Vonderfecht says his organization began three years ago to prepare for population health management and the potential that MSHA could lose 30% of its inpatient volume with the change. The organization's 10-year strategic plan shifts the patient treatment focus away from expensive episodic care in hospitals and emergency departments to more reliance on disease management protocols and frequent patient contact with primary care physicians.
"It is common sense that you are trying to keep people healthy instead of trying to treat sick people," says Vonderfecht. He adds that MSHA is more focused on ambulatory outpatient and retail medicine "than we have ever been in the past."
The old adage about the squeaky wheel may apply here. Patient experience and satisfaction was included among the top three priorities by 54% of respondents, putting it at the top of the list for the second consecutive year. With the introduction of value-based purchasing and its link to HCAHPS, the federal Centers for Medicare & Medicaid Services has certainly turned up the heat to transform patient satisfaction from a marketing opportunity to a meaningful measure with clear fiscal implications.
Healthcare leaders are responding, at least in the short term. Indeed, the presence of care models (population health, medical home, etc.) registering as high as the fourth priority (27%) indicates seriousness about changing the industry's status quo. Still, two key priorities—clinical quality (48%) and cost reduction and process improvement (45%)—continue to earn prominence, capturing the second and third slots, respectively.
Tied for fourth place, also with 27%, is physician-hospital alignment. While MSHA views population health as a key strategic path and is an early adopter, others may be taking a more measured approach to care models, explains Timothy D. Ranney, MD, MBA, vice president and chief medical officer at Missouri Baptist Medical Center, a 487-bed acute care hospital in St. Louis.
"Healthcare is still in a payment model that doesn't support population health," he notes, cautioning that "as you learn the competency, it is important that you don't transition so early that your revenue stream goes away." Ranney expects care models to quickly move up the priority list over the next few years. As providers make the transition, he says they need to think about how different payment models such as bundled payments and commercial reimbursements will affect their care model, as well as how accountable care organizations might play into the mix. "How successful will some of those CMS programs become, and what will they look like? How will that impact payments?" Even within an ACO model, he says some will still be paid on a "semi-fee-for-service basis."
As Vonderfecht notes, "it gets down to how far out is your vision." Organizations that are thinking in the shorter term will have different priorities than organizations that are thinking about 2014 and beyond.