Challenges and Opportunities Facing Payors and Providers – Part II

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Dr. John Rowe continued the lively discussion on the issues with healthcare systems forming their own health plans.  He noted that forming a health plan is very complicated and involves a deep knowledge of the domain, operational, financial and legal risk, a large amount of financial capital and a complex regulatory environment.  He discussed how each of these issues pose significant challenges to healthcare systems forming their own health plans.

Dr. Rowe also expressed concern about the impact of recent Salter Medical Group case on ACOs and expanding healthcare systems.  In Saltzer a federal judge in Idaho ruled that providers consolidating in pursuit of realizing the goals of healthcare reform are still subject to conventional antitrust restrictions.   Dr. Rowe also noted that some of the changes currently in the healthcare environment may not continue, such as the robust expansion of narrow network exchange plans, while other trends, such as the expansion of Medicaid will likely continue.  Dr. Rowe concluded by stating that healthcare pricing is indeed coming down and that the focus of the energy behind many of the current and future changes in healthcare will be with the providers.

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Challenges and Opportunities Facing Payors and Providers – Part I

Dr. Norman Peyson

The late morning session at the 2014 Mailman School of Public Health, Health Policy and Management Conference featured two veteran industry powerhouse speakers, Dr. Norman Payson and Dr. John Rowe.

Dr. Payson posed the question of can a hospital be economically and effectively be responsible for total healthcare costs and delivery of high quality care. He noted that from a hospital standpoint forming a health plan is both the right thing to do within the community and eliminates the middleman in the healthcare insurance market.  He noted that pricing is “played out” in the healthcare insurance market where healthcare insurance pricing can no longer rise at will, employers will be gearing towards paying a fixed amount for healthcare per employee, there is a more competitive insurance environment with the healthcare exchanges and healthcare costs are increasingly shifting to consumers.

Dr. Peyton noted that some of the challenges with hospitals setting up their own health plan involve lack of management, lack of understanding of healthcare pricing and creating internal rivalries within the organization itself.  The management in most hospital systems have little experience and understanding of the health plan insurance business.  Health systems establishing their own health plan create an internal rivalry dynamic where the health plan side of the business is focused on keeping people out of the hospitals and containing costs while the hospital side of the business is concerned with filling beds.

Options including partnering with healthcare insurance providers in forming and implementing your own system health plan. Another option is partnering with providers that have a large market share within your marketplace that can provide the patients to your healthcare system.   Dr. Payson noted that pricing health plans and paying providers in the plan are often areas where healthcare system leaders often are lacking in their knowledge and understanding.

An ending recommendation of Dr. Payson discussed was that a  healthcare system can beta testing doing their own health plan with their own employees to see if they can get it to viably work on a smaller scale.

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Dr. Laura Forese: The View From The Inside – Bigger, Faster, Smarter

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Dr. Laura Forese, MD, MPH the President of the New York Presbyterian Healthcare System, and an alumni of the Columbia University EMPH program, delivered the keynote address today at the 2014 Mailman School of Public Health, Health Policy and Management Conference. She noted how the merger of the different hospitals within the New York Presbyterian Healthcare System was designed in such a way that pulling the system apart would be extremely difficult.  This was done to prevent the pitfalls that other failed healthcare system mergers  have had where different the entities did not get onboard with the establishment and integration of the new healthcare system.

Dr. Forese noted that it is hard for physicians today to practice independently in an integrated healthcare world and maintain good patient care while maintaining a high personal quality of life. There is a benefit for physicians working in larger groups both in terms of enhanced patient care, integration with healthcare systems, having more leverage with payor sources and vendors.

Dr. Forese discussed that for hospitals, the benefit of being in a larger healthcare system allows for more efficient uses of resources within the system including more sophisticated highly specialized and costly medical areas such as burn units. She mentioned that larger healthcare systems give hospitals the ability to serve their patients better and like larger physicians groups give them more leverage with payor sources and vendors. In New York she noted there are going to be five big players in the marketplace, New York Presbyterian, NYU, Northshore LIJ, Mount Sinai and Montefiore. Some of these healthcare systems will be entering into the insurance business. New York Presbyterian will not be going this route and will be focusing on the best in patient care.  Community hospitals in the New York area will continue to be merged and/or closely integrated with one of the five larger healthcare systems.

From a patient perspective Dr. Forese talked about the rise of consumerism. She noted that people are now paying more for their own healthcare and are becoming more saavy consumers. There is also a rise in convenient urgent care centers and night time pediatric centers as well as disruptive technologies with healthcare monitoring that is likely to change how healthcare is delivered to consumers.

Dr. Forese concluded that the changes in healthcare systems especially in the New York area will be rapidly occurring in the next few years as a reaction to the new healthcare environment that requires all providers to be bigger, faster and smarter.

 

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Some Top Healthcare Trends for 2014

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In the Columbia University EMPH program we constantly are learning about different trends in healthcare.  We have especially been discussing changes brought about as a result of the Affordable Care Act and how it will impact the structure of healthcare organizations, the access to, the delivery of and payment for care, compensation of healthcare providers and the increasing use of technology and data throughout the healthcare system.  I came across an interesting blog post here by Susan DeVore, president and CEO of Premier — a healthcare improvement alliance, that nicely summarizes many of the trends that we have been discussing in our classes.

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New Health Law Is Sending Many Back to School

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One of the reasons so many of us have chosen to attend the Columbia Executive Masters in Public Health Program is that we realized just how important it is to keep our education and skills current and razor sharp in the rapidly changing world of healthcare.  The opportunities in healthcare today are tremendous but so are the challenges.  I came across an article from the New York Times that discusses the need for healthcare professionals to stay on top of their game.  You can find the article here.

There is no doubt that individual classes and certificate programs are useful for many professionals seeking continuing education.   However my experience at Columbia’s EMPH program has convinced me that if you are a seasoned professional that really wants to be on the cutting edge of the business and administration side of healthcare the EMPH program at Columbia is clearly the way to go for several reasons.  First the program is comprehensive and gives you a 360 view of the changing landscape of the new healthcare world.  Next, the classes are taught in person by national leaders in the healthcare industry who have an insiders perspective on the areas that they teach.   Third, you are part of a cohort of seasoned healthcare professionals that turn lectures into lively face-to-face discussions giving a variety of perspectives and demonstrating how the lessons learned in class are applied by your cohort members in actual on the ground situations that they are currently working on.  Lastly, the networking opportunities are tremendous both within the cohort and from the faculty and alumni base of the Mailman  School of Public Health.  All of this leads to a superb overall experience that not only keeps your knowledge base up to date but provides you with the tools and a degree to take advantage of the career opportunities that are flourishing in this changing healthcare environment.

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Special EMPH Lecture with Bruce C. Vladeck, Ph.D. of Nexera

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Last evening the students in the EMPH program had the pleasure attending the Steven Rosenberg Lecture on Healthcare Quality.   The lecture featured Bruce C. Vladeck, Ph.D. of Nexera on Putting the Patient in Patient Centered Care.  Dr. Vladeck gave an overview the history of the patient-centered care concept. The lectured then focused on different definitions of patient-centered cared used in the health care industry as well as current trends.  The evening ended with an informal question and answer session with Dr. Vladeck, Columbia faculty and practitioners and EMPH students.

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EMPH Student Spotlight – Ingrid Edshteyn

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Ingrid Edshteyn is a Preventive Medicine physician, PGY2, at Yale-Griffin Hospital and has recently been elected to the Executive Board of the American College of Lifestyle Medicine. She has embraced Preventive and Lifestyle Medicine as it encompasses both disease prevention and health promotion for individual patients and populations. Her commitments include the Yale-Griffin Prevention Research Center and Griffin’s Weight Management and Wellness Center, where she is developing a model for the clinical integration of a scalable lifestyle program. The EMPH course on Health Policy enabled her to identify the salient needs and opportunities within the changing healthcare system and the Management coursework empowered her to effectively lead the multidisciplinary committees involved within the hospital and professional societies. The EMPH program has had a substantial and direct impact professionally, enabling a broader and more cohesive understanding of our healthcare landscape.

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A Wonderful Evening Presentation and Discussion With Christopher Koller

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This past Thursday right after classes we were treated to a wonderful evening presentation and discussion by Christopher Koller, President of the Milbank Memorial Fund on “Linking Evidence to Practice to Improve Population Health – Lessons from the States.”  Chris, previewed for us the presentation that he is making to governors around the country on the impact that they can have in reshaping  health care outcomes and lowering health care costs in their state by “going big” into revamping their health care systems. He presented extremely interesting results from both Vermont and Oregon and discussed new changes from the State of Arkansas.  After the formal presentation Chris held an open and candid discussion on the trends that he is seeing in healthcare systems in different parts of the country.  The seasoned EMPH students engaged Chris in a lively discussion.  Another intellectually stimulating in person event with an industry thought leader which is what makes Columbia’s EMPH program so special and unique.

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Getting “Lean” is not Just for Keeping in Physical Shape or Manuafacturing Anymore

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I have been a fan of Lean production and management practices for over 25 years (a big fan William Edward Deming) and have used these practices in many of my own professional services organizations.  In our recent EMPH class in Managerial and Organization Behavior taught by Dr. Thomas D’Aunno, we have discussed the use of Lean practices in health care settings.  A very important and current issue at a time where all health care providers are carefully looking at increasing quality and operational efficiency.  A recent article I came across by Mark Graban which you can find here, discusses the use of Lean practices for all types of knowledge based work.

 

 

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Welcoming Our Newest EMPH Family Member!!

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One of the best parts about the Columbia EMPH program is that it is not an online program but a diverse cohort of seasoned professionals who get together each month to have classes, socialize and network.  This in person experience allows us to bond as a group and celebrate important personal events and milestones in our lives.

It is my please to introduce the latest member of our EMPH family Alexander, son of our classmate Kristin Meyers.  We had a baby shower for Kristin during one of our lunch breaks which was truly a lovely event.  Congratulation to Kristine and all of her family! We are looking forward to meeting Alexander in person when the weather is perhaps a bit nicer and welcome him into our EMPH family.  He looks like he is ready to create health care policy that will change the world!

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