is to partner with insurers who are showing better quality results long term so their overall volume will increase. You're not going to make as much per stay, but you're going to have higher volumes.
Hendel: We're definitely viewing ourselves as having one foot on the dock and one foot on the boat for likely a decade. That changes the emphasis from a volume perspective of procedures or admissions or units, to concentrating much more on the overall greater health of our communities and the patients and families we serve. It is both a challenge and a tremendous opportunity. The emphasis on population health is the one single activity that excites me most about healthcare in the coming 10–15 years.
This article appears in the March 2012 issue of HealthLeaders magazine.