Phil Castle, The Business Times
Collaboration and innovation have helped provide better health care at a lower cost, but challenges and complexities continue to effect transparency and especially affordability, local administrators say.
Progress could come slow, said Steve ErkenBrach, president and chief executive officer of Rocky Mountain Health Plans. “This is not a light switch. It’s a thermostat.”
ErkenBrach was among four members of a panel that also included Brian Davidson, president of St. Mary’s Medical Center; Stacy Mascarenas, community development administrator with Family Health West; and Chris Thomas, president and CEO of Community Hospital. The four addressed various trends affecting health care at the conclusion of health care summit in Grand Junction.
Jeffrey Hurd, a lawyer and past chairman of the Grand Junction Area Chamber of Commerce board of directors, posed questions and moderated the ensuing discussion. While Hurd initially asked the panelists to describe what they viewed as the future of health care, many of the subsequent questions focused on cost and affordability.
Davidson said collaboration among health care providers has resulted in improved care at a lower cost. He cited as an example an effort involving St. Mary’s and Colorado Canyons Hospital and Medical Center operated by Family Health West in Fruita to treat patients who no longer require intensive care, but still need rehabilitation and other services. An expansion at Colorado Canyons Hospital added nine rooms and other facilities to accommodate so-called transitional patients. St. Mary’s aligned its patient care with the program, which Davidson said could provide care at half the cost.
Thomas said the new facility Community Hospital opened will actually save money in providing additional services that increase the volume of care offered there.
Davidson said St. Mary’s improves access to health care by offering procedures that patients would otherwise have to travel to Denver or Salt Lake City to obtain.
ErkenBrach said a program conducted by Hilltop Community Resources offering prenatal care to women has reduced health care costs associated with pregnancies, deliveries and newborn care. HopeWest similarly has helped reduce costs in offering palliative care to those facing serious illness and death, he said.
Moreover, a health leadership consortium exists in Mesa County to work on problems, ErkenBrach said. “We have to realize we’re all in this together. How can we make it better tomorrow?”
Davidson said St. Mary’s joined with Primary Care Partners and Rocky Mountain Health Plans to operate what’s called a clinically integrated network to evaluate and modify practice patterns to raise quality and lower costs through interdependence and cooperation.
The network offers a way to accommodate changes in the way health care providers are paid for services, Davidson said, in shifting from a fee-for-services model to paying providers based on the quality, rather than quantity, of their care. A fee-for-services model creates incentives for providers to order additional services for patients, even if they’re not clinically demonstrated to be necessary, Under a values-based model, providers that achieve measurable results and lower costs share in some of the money from the savings.
Thomas said more efforts are needed in health care to change incentives — to lower costs and share the savings. A partnership between Community Hospital and Mesa County School District 51 has worked well to lower costs for the district, he said.
The four panelists were asked why health care can’t operate like other industries in a free market.
Davidson said the elements of a free market include ample buyers and sellers, low entry costs, no externalties and rational buyers. “None of that applies fully to health care.”
Another problem, the panelist said, is there’s no transparency in health care pricing. Mascarenas said that makes it difficult for consumers to make informed choices.
The government and insurers reimburse health care providers at different rates. Reimbursements from Medicaid and Medicare are often too low to even cover costs. Moreover, patients end up paying different amounts for the same procedures in a situation similar to the way airline passengers pay different amounts for seats on the same flight.
On way to lower health care costs, the panelists said, would be to reduce demand, to encourage people to eat healthiets and live healthier lifestyles that would require less medical care.
The health care industry should change in that effort, Davidson said. “We don’t provide health care. We provide sick care.”
Mascarenas said businesses can play a role as well in encouraging their employees to stay healthier.
Davidson advocated an even broader approach. “The health of our nation is everyone’s responsibility.”