Dennis D. Keefe is president and Chief Executive Officer of Care New England, a Rhode Island health care system comprised of Butler, Kent and Women & Infants hospitals, VNA of Care New England, its affiliate, HealthTouch, Inc., and the Care New England Wellness Center.
The following op-ed was printed in the Providence Journal on February 28, 2012.
Perhaps the closest that any of us will get to time travel is to look at the Massachusetts experiment with health-care reform. It is a view six years into the future of what awaits us on the national scene. That is the case whether or not the federal law advanced by President Obama stays intact or ends up getting repealed, because many of the sweeping changes are embedded in Medicare and Medicaid policy already being implemented.
I recently came from Massachusetts, where I completed a stint as chairman of the 62-hospital-member Massachusetts Hospital Association and served for nine years as chief executive of the Cambridge Health Alliance, the last remaining public-hospital system in the commonwealth. I watched the concept of universal coverage emerge from an idea to the present reality, and I have since seen the impact the reform movement has had on Massachusetts’s market.
The changes have been nothing short of dramatic, with more than 97 percent of the Massachusetts population now covered. The goal was to get people covered during the first phase of reform, and then to move on to dealing with the costs. Hence, Governor Patrick recently called on the legislature to embrace global payment plans and end the traditional fee-for-service system, changes that are squarely aimed at dealing with the cost issue. Make no mistake, the future is here.
So, how is Rhode Island facing up to the new future of health care? From my observation, having just spent the first several months of my tenure getting to know the academic leaders, hospital executives, health insurers, elected officials and public-policy makers involved in Rhode Island health care, all agree an answer is needed to the state’s declining employment, personal income and population. The good news is that all acknowledge the magnificent potential of health care and the further economic-development synergies possible through the enhancement of the knowledge economy.
Where there is less consensus is the gateway to that successful future. Some have suggested it is a revisit of the Lifespan-Care New England merger and the building of a mega health system, such as the University of Pittsbrugh Medical Center system in Pittsburgh, which kick-started the transformation of the steel city into a thriving biomedical center. Others have seen hope in a for-profit system’s entry into our market and the emergence of a competitive new health-care system in our midst. Still others have argued that bigger health-care systems only drive bigger inpatient use and bigger costs, and they would advocate further development of Rhode Island’s primary-care network, its community health-center infrastructure and the creation of an accountable-care-organization approach to care.
What is the answer? As with any complex issue, there is probably not a single path forward to success. All in all, we need to move from our old framework into a new business model for health care. We will need to make health care more affordable for the business community. We will need to pioneer new wellness- and disease-management models that keep people out of the hospital, and to realign our payment systems accordingly. We will need to explore new ways to improve the continuum of care while assuring that our academic medical centers and community hospitals remain strong programmatically and financially. And we will need to look beyond Rhode Island’s borders and acknowledge that we are operating in a regional marketplace.
Change will need to be transformational. Changes on the margin will not let us achieve what the Institute for Health-care Improvement deems the Three Part Aim: improving the health of the population; enhancing the patient experience of care (including quality, access and reliability); and reducing, or at least controlling, the per-capita cost of care.
As a state, we must engage in an open and honest discourse to determine our collective vision for health care in Rhode Island. This dialogue must include discussion of tools and mechanisms to create clinical and economic alignment among key constituents — physicians and other care providers, health systems, public and private payers, business leaders — essential to redesigning care delivery. I call it health-care delivery reform supported by payment reform.
Perhaps the place to start is Rhode Island’s new Health Care Planning and Accountability Advisory Council, which has been charged with reviewing the state of Rhode Island’s health care and developing a cogent approach to statewide health planning. A sound plan could provide us with the context and the guidance for the change that is needed and the hard decisions that will inevitably follow. And, whether through this panel or some other , let us not forget the importance of having consumers and patients at the table. As we seek to instill new behaviors in the areas of proper diet, healthier lifestyles, prevention, wellness and general avoidance of disease, the involvement and input of consumers will be essential.
Another area warranting examination is the state’s Hospital Conversion Act (HCA). For organizations to take on responsibility and risk for population-based care, they will need scale, geographic reach and the full continuum of health-care services, including primary care, specialized services, rehabilitation, wellness and home health services. And how would institutions develop these programs while making the most efficient use of community resources and without costly duplication of services? In many cases, they would choose to joint venture, affiliate or merge.
The HCA, while maybe necessary and even visionary in its inception, may have had the unintended consequence of stunting such growth and partnership. Perhaps this is why many of our community hospitals face financial distress. It was recently reported through Rhode Island’s Hospital Association that, for the first time in memory, our state hospital industry showed a collective negative margin.
Regardless of the cause, it is clear to me that our distressed community hospitals need a solution, and all hospitals and other health-care systems need the flexibility to explore the full range of available strategic options. Without lessening the spirit of the law and the rigor of reviews, now may be the time to re-examine the HCA and to assure that we are doing everything possible to encourage appropriate development of one of the few industries that holds so much potential for our state. The market waits for no one. For us to avoid missing the inherent opportunities in the promise of the health-care industry for Rhode Island, we all need to come together in new and bold ways.