We know what to do … let's get on with the work. Everywhere I go, health care leaders see a future where value is rewarded over volume, where care is better coordinated and targeted to be much safer, more effective, and even possibly lower cost. There is immense clarity and consistency in the views of leaders I interact with, and they are exhorting their organizations to not get distracted by the Supremes, the Election, the Deficit, or the economic collapse of Western Europe. This is encouraging.
To be fair, there is considerable uncertainty in the macro political and economic environment, and health care is in the eye of that storm. At the same time leaders are trying to focus their organizations on what they can control by concentrating on changes that must happen, no matter what. This is the work. There are many common themes in the work agenda, and all must happen if health care is to reach a sustainable future. Here are five keys I hear from hospital leaders:
1 | The Centrality of Clinical Integration. A majority of hospitals own medical groups and many more physicians are joining these groups every day. A new generation of physicians (of both genders, I may add) value security, lifestyle and predictability of employment over the 100-hour entrepreneurial workweeks of their forebears. These young doctors (and many older physicians weary at the annual uncertainty of SGR negotiations, malpractice fear, and the deliberations of all the crazy people in Washington), have offered themselves to be part of a new cadre of physicians in closer alignment with the hospital. Truly integrating physician groups into an organization is extremely challenging because of the wide differences in culture, training, motives and values of the players, but this is job 1.
2 | Health IT is a Platform Not a Panacea. There is a lot of meaningless use out there. Organizations are investing fortunes in clunky electronic health records (most of which are updates of steam-driven legacy systems from another century). But it's all we've got, and you can't transform care unless you use IT to help. It's a platform for change, not a panacea for higher performance. Most hospitals will make the first hurdle of meaningful use performance and get their just rewards. They will struggle more with the subsequent stages that require connectivity and meaningful exchange beyond the walls of the hospital.
3 | Learning to Live on Medicare. Everywhere I go (and surveys support this assertion) hospital leaders are urging their organizations to learn to live on Medicare levels of reimbursement. It is easy to point to on a Powerpoint slide (I know, I do it for a living); it's much harder to do (maybe requiring 10, 15, 20 percent reductions in costs).
4 | Managing Business Model Migration. Most health systems have clarity about the general direction of the new future, "The Second Curve" as I dubbed it. But getting there is hard: How fast, what sequence of initiatives, with what underlying economics are all thorny questions that leaders are now grappling with. For example, I see children's hospitals doing great work to prevent prematurity, only to hammer their NICU revenues. I see hospitals doing the math on readmissions: "I'll avoid a dollar in penalty, if I give up $6 in revenue." OMG.
5 | Building a Culture of Quality and Accountability. All of this work is important, not because it is fashionable, or financially rewarding, but because it is the right thing to do. Leaders are reminding their boards, their staffs and their physicians why we all got in to health care in the first place. The core of the work is to lead a cultural change toward high performance, quality and accountability.
We will be focusing on all these themes at the Health Forum Leadership Summit in San Francisco in July. Join us.
Ian Morrison is an author, consultant and futurist. He will serve as synthesizer of the Health Forum-AHA Leadership Summit.
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