Health Systems Changing Under Pressure
November 29, 2012 — Leaders of top health systems in the U.S. — Geisinger, Penn, Hopkins, Mayo, Kaiser, the VA, and more — seem to agree: Obamacare is now driving sweeping change in the systematic delivery of healthcare across America, and will keep it going at an accelerating pace over the next few years. The folks paying the bills — like IBM, Exxon, and state governments — also agree. Health systems can either change their ways to deliver superior outcomes or face extinction.
The ECRI Institute brought together a remarkable collection of leaders from all spheres of American healthcare in Washington this week for two days of exploring the notion of “Creating Systemness within Healthcare Delivery.” Systemness is an atrocious bit of jargon that describes the ability of a health system to deliver outstanding outcomes for every patient through operational excellence.
The financial stakes are enormous. The U.S. spent $2.4 trillion (18% of our economy) on healthcare in 2010. Hospital care and professional services account for most ($1.5 trillion) of that big heap of money, and most of that is now delivered through big health systems.
Huge health systems developed in response to financial pressures that grew as payers and policy makers sought to bring health costs under control. Hospitals have merged or acquired other hospitals to form these systems. They have acquired medical practices and developed health insurance plans. The effect of becoming a large system is to provide scale that has allowed these systems to prosper in the face of financial pressures.
The funny thing is that these huge systems, all too often, are anything but systematic in the way they deliver healthcare to patients. For two days, these titans of healthcare traded stories about dysfunctional systems that look more like “shotgun marriages” than efficient systems for delivering world-class healthcare. Presenters held out the VA Health System as a paragon that efficiently delivers excellent outcomes. The VA model for patient-centered care (at right) indeed has merit.
The quest for systemness comes because Obamacare and pressures from payers will make it impossible for dysfunctional health systems to survive the changes that are underway in American healthcare, now that Obamacare is here to stay. Ironically, the goal is to produce a system that serves the individual health of every patient. Somehow, constructing a system to serve the individual seems counterintuitive.
Change image © Felix Burton / Wikimedia Commons