Project on Integrated Delivery Systems and Financing Models Frames Critical Discussion
September 12, 2010
Posted by chcablogadmin in : Financial Viability, Healthcare Reform, Leadership
A current research project is bringing hospital experts to the table across several disciplines to begin to strategize viable finance models and care delivery models in anticipation of reform constraints. Larry Tubb, Senior Vice President for System Planning at Cook Children’s Health System in Fort Worth, is part of the group and weighs in with his feedback. — Don
Can children’s hospitals create a range of financing and delivery models under the new consolidation and reimbursement pressures of health reform? A CHCA research project is trying to answer that question. Last week, 14 hospital representatives as well as those from NACHRI and the American Academy of Pediatrics participated in a roundtable discussion at Children’s Mercy Hospital and Clinics, Kansas City.
The workshop was one step in a project that began last April. Kurt Salmon Associates and CSC are the consultants on the project. Earlier this year, key attributes of integrated delivery systems were identified by the Strategic Planning and Business Development Forum group followed by the consultants profiling Owner Hospital current financing models and risk arrangements. Those results were the basis for the recent workshop.
Larry Tubb
“Research endeavors such as this keep us engaged and current. Information becomes critical in this environment.” — Larry Tubb
“The consultants have done good preliminary work including giving us the structure useful to define our talking points — reform isn’t well defined, there are a lot of avenues to chase down,” shared Tubb. “Framing the discussion is step one and we now have the right structure to do that. It is also critical that other hospital perspectives be considered as well.”
“This project will help inform CEOs of key issues and provide a framework for them to discuss with their boards,” Tubb added. “Implications of reform and reimbursement are very confusing for experts and especially our boards. Someone shared a great quote at the meeting ‘uncertain implementation of unstable legislation’. The resulting work from this project will allow us to communicate with boards accurately and clearly.”
“We are looking at a long-term process,” he stated. “The engines don’t get turned on until 2014 which creates a unique set of challenges. Accountable Care Organizations will be a critical component, both for adult and pediatric care systems. But, there is no clear definition of what it is and what it will end up looking like. Our group discussion focused on managed care organizations as the tool by which ACOs might be implemented, but there are certainly other vehicles to manage risk. And, the ACO model might be applicable only to government payors.”
“What struck me is that all of the hospitals at the table had taken different approaches to managing risk and delivering care and they worked well in past,” noted Tubb. “We operate in different socio-economic environments, competitive markets and state funding structures. Even though we all provide pediatric care, there is uniqueness to each facility. We may have to customize our approach.”
“I also had the realization that there is no clear winner in financing models but there are great ideas out there. We need to figure out how to optimize the best ideas, but it probably won’t be one-size fits all,” Tubb explained. “Other strategies that merit discussion are contract negotiations and partnerships to share risks and benefits. We need to hone our coping skills and ask how we continue with the new rules.”
“We also all have a uniform concern about resources — primary care is the thrust of health care reform but the number of providers is declining,” explained Tubb. “It may take awhile to turn this trend around and make it financial viable to provide primary care. Who is going to be providing the care? We don’t have a solution but we are all mindful.”
Tubb concluded, “Finally, everyone present agreed that it is vital for CHCA to continue to help present the case for the value of children’s health — medical care along with wellness and prevention.”
In October, the Revenue Cycle Forum members will discuss reimbursement trends and the implications for range of financing models. Final results will be presented to Owner Hospital CEOs at the November Executive Dialogue. Next spring, plans include having COOs and CFOs further discuss the results and implications at their Forum meetings. In addition, CFOs are also providing input to the project.
If you have additional questions about this project, please contact Jacqueline Kueser (Jacqueline.kueser@chca.com).
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