Patient-centered care key to curbing costs

TALKING POINTS: More than 450 people attended the PBN-sponsored Health Care Summit at the Crowne Plaza Providence-Warwick last month. / PBN PHOTO/RUPERT WHITELEY
TALKING POINTS: More than 450 people attended the PBN-sponsored Health Care Summit at the Crowne Plaza Providence-Warwick last month. / PBN PHOTO/RUPERT WHITELEY

The CEOs of three commercial health insurers in Rhode Island joined the leaders of Lifespan, the state’s largest hospital network, and Coastal Medical, one of the state’s largest physician-run primary care practices, for a March 28 discussion on “Health Care Reform and the Insurance Exchange.”
Together, they offered details of new insurance products and new health care delivery models that they are bringing into the market. At the center of those efforts is an attempt to engage with the consumer and make the patient the focus of health care delivery.
For the more than 450 people crowded into the Grand Ballroom at the Crowne Plaza Providence-Warwick for the Providence Business News-sponsored event, it was a glimpse into the future direction of health care in Rhode Island.
Peter Andruszkiewicz, president and CEO of Blue Cross & Blue Shield of Rhode Island, began the panel discussion stressing the importance of patient-centered care in new insurance products and investments in health care delivery service by Blue Cross.
“I’ve been in the health insurance business for 30 years,” he said, saying that the emphasis has supposed to be about building a relationship with providers and patients. “It’s been anything but that. We’re just beginning to change the incentives.”
Blue Cross has invested in new shared savings contracts and in patient-centered medical homes in Rhode Island to encourage population health management and root out waste, according to Andruszkiewicz.
He pointed to the rapid growth of Blue Cross’ investment in patient-centered medical homes. In the last three years, it has grown from six practices with 14,000 patients to 80 practices with more than 160,000 patients.
James Roosevelt, Jr., president and CEO of Tufts Health Plan, offered some insights into his health-insurance’s plans for the Rhode Island market, with a push to help small businesses become self-insured. He also suggested that a plan similar to one in Massachusetts, a partnership with Steward Health Plan that created a tiered, limited-network insurance product, is something under consideration to be offered on the new R.I. Health Benefits Exchange. Neither Steward nor Tufts has offered any detailed enrollment numbers to date.
Stephen Farrell, CEO of UnitedHealthcare of New England Inc., talked about the ways that UnitedHealthcare was attempting to engage the consumer in its new products, such as “Choice Advanced.” “Better information leads to better decision-making leads to better health outcomes,” he said. Farrell called his firm’s products “groundbreaking” in their attempts to make costs visible and transparent to consumers, so that they are empowered.
Farrell touted UnitedHealthcare’s national, for-profit reach – with more than $20 billion in insurance revenue annually, investments in 10 accountable care organizations nationwide, with two of the innovative entities here in Rhode Island, at Coastal and at Lifespan, and the ability to mine health IT data from some 75 million customers in better managing population health.
“We have a very fragmented health care system,” Farrell continued. “Our goal is to align the interests of the patient, the provider and the insurer.”
Dr. Timothy J. Babineau, president and CEO of Lifespan, the state’s largest hospital network as well as its largest private employer, with more than 12,000 employees, talked about the need to redesign health care delivery around the needs of the patient, not the provider. Despite the great advances in science and technology in health care, Babineau said, “If you think about health care as an industry, we’ve evolved very little in terms of responding to the market.”
In terms of the need for cutting medical costs, Babineau continued, it needs to be “much more than paying 95 cents instead of a $1 for a Band-Aid.”
Babineau praised Lifespan’s efforts to redesign the delivery of care to be patiented-centered, thinking about health care not just as what occurs in a hospital, but what happens before and after, too.
Babineau cited the experience at The Joint Center at The Miriam Hospital, where through the use of Lean and Six Sigma techniques, the hospital has been able to reduce the number of patients who need to go to a nursing home for rehabilitation stays from 60 percent to 21 percent. “That’s where the opportunity is,” he said.
Babineau also talked about the new $100 million investment by Lifespan to rebuild its health IT system using Epic software and technology. “The practice of medicine is about the exchange of information,” he said. The choice of Epic, he continued, was reinforced by the decision by Partners Healthcare in Boston to choose Epic and invest $800 million to rebuild its IT system. Care New England, the second-largest hospital network in Rhode Island, has also partnered with Epic to rebuild its ambulatory care IT system, as well as create a unified platform for its physician practices. Babineau said that the Lifespan network had 280 separate IT interfaces; with EPIC, in the future, every department and surgical center would now operate across one platform.
William P. Deveraux, a partner at the law firm of Pannone Lopes Devereaux and West, LLC, called the new health IT systems and the transparency they promote “a wonderful thing for software engineers and lawyers, because there was a significant risk of inadvertent disclosure.”
Dr. G. Alan Kurose, president and CEO of Coastal Medical, countered Devereaux, saying that the lack of clinical information available to providers at the point of care was a much more significant problem – “a hundred times, 500 hundred times, 1,000 times greater” – than inadvertent disclosure of personal medical information.
Kurose also offered details of Coastal Medical’s innovative, shared-savings contracts with Blue Cross and its accountable-care organizations with Medicare and with UnitedHealthcare.
Before coming to the forum that morning, Kurose said he reviewed Excel spreadsheets at the breakfast table, with some 67 databases looking at the total cost of Coastal’s operations.
The inpatient hospital costs were about 21 percent for Blue Cross; for Medicare, the inpatient hospital costs run about 39 percent. What that points to, he continued, is the need for system redesign, because about 80 percent of the costs incurred with Blue Cross happen outside the hospital, and with Medicare, 60 percent of the costs happen outside the hospital.
Kurose also touted Coastal’s innovative approach to providing primary care 365 days a year, as a way to deliver “the right care at the right place at the right time.”
Sen. Joshua Miller, D-Cranston, chairman of the Senate Committee on Health and Human Services, called the panel discusion “a great opportunity” for someone like himself who is trying to keep up with all that is happening.
Edward Quinlan, president of the Hospital Association of Rhode Island, said it was “a great service to the community.” •

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