Hospitals and health systems are facing new collaboration models as they aim to convert into more patient-centric organizations, according to a report from Ernst & Young.
Financial pressures, quality of care measures and new delivery models are spurring the change in healthcare, and Ernst & Young's report explores seven areas of collaboration where hospitals and health systems are focusing their resources.
1. Federal healthcare policy. Now that the Supreme Court has upheld most of the Patient Protection and Affordable Care Act, save the provision of Medicaid expansion that is now optional for states, providers are now assuming it is the concrete law of the land. The main goals of the PPACA were to expand coverage to roughly 30 million Americans, reform the delivery system to improve quality and efficiency and lower the overall costs of providing healthcare.
Hospitals have been preparing for the PPACA for a couple years now, but those are not the only federal healthcare policies that require attention. Sequestration cuts to the Medicare program, entitlement reform, shifts toward Medicaid managed care and other policy decisions are forcing hospitals and health systems to formulate a new vision for healthcare — and soon.
2. New payment models. The PPACA and other federal health policies have spurred a range of pilot payment programs, most notably accountable care organizations, patient-centered medical homes and other shared savings collaborations. Ernst & Young associates said these types of payment models are aligning the incentives across the entire continuum of care — hospitals, patients, payors and others — and focus on the prevention of illness rather than the treatment of it.
"Healthcare providers seeking to pursue these new models must assess their capabilities — and find partners who can act collaboratively in bearing risks, sharing rewards and consistently delivering accountable care," according to the report.
3. Program integrity. HHS and the Department of Justice have ramped up their fraud and abuse efforts, resulting in record-breaking recoveries of Medicare and Medicaid funds. Federal and state regulators have set goals to prevent fraud, waste and abuse from entering the Medicare and Medicaid programs and to go after those who have gamed the system.
These initiatives, such as Recovery Auditors and False Claims Act activities, have put pressure on health systems and hospitals to reinforce compliance and instill integrity throughout their organizations.
4. Information technology. Hospitals and physician practices are installing electronic health records and other health IT initiatives at break-neck speeds in an effort to comply with new healthcare reform initiatives and better patient care, and healthcare organizations are realizing the need to collaborate on several fronts.
Providing access to data while preserving information security is requiring all providers to continually evaluate and invest in the technologies that will allow for secure data sharing. Information is not restricted to those within a single hospital or organization, though — health information exchange requires collaboration among all healthcare providers.
5. Consolidation and integration. Healthcare and hospital mergers have spiked significantly in 2010 and 2011, and the trend is expected to continue at the close of 2012. In fact, a recent survey of hospital leaders found that 78 percent of organizations are exploring or have M&A deals under way. The most common forms of consolidation include hospitals acquiring physician practices, hospitals merging with other hospitals and/or health system, joint ventures and affiliation/collaboration agreements.
Weak access to capital, shifting demographics, evolving hospital-physician-payor alignment and other drivers are pushing the consolidation wave, and it's not expected to pass soon in light of healthcare reform's collaborative emphasis. "Hospitals and health systems throughout the country are expected to continue to fortify their positions through consolidation strategies that ensure their viability — and add breadth and depth to their service offerings," the report said.
6. Patient-centered care. The previous areas of collaboration focus on broader healthcare policy and structural issues, but collaboration must also exist within the provider organization to achieve a patient-centered mission.
Collaboration among clinicians, between clinicians and patients, between hospital leaders and physicians, between providers and payors and among all hospital stakeholders is required to achieve better outcomes — but as Ernst & Young's report suggests, effective collaboration "is a skill that requires training, cultivation and continuous reinforcement."
7. Healthcare tools and measurements. Healthcare reform inherently requires a sense of accountability among hospitals and other providers to ensure the best outcomes are actually occurring. Healthcare organizations can utilize several tools, measures and benchmarks — such as Agency for Healthcare Research and Quality measures, the Assessment of Interprofessional Team Collaboration Scale, the Healthcare Team Vitality Instrument and a plethora of others — to build a "more cohesive, quality-focused, patient-centered organization," according to the report.
Financial pressures, quality of care measures and new delivery models are spurring the change in healthcare, and Ernst & Young's report explores seven areas of collaboration where hospitals and health systems are focusing their resources.
1. Federal healthcare policy. Now that the Supreme Court has upheld most of the Patient Protection and Affordable Care Act, save the provision of Medicaid expansion that is now optional for states, providers are now assuming it is the concrete law of the land. The main goals of the PPACA were to expand coverage to roughly 30 million Americans, reform the delivery system to improve quality and efficiency and lower the overall costs of providing healthcare.
Hospitals have been preparing for the PPACA for a couple years now, but those are not the only federal healthcare policies that require attention. Sequestration cuts to the Medicare program, entitlement reform, shifts toward Medicaid managed care and other policy decisions are forcing hospitals and health systems to formulate a new vision for healthcare — and soon.
2. New payment models. The PPACA and other federal health policies have spurred a range of pilot payment programs, most notably accountable care organizations, patient-centered medical homes and other shared savings collaborations. Ernst & Young associates said these types of payment models are aligning the incentives across the entire continuum of care — hospitals, patients, payors and others — and focus on the prevention of illness rather than the treatment of it.
"Healthcare providers seeking to pursue these new models must assess their capabilities — and find partners who can act collaboratively in bearing risks, sharing rewards and consistently delivering accountable care," according to the report.
3. Program integrity. HHS and the Department of Justice have ramped up their fraud and abuse efforts, resulting in record-breaking recoveries of Medicare and Medicaid funds. Federal and state regulators have set goals to prevent fraud, waste and abuse from entering the Medicare and Medicaid programs and to go after those who have gamed the system.
These initiatives, such as Recovery Auditors and False Claims Act activities, have put pressure on health systems and hospitals to reinforce compliance and instill integrity throughout their organizations.
4. Information technology. Hospitals and physician practices are installing electronic health records and other health IT initiatives at break-neck speeds in an effort to comply with new healthcare reform initiatives and better patient care, and healthcare organizations are realizing the need to collaborate on several fronts.
Providing access to data while preserving information security is requiring all providers to continually evaluate and invest in the technologies that will allow for secure data sharing. Information is not restricted to those within a single hospital or organization, though — health information exchange requires collaboration among all healthcare providers.
5. Consolidation and integration. Healthcare and hospital mergers have spiked significantly in 2010 and 2011, and the trend is expected to continue at the close of 2012. In fact, a recent survey of hospital leaders found that 78 percent of organizations are exploring or have M&A deals under way. The most common forms of consolidation include hospitals acquiring physician practices, hospitals merging with other hospitals and/or health system, joint ventures and affiliation/collaboration agreements.
Weak access to capital, shifting demographics, evolving hospital-physician-payor alignment and other drivers are pushing the consolidation wave, and it's not expected to pass soon in light of healthcare reform's collaborative emphasis. "Hospitals and health systems throughout the country are expected to continue to fortify their positions through consolidation strategies that ensure their viability — and add breadth and depth to their service offerings," the report said.
6. Patient-centered care. The previous areas of collaboration focus on broader healthcare policy and structural issues, but collaboration must also exist within the provider organization to achieve a patient-centered mission.
Collaboration among clinicians, between clinicians and patients, between hospital leaders and physicians, between providers and payors and among all hospital stakeholders is required to achieve better outcomes — but as Ernst & Young's report suggests, effective collaboration "is a skill that requires training, cultivation and continuous reinforcement."
7. Healthcare tools and measurements. Healthcare reform inherently requires a sense of accountability among hospitals and other providers to ensure the best outcomes are actually occurring. Healthcare organizations can utilize several tools, measures and benchmarks — such as Agency for Healthcare Research and Quality measures, the Assessment of Interprofessional Team Collaboration Scale, the Healthcare Team Vitality Instrument and a plethora of others — to build a "more cohesive, quality-focused, patient-centered organization," according to the report.
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