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We’re training our physicians, because we see them as the cultural foundation to making this happen. In the last year, we’ve already taken over 300 faculty members across the various disciplines in the hospital and put them through a business school course to teach them about creating value reduced costs. How do you get rid of the excess that’s unnecessary so that when patients come in we’re taking care of them, we’re giving them what they really need, and then we’re moving them on so that we can reduce costs throughout the system?
The Affordable Care Act, really all it does is shift the way we fund the healthcare enterprise. It doesn’t change that really important foundation of how we run healthcare, what the expectations are, do we do these expensive tests that we know aren’t necessarily required but we’re practicing medicine in a way that is preventing us from being at risk—although the data would show it’s not clearly important to do it.
So it’s all about changing the way we provide care. Every hospital system needs to do that, and we need to find an exchange for ourselves where we benchmark the best practices so that every hospital can utilize that.
LAWLOR: One of the more significant aspects of the exchanges is really aligning the patients’ expectations with what a number of the providers are doing. So if they deal more directly with the cost of healthcare when a provider talks to them about, well, this test may not really be necessary, there’s no good evidence, that may ring truer for the patient and they may begin asking more of those questions.
WEBB: The costs and value of healthcare are hard to understand for patients and for employers. It can be hard for us as providers, even, to know how much a patient is going to end up paying. And so it’s hard for employers and patients to drive costs down if they don’t understand what the costs are. It’s hard for them to select the optimal place for them to obtain their healthcare. We’ve made an effort in our practice to try to provide price transparency for patients who are asking beforehand how much an MRI or an X-ray would cost, and we’ve found that patients have responded to that ability to know. Until there is more transparency both with respect to costs and outcomes, it will be hard for market forces to drive costs down.
BARLOW: I think we’ve underestimated the ability of physicians to manage data on a cost basis. It’s data that’s never been given to physicians. And they’re trained and skilled in data assimilations, making decisions, but we’ve never been able to help them be sensitive to the cost elements of some of those decision points.
So as that’s happening, it’s been fascinating to see as we’ve been doing our ACO work those data sets now being available and how you can really see that variation and really dive in, even though the data’s not perfect, they can see relevant peer groups and differentiations, and it changes behavior quite dramatically. So that’s a big progression that we’ve got to continue to explore.
The second piece is getting to that patient engagement stage. Are we at the tipping point from a financial standpoint that it’s painful enough that people engage? Because the only real issue that’s going to, in the long term, provide a cost difference is lifestyle changes. There’s lots of things we can do to the system. We’ve still got to get to that point where people embrace health and wellness—they’re not just looking for a pill or a surgery as the source of their healing. People ask me how we’re doing, and I keep on saying as long as people are fat and lazy, we’re in good shape. That’s a sad commentary.
KEN JOHNSON: While the Affordable Care Act didn’t create prevention, the Affordable Care Act does support prevention. And our rates of obesity and diabetes are going to continue to climb. They’re not going down. We fought a good fight with tobacco, but we haven’t done so well with obesity.
So consumer-driven health behavior is just as important as healthcare. And until we can get a handle on that somehow, costs are going to continue to go up, for employers as well.
BATEMAN: I have respect for things that have been said with regard to taking redundancy out of the system and reducing the amount of defensive medicine that’s practiced—but in the end, hospitals will get better at cost management if we can predict the demand better. So if a larger number of people are in the pool, the end is larger, we’ll be able to predict demand better and wring the inefficiency out of the system better. The up and down of the hospital census—that’s where the inefficiency lies for us.