No doubt you're feeling the strain as we huff and puff around the much-ballyhooed second curve of health care. The transition from volume- to value-based payment is a fundamental shift in the way health care works in this country, but it’s not exactly happening overnight. As the American Hospital Association’s Rich Umbdenstock likes to say, we’ve got one foot in the boat and the other still on the dock as reimbursement continues to be tied mostly to fee for service.

The transition to pay for value does seem to be picking up steam, however, with recent moves by the Centers for Medicare & Medicaid Services and the launch of the Health Care Transformation Task Force. The task force includes representatives of providers, payers, purchasers and patients who have come together to align private and public sector efforts to promote value-based purchasing.

The group is chaired by Richard Gilfillan, M.D., president and CEO of Trinity Health in Michigan. In “The Interview” on Page 28, Gilfillan says the “aspirational goal” is to get all types of providers to focus on delivering the Triple Aim of delivering high-quality care, promoting health and controlling costs, “and really restructuring their business and clinical models to accomplish that.” He points to three mechanisms to do it: bundled payment, accountable care organizations and two-sided risk arrangements.

For hospitals to thrive, they’ll need leaders who are willing and able to move past the old ways of doing things. When people talk about the leadership traits necessary to navigate the second curve, certain words keep popping up — “innovative,” “visionary” and, perhaps most jarring to longtimers in the field, “entrepreneurial.” Hospital executives — and their board members, too — will have to run hard to keep up with an ever-shifting landscape, and they'd better be able to react quickly and creatively to sudden opportunities. If they don’t, someone else will, and those “disrupters” will take important business with them.

Executive recruiters tell us that they now look as much at behavioral competencies in hospital job candidates as they do at technical competencies. In part, that means the ability to create a culture that encourages and empowers staff across the organization to break through their job siloes and — like their leaders — be open to change and eager to innovate.

In last month's Executive Dialogue about creating the workforce of the future, Laura Fielding of Holy Family Memorial in Manitowoc, Wis., said her organization used to have a conventional, hierarchical culture. After a reassessment a few years ago, Holy Family leaders found that what they needed to thrive going forward was "a much more humanistic, encouraging, self-actualizing and achievement-oriented culture."

It's the kind of culture other organizations would be wise to adopt as they make their wobbly way through all the curves of health care transformation. "My fear is that we are so focused on the second curve that we are ignoring the third curve," said Rush University Medical Center CEO Peter Butler in the same Executive Dialogue. He was referring to the emergence of the engaged health care consumer and how that requires still more adaptive thinking. It's safe to assume there will be fourth and fifth curves down the road.

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