The former CEO of a large safety net calls for a shift of healthcare dollars to social needs. She instituted such changes at her organization and simultaneously delivered " fabulous" care, and saved the system money.
The Lown Institute's annual conference began the day after the House of Representatives voted to repeal the Affordable Care Act. The Boston-based group is focused on "right care," a term that broadly refers to the delivery of appropriate care in a humane, costs-effective way.
You would think the conference attendees would be all over the Republicans, and they were, to a degree.
In his opening, virtual keynote, global economist Jeffery Sachs called the legislation an "attack on the poor" called its supporters "creeps" and worse.
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Still, not everyone at the event was a huge supporter of the Patient Protection and Affordable Care Act. Sachs and some members of the "Right Care Alliance" have a vision of care that looks more like European single-payer programs. That those countries spend far less for better outcomes was a "right care" theme throughout the weekend. (It was also the theme of a January issue of The Lancet.)
So, what can a single hospital do? One of Saturday's keynote speakers, Patty Gabow, MD, the former CEO of Colorado's Denver Health, offered some ideas. Non-profit Denver Health includes the 525-bed safety net hospital, Denver Health Medical Center.
First, don't expect Congress to save the system. Instead, Gabow proposed a to-do list for health systems that is heavy on improving the social determinants that affect health, but also places a high value on such ideas as a living wage for all employees.
Gabow said she made similar changes in Denver, delivered high quality care, and saved her system money.
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"You may wonder, after hearing that I spend 40 years at a healthcare institution, why I would pose a question like this: Can American healthcare deliver health? "she said.
"It is precisely because I spent 40 years at a safety-net institution that took fabulous care of patients. I saw every day that our patient had barriers to well- being and health." During and after the talk, Gabow elaborated on her list of what healthcare can do list.
Continue the efforts on access, cost and quality.
She cited lean innovations in management at Denver Health that translated into $192 million in financial benefits over seven years. They included supply chain and pharmacy management changes that kept money from going out the door and changes to revenue cycle management, such as getting the uninsured on Medicaid.
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Increase focus on behavior components.
Gabow noted that patient behaviors such as tobacco use, diet, physical inactivity, alcohol and drug use and sexual practices cause as many as 40% of all US deaths. She noted that levels of obesity and drug abuse disorders are higher in the US than elsewhere.
She was adamant about the need to address the social determinants of health. To combat these realities she urged leaders to:
- Contribute to community education on social determinants and advocate for addressing them
- Co-ordinate community benefits to address social safety nets
- Create linkages with social safety nets
Geographic variation reflects the impact of social needs on health, which leads some to suggest that "your zip code matters more than your genetic code in determining your life expectancy," Gabow said.
Invest in Social Care
To make her case, she compared Douglas and Denver Counties in Colorado. Douglas has fewer health facilities, but far more white, high school graduates. It has a lower crime rate than Denver and 11% of children qualify for free lunch. It ranks No. 1 in the Colorado county health rankings generated by the Robert Wood Johnson county health rankings.
Denver, which is home to more minorities and where 69% of the children qualify for free lunch, is ranked 38.
"When I meet the city council, I say 'We don't need more urgent care centers. We don't need more freestanding emergency rooms. We don't need more hospital beds in Denver. You need to invest in the social care system if you want Denver to look like Douglas County.'"
The way to do that, Gabow says, is by
- Paying a living wage to all employees
- Instituting robust tuition reimbursement programs
- Reducing income disparity within their institutions
One of the keys to containing costs at Denver Health was "getting more care from the same number of workers" by treating and paying them well. For example, even though Denver Health is a safety next system, it offers a small tuition stipend to employees.
Gabow also suggested that hospitals look at the pay gap between hospital executives and other employees.
Ultimately, she is calling for a redistribution of healthcare dollars toward social needs. She acknowledged that won't happen easily or overnight.
We have to "take the time to understand what is working in our system, what is not working, and what is working in other countries," she told HealthLeaders.
She offered another way to look at it: "If someone told you that you could buy a car for half the price and it would last twice as long, you would probably want to buy it."
Tinker Ready is a contributing writer at HealthLeaders Media.