Employers and Providers Working Together for Quality & Value

“Health insurance costs are out the door, and we need to do more to control the costs,” stated Wendy Ebersole, Human Resources Director for Kinsley Construction. This is one of the reasons why Wendy attended AF4Q – South Central PA’s “Improving the Quality & Value of Health Care – A Summit for Employers and Providers” in October. Wendy, along with other local employers and providers, listened to various speakers present their views on reforming the delivery of health care.

According to Keynote Speaker Paul Grundy, MD, MPH, FACOEM, FACPM from IBM Corporation, “Of all the states, Pennsylvania ranks 38th for avoidable hospital use and costs. The more we pay for health care, the more we spend and the worse the value system. The transformation must be a collaboration of buyers and payers. Health care is a business issue; not a benefits issue. We need to look at what we are buying, why we’re buying it and what we can change.”

According to Grundy, the way to truly understand costs and determine where they can be reduced without compromising outcomesis by using the Patient-Centered Medical Home (PCMH). The PCMH creates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Ultimately, the patient needs a long-term comprehensive relationship with a personal physician empowered with the right tools and linked to their care team.

Following Grundy’s presentation, Dr. Karen Jones, physician champion for AF4Q – South Central PA,discussed one of AF4Q’s local initiatives in primary care, the Planned Care Collaborative. She explained the benefits that the collaborative brings to the practice internally, and to the patients. “By tying in the PCMH model, the Planned Care Collaborative is an approach that emphasizes partnership with the patient and, as appropriate, the patient’s family. Through eliminating waste, more time can be focused on the patient, and in the end, this concept can reduce preventable hospitalizations, hospital readmissions, and emergency room visits while improving health outcomes and reducing the cost of health care services.”

Dr. Charlie Chodroff of WellSpan Health followed Dr. Jones by sharing one of the initiativesWellSpan Health is focusing on to improve quality care and cost. “WellSpan Health’s strategy is to focus on a bundled payment, which involves creating aligned incentives among WellSpan physicians and facilities for a limited set of common inpatient procedures; learning to manage costs (avoidable complications, unnecessary care) within the context of the bundled payment price; and testing with populations, starting with our own workforce.”

The summit concluded with an open-discussion led by Harold Miller, executive director of Center for Healthcare Quality and Payment Reform, and president and CEO of Network for Regional Healthcare Improvement. He encouraged input from the audience on what York and Adams counties need to do to get its arms around the health care costs. He emphasized that change won’t happen today, but leaders need to come together to start the discussion, and take action. The group discussed their thoughts on how primary care practices should be paid for caring for patients with chronic disease, what changes in benefit structures should be made, and what barriers will be faced in transitioning to better payment models.

“I found the event to be very beneficial. I was pleasantly surprised to hear physicians are on the same side as the employers – wanting to see more involvement with the family physician and follow through with the entire patient’s case. So often, employees get lost in the maze, and don’t know what questions to ask their physicians, or what to do for their health. This can help break this confusion and put them on the right track,” added Ebersole.

To learn how you or a member of your organization can participate in upcoming payment reform discussions, please contact Chris Amy. To view the PowerPoint presentations from the event, visit http://www.aligning4healthpa.org/body.aspx?newsid=11633.

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