futurescan 2014
TRANSCRIPT
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INTRODUCTION
The title for this
introduction derives
from Sheldon B.
Kopp's book, f
You
Meet the Buddha on
the Road Kill Him
The premise, as you may surmise,
is this: One can and should accept
guidance, but one must always
remember to seek his or her own
truth. Kopp (1972, 56) writes:
The most important
things
that each
man must
learn
no
one
can teach him.
Once he
accepts this disappointment
he
will
be able
to stop depending on
the guru
who
turns out to be just
another
struggling
human
being.
This wisdom applies to healthcare
leaders in 2014. Consider the
following:
While some healthcare systems
have been formed seemingly in
2
FUTURESCAN
2 1 4
IF YOU MEET
THE BUDDH
the quest for scale for its own
sake, others have prudently
asked, Scale to do what? How
will it help
us
provide improved
patient care?
Some healthcare organizations
have rushed to sign up as
Medicare accountable care
organizations {ACOs). Others,
some with well-established
insurance company subsidiaries,
have been more cautious, asking,
Are we prepared to assume
actuarial risk for an attributed
population with no lock into our
network?
Marketing executives and
some provider organizations
see insurance exchanges as
an immediate opportunity
to increase volume. But their
counterparts in other enterprises
are skeptical. They ask, How
long will it actually take for half
a dozen federal agencies {and a
similar number at the state
level)
to implement this program? How
long will it take to reach full
enrollment?
Some leaders are reluctant to
trade in their legacy T systems
by Don Seymo
About the
Author
Don Seymour, president ofDon
Seymour Associates in Wincheste
Massachusetts, has been a strategy
adviser to hospital boards, CEOs, an
medical staff leaders since 1979 A
frequent presenter on subjects relate
to senior leadership in healthcare or
nizations, Seymour is on the facultie
of he American College of Healthca
Executives and the Governance
Institute. Additionally, he
h s
made
presentations
to
the American Hosp
Association, numerous Fortune 100
companies, and a variety of other
national, state, and regional groups.
He h s served s executive editor
of
Futurescan
since 2004 A past
president
of
he Society for Healthca
Strategy Market Development,
he received its Award for Individual
Professional Excellence in 2008
for a platform that will truly
support clinical integration and,
in the long run, population
health management. Others
argue, The time is now. The
culture change alone may take
ten years to get it right.
While some leaders don't have
the fortitude to battle for clinical
integration and the employed
physician model, others readily
embrace the challenge: It's the
right thing to do, and it won't get
easier
if
we wait.
Every pilgrim must chart his or
her own journey to enlightenment;
every healthcare provider must
assess its own values, strengths, and
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8/10/2019 Futurescan 2014
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limitations and then establish
and
pursue its own vision.
Enter
Futurescan
Occasionally,
readers ask,
How
often have
you been right? It's a reasonable
question. We strive always to he
both
accurate and correct,
but
we haven't kept score.
Our
edito
rial policy has focused more
on
raising issues that every provider
faces on its journey and provid
ing guidance: and insight. We lack
the:
wisdom and hubris to
think
that
we are the Buddha;
we:
arc
simply humble acolytes struggling
with the challenges and opportu
nities inherent
in
the healthcare
environment.
This year's edition
of
uturescan
continues in that tradition. We
hope it enlightens your path
as
you
ddve
into the following eight opin
ion pieces.
On coordinating care for
popu
lation health: Forward-looking
hospitals are engaging in challeng
ing but necessary changes that pro
mote population health. Whether
improving the overall health
of
their population through better
care coordination
or
working with
community partners to improve
the health
of
the broader com
munity, hospitals are committing
resources to promote population
health. Participating in a health
information exchange and sharing
health data with other providers
will allow hospitals to effectivdy
address population health trends.
Hospital and healthcare system
Icade.rs recognize that advanc-
ing population health will enable
them to thrive
in
a value-based
landscape. With strong collabora
tions, formal structures that enable
care coordination, and the ability
to
leverage health data, hospitals
can create population health initia
tives that will lead to success in
the evolving care
environment.
Heather Jorna and Stephen A
Martin Jr.,
PhD
On meuuring
the suca:ss
of
population health: In the end, we
must have a paralld strategy fur
keeping healthy people healthy and
for managing the small percent-
age of patients who drivt: the vast
majority
of
total costs in each
of
our
local systems. Some vexing ques
tions remain that we will have to
answer
in
the next
five yea.rs.
For
example: who owns the patient? Is
it
the attending physician, the ACO,
the multispecialty group practice?
Who
is the real driver in improving
the health
of
the population? Will
this improvement
ll
occur at the
local, regional,
or
national levd?
How w ll
we measure our
success?
Will the Triple
Aim
he rdevant
in five yea.rs or will the Leading
Health Indicators become the front
runner?-David B. Nash,
MD
On
p.by.idan alignment:
Although physician employment
can simplify or diminate many
regulatory challenges, it is not a sil
ver bullet for physician alignment.
Because physician employment
transactions can carry hefty capital
investment costs and new practice
expenses, large-scale employment
is an impractical solution for many
hospitals. Employment needs
to
he a carefully titrated ingredient
in
an overall physician alignment
strategy. Moving the dial on
value will require expanded reliance
on aligned primary care: physi
cians, and you w ll need to face the
financial headwinds that currently
hamper progress. The creation
of
worthy financial incentives to fund
and reward the transformation
required to better manage popula
tions at the primary care interface
will be essential. Getting there will
he hard, so start this work
now.
Brian A Nester,
DO
On
provider affiliations:
The
imperative for hospital leaders
will be in honestly assessing and
understanding
how
their organiza
tion can best serve its mission and
the population entrusted
to
its
care. Does the organization hav
the resources (financial, human,
reputational, and intellectual) to
he a controlling consolidator
in
this market, or
is
the organiza
tion better suited to play a mor
defined, participating role in th
broader continuum? Does the
organization truly understand
h
all of the fragmented componen
must come together
and
oper-
ate as a whole to achieve optima
performance against the metric
population health? Is the organi
zation better suited to lead
or
to
participate in a more defined rol
-Mark Parrington, FACHE
On rdmbunemcnt and cwt
m
agement:
With such phenomen
changes in the healthcare marke
hospital and healthcare leaders h
no
choice but
to
seek new oppo
nities for growth while
also
driv
greater affordability for consum
ers and patients. We will have to
reinvent oursdves and devdop n
markets and niche industries to
meet our patients' expectations f
quality care that is also affordabl
t
will not be the biggest among
who will survive; it will be the m
creative and resourceful. Bringin
value to
patients-focusing on o
mission and not our margins-
w ll
drive innovation that leads
sustainable business in healthcar
s
hospital leaders,
we
can be th
solution that America
deserves
Bernard J. Tyson
On
in.funnation tcdanology
interoperability:
Some leading
organizations, small and large,
have begun
to
derive benefits fr
coordinated care supported
by
robust
IT
infrastructure, such
a
single-source clinical solutions.
who
has
the data will rule will
be the mantra
of
the future. Mo
imponant,
he who has the data
and can tum it into meaningfu
information will be positioned f
long-term success.-John
P
Ho
FACHE,
and
Michad S. Wallac
FACHE
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5
REIMBURSEMENT AND COST MANAGEMENT
THE QUEST
FOR
AFFORDABILITY
N
HEALTHCARE
Healthcare in the
United States is at
a critical inflection
point.
W ith healthcare costs expected to
reach an unsustainable 20 per
ce
nt
of
the co
untry s
gross domestic
pro
duct
by 2020 the entire
in
dus-
tr
y is rightfully, under intense
scrutiny. T he res ulting transfo rma-
tion
of
the heal thcare industry w
ill
require healthcare leaders to care
fully consider
reve
nu
e growth and
cost manage ment amid declining
reimbursement for care.
There h
as
n
eve
r been a more
exc
iting time to be in h
ealthcare-
or a more challenging one. We must
look closely
at
one of o
ur
country s
biggest
and
most p
ress
ing prob
lems the affordability
of
health
care and lead the way ro
so
lution
s.
W hether
we
approach the next
decade with co nfidence or trepida
tion one t
hi
ng is certain: T his is no
time
fo
r b
us
in
ess as
usu
al
.
T he collecti
ve
view
of
co ns
um
ers employers and the
gove
rnme
nt
is
th
at
th
e cost
of
care is too high. As
an industry healthcare and irs lead
ers need
to
be m
ot
ivated to actively
redu
ce
costs and be prepared to
face
lower reim
bu
r
se
ment rates that are
intended to d ri
ve
costs down.
Affordab
ili
ty wi
ll
certainly be
the domin
ant fo
rce for change
in the heal thcare mark
et
over the
next decade and is one of the big-
gest drive rs
of
the reimbursement
trends discussed in this article. H ow
we manage costs
and
cont
in
ue to
evol
ve
our b
us
iness
mod
el
w
hile
still delivering high-quality p
at
ie
nt
care w ill determine our viability
as
we
look ahead at the changing
healthcare la
nd
scape.
Clearly, the new focus on costs
will be long-term. Both in theory
and in
pr
actice organizations that
own more pieces of the healthcare
dollar can more effectively man
age costs while maintaining high
quality standards of care. Certainly,
moving to a bundled-payment
approach- sharing more risk along
y
erna
rd
J
Tyson
Ii A
1
Bernard
J
Tyson is
CEO
of Kai
se
r
Foundation Hospitals and Kaiser
Foundation Health Plan, Inc. During
his nearly 30-year career at
Kai
ser
Permanente, which serves more
than 9 million members in eight
s
ta t
es and the District ofColumbia
Tyson has successfully managed all
major aspects of the organization.
He h
as
served in roles from hospital
adm inistrator to division
pr
esident ,
leading
Kai
ser Permanente s busi
ness in Californ ia and other regions.
In his prev ious position as executive
vice president for Health Plan and
Hospital Operatio
ns
,
he
was respon
sible for both the care and cov
era
ge
ofmembers in one of he nation s
largest health plans and hospita l sys
tems-
38
Kai
se
r Permane
nt
e
owned
hospi tals and more than 600 medic
al
offices ac ross the United States. A
San Francisco Bay Area nat ive Tyson
r
ece
i
ve
d a bachelor of scien
ce
degr
ee
in health serv
ice
management and a
mas ter
of
bu siness degree in hea lth
service a
dmini
stration from Golden
Gate University in San Francisco. H e
earned a leadership certificate from
Ha
rva
rd Uni
ve
rsity. He serves on the
boa
rd
of di rectors of the
Am
erican
Heart Association and as chairman
of
The E
xe
cuti
ve
L
ea
dership Council.
the continu
um
- is intended to
create greater efficiency and d ri
ve
down the cost
of
care.
Othe
r powerful curre
nt
s
of
change offer
po
tenti
al
solutions.
HE A LTH
CAR
E T R END S A ND I MP L I CA T I O N S 2 0 4 2 l q 2 7
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FUTURESC N SURVEY RESULTS.
Reimbursement
and
Cost Management
How likely is it
that
the following
will
be seen
in
your hospital's
area
by 2019?
Very
Somewhat Somewhat
Very
Likely Likely Unlikely Unlikely
() () () ()
I I
I
8
42
Your hospital will have financial arrangements in place with physicians
to
support bundled payments.
How likely is it that the following will be seen in your hospital by 2019?
ACHE
..uJ l I
. .
M'7.Jll n
27
38
SHSMD
40
43
-
oth
31
40
Your hospital w
ill
s
upport
a provider capitation model (receiving a
se
t payment for members
of
the
covered populati
on
for a peri
od of
time).
32
42
At
leas
t
15
percent
of
yo ur hospital's patients will be under an at-risk (capitated) contract.
53 30
Your hospital will h
ave
made greater inve
st
ments in alternate sites
of
care delivery (e.g., satell
it
e
outpatien t facilities).
Your hospital will be
fi
nancially sustainable with fewer inpatient admissions.
74
22
Your hospital's strategic plan w
ill
h
ave
a goal
of
reducing u nnecessary admi
ss
ions.
Note: Percentages may
not
total to exactly I
due
to roundi
ng
ti
l i l
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Wh act
diet
Organizations will support bundled payments. Nea
rl
y 90 percent
of
respondents think it likely that by 2019
th
eir
hospital will have arrangements in place with physicians in their area to support receiving bundled payments.
Hospitals will support a capitation model. Most survey respondents (66 percent
of
ACHE respondents and 83 per
cent of SHSMD respondents) predict that by 2019 their hospital will support a provider capitation model. Further,
about three-quarters
of
survey respondents predict that at least 15 percent
of
their hospitals patients will be under an
at-risk contract by that time.
Hospitals will invest in alternate care delivery sites. Most (83 percent)
of
the CEOs surveyed believe that by 2019
their hospital will have increased its investment in alternate sites
of
care delivery, such
as
satellite outpatient facilities.
Hospitals will
be
financially sustainable
with
decreased
inpatient
admissions. Among CEOs responding to the sur
vey, 82 percent predict that by 2019 their hospitals will be financially sustainable with reduced inpatient admissions.
Strategic plans will target
reducing
unnecessary admissions. Almost ll practitioners (96 percent) believe that their
organization s strategic plan will, by 2019, include goals for decreasing unnecessary admissions.
Technology is mobilizing healthcare
as never before, and the expecta
tions of a younger, more diverse,
and more sophisticated workfor
ce
demand innovation. We can har
ness this momentum to create a
profoundly different healthcare
delivery and financing system.
But our true north should be
our
pat
ients and customer
s,
who
deserve real value from new
or
revised ways of providing healthcare
and servi
ces.
We must navigate to sustained
improvement in healthcare in
th
e
United States, and I see the follow
ing trends shaping that journey.
Trends
Providers will shift from fee
for-service
and
volume-based
measures
to
a provider capitation
model, where risk
and
patient
populations
are
managed i -
ferently
than
costs are.
The
cur
rent fee-for-service model, which
rewards more use with more
revenue, w
ill
go away in many
markets. Enrollment in managed
care plans
ha
s increased steadily
since the 1990s, and this shift away
from fee-fo r-service will accelerate
as
patients and purchase rs recognize
that more healthcare services do not
equate with better health outcomes
(Kaiser Family Foundation 2012).
The uturescan survey results show
that nearly 90 percent
of
hospital
CEOs believe that by 2019 their
hospital will have arrangements in
place with phys icians in their area
to support bundled payments.
The
ri
se
of
accountab
le
care
organizations and other pay-for
performance strategies is creating a
demand for more transparency and
is driving hospitals and physician
groups to align and take on more
risk as they struggle to improve per
formance and compete fo r market
share. As a result, the healthcare
industry continues to bustle with
mergers and acquisitions, showing
a 15 perce
nt
increase in activiry in
the first h
alf
of2 13
(de
la
Merced
2013). This receptiviry to greater
acquisition activiry and partnership
opportunities is reflected in the
uturesc n
survey data.
But managing costs
is
differ
ent from managing care, as
we
saw
in the late 1980s and early 1990s
when
HMO
s expe
ri
enced tremen
dous public backlash because some
plans we re incentivizing physi
cians to
re
strict care and withhold
services . Hundreds of plans either
closed or were acquired by com
petitors (Christianson, Wholey, and
Sanchez 1991).
Successful risk-based models
will keep central what
is
best for
patients and wi
ll
align payme
nt
incentives to promote value instead
of
volume of car
e.
T he uturescan
survey results indicate support for a
provider capitation model by 2019.
Hospitals
and
healthcare systems
will develop greate r specificity
around
appropriate admissions.
Hospital admissions for both
government-sponsored and com
mercial populations have dropped
significantly in many markets and
are projected to drop in all mar
kets over the next
five
to ten years
(Grube, Kaufman, and York 2013).
The
trend
of
declining admissions
is
likely here to s
tay, as
hospitals
and healthcare systems adjust to
declining reimbursement rates and
revenue for inpatient services as
well as new reform regulations that
do not pay for hospital readmi
s-
sions
(fo
r
ce
rtain diagnos
es)
.
Of
the CEOs responding to
the uturescan survey, 82 percent
predict that by 2019 their hospital
will be financially sustainable with
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reduced inpatient admissions. And
almost all (96 percent) believe that
their organizations strategic plan
will, by 2019, include goals for
decreasing
unn
ecessary admi
ss
ions.
Hospital leaders will focus
on
wellness and prevention to further
reduce preventable hospitalizations
and to direct care to the right set
tings. Inpatient care will
not
be the
default choice for care. Hospital
leaders will have to provide more
oversight
of
the appropriateness
of care and apply care standards
according to evidence-based
medicine.
The treatment
of
routine
back pain
is
a
perf
ect example of
how hospital leaders can influ-
ence adherence to best practices.
According to a recent H arvard
University study, many doctors are
not
following
th
e es tablished guide
lines for care, which stress a le
ss-
is
more approach that includes core
exercises, increased activity, and
physical therapy (Mafi
et
al. 2013).
Instead, ph
ys
icians are exposing
patients with back pain to unneces
sary X-ra
ys
and potentially addi
c
tive prescription pain medication.
They are also referring greater
numb
ers of patients to specialists
who are likely to perform spine
surgery, despite little evidence that
s
ur
gery is
an
appropriate first-line
treatment fo r low back pain. f
physicians consistently
fo
llowed
the es tablished guidelines, patients
wo
uld receive
bett
er and safer care,
and hospitals c
ould
save pay
or
s a
significant portion of the 86 bil
lion annual cost of treating low
back pain.
Hospitals will invest in alterna-
tive sites o care delivery and will
develop a financial model that is
sustainable with fewer inpatient
admissions. Technology is chang
ing the traditional footprint of care
delivery so rapidly that it is hard
to predict wh
at
th
e delivery model
might l
oo
k like in eve n five years.
Technology is making health
care increasingly mobile and
enabling patients to access care in
convenient and customized loca
tions, such as work sites and retail
centers, as well
as on
mobile devic
es . s care becomes more mobile,
patients' expectations around care
and
se
rvice will become
mor
e
sophisticated. Savvier consumers
mean increased expectations for
connectivity and access. Decisions
about where care is provided will
be made from the patient
s
perspec
tive
in
stead of the provider
s. New
delivery configurations will have
profound effects on hospitals' staff
ing and workflows. Consequently,
hospital and healthcare leaders will
have to champion new staffing and
scheduling models that
turn the
old provider-centric paradigm on
its head.
The acute care hospital will
become the care setting for only the
most critically ill, while outpatient
care settings enabled by technol
ogy will provide preventive care
and
wellness, ambulatory, and
post-acute care
se
rvi
ces
in comfort
able, customi
ze
d, a
nd
c
on
venie
nt
environments.
Hospitals will invest in technol-
ogy, specifically electronic medi-
c l
records EMRs), to reduce the
cost o care. Ho spitals will invest
in EMR
sys
tems
to
manage care for
their patie
nt
populations, especially
high-risk patients. In addition,
hospitals will leverage EMRs to
coordinate p
at
ient care among
the physician
s
office, hospital,
laboratory, pharmacy, and patient
s
hom
e
nd to eliminate the pitfalls
of incomplete, missing,
or
unread
able paper cha
rt
s.
EMR technology offers caregiv
ers imm
ed
iate access to patients'
critical medical information, result
ing in better care. It also provides
patie
nt
s with access to convenie
nt
,
time-saving features such
as
online
scheduling,
pr
escription filling,
and
connecting with their doctors via
secure e-mail.
Implications for ospital
eaders
No matter where one lands
on
the
payment
continuum
- bundled
payments, shared risk, partial capi
tation,
or
full risk- assuming more
risk will require healthcare organi
zations to invest substantially up
front in the infrastructure for pre
ventive care and care management
and to tolerate longer payback peri
ods
on
investments.
This
up-front
financing could prove to be a bar
rier to infrastructure investment for
small- to medium-sized healthcare
providers.
Succe
ss
ful hospita
ls
will
empower physicians to manage
care decisions and coordinate care
throughout the continuum, includ
ing pharmacy, outside medical,
post-acute,
and
end-of-life care and
prevention and wellness services .
Physicians will use real-time data
to
und
erstand and
man
age the care
of individuals, clinical c
ohort
s, and
communities.
And th
ey will prac
tice
ev
idence-based medicine, using
proven clinical protocols to consis
tently yield the best care.
The increased emphasis on
care management and quality will
re
quir
e leaders
and
organizations to
be more interdependent
than
eve r
before. Vigilant oversight of transi
tional care is critical, and coordina
tion of care will ex tend into the
co
mmuni
ty as hospitals increasingly
partner with communi
ty
health
advocates and other
se
rvices to
reduce admissions and address the
social, economic, and behavioral
drivers of hospital use.
With such phenomenal changes
in the healthcare market, hospital
and hea
lth
care leaders have no
choice
but
to seek new opportuni
ties for growth while also driving
greater affordability for consum
ers and patients. We will have to
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8/10/2019 Futurescan 2014
8/13
reinvent ourselves and develop new
markets and niche industries to
meet our patients' expectations for
quality care that is also affordable.
t
will not be the biggest among
eferences
us who will survive; it will be the
most creative and resourceful.
Bringing value to patients- focus
ing on our mission and not our
margins-will
drive innovation
that leads to sustainable business in
healthcare. As hospital leaders, we
can be the solution that America
deserves. Ill
Christianson, J.B., D.R.
Who
l
ey and
S.M. Sanchez. 1991. State Responses to
HMO
Failures.
Health ffairs 1
(4):
78-92.
De la Merced, M.J. 2013. Merger Activity Was Down but Not
Out
in First Half.
The
New York
Times
Dea/Book
Published July
1.
http://dealbook.nytimes.com/2013/07101 merger-activity-was-down-but-not-out-in-first-half/.
Grube,
M.,
K. Kaufman, and R. York. 2013. Decline
in Ut
ilization Signals a Change
in
the Inpatient
Business Model.
Health ffairs
Blog Posted March 8. http://healthaffairs.org/blog/2013/03/08/
decline-in-utilization-rates-signals-a-change-in-the- inpatient-business-model/.
Kaiser Family Foundation. 20 12. State Health Facts: Total
HMO
Enrollment. Published June.
ht
tp://kforg/
ot
her/state-indicator/total-hmo-enrollment/.
Mafi, J.,
E.
McCarthy,
R.
D a v ~ : m d t a n d o n 2013. Worsening Trends in the Management and Treatment of
Back Pain.
J M Internal Medicine
173 (17):
1573-81.
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7 EQUITY OF CARE
ELIMIN T ING HEALTHCARE
DISPARITIES THE CALL TO ACTION
Racial and ethnic
minorities now make
up about one-third of
the US population,
but
by 2042 they
will
become the majority.
While
all
patients are equal, they
are not the same.
They
may
for
example,
be
exposed to different
environments and workplace haz
ards, have different diets, interact
differently with healthcare provid
ers
and
face
different challenges
in complying with medical advice.
For these reasons and many others,
some still unknown, patients from
traditional racial and ethnic minority
groups often receive a lower qual-
ity of healthcare, even when the
comparisons control for income and
health insurance status
IOM 2003;
Mayberry, Mili, and Ofili 2000).
Healthcare disparities can lead to
increased medical errors, longer hos
pital
s t a ~
avoidable hospital admis-
36 FUTURESCAN 2 1 4
by
Richard
J
Umbdenstock F CH
sions and readmissions, and the over
or underutilization of procedures.
The
RE L
Challenge
Despite our best efforts, we know
that race, ethnicity, and language
preference (REAL) continue to
affect the likelihood that patients
will receive the care they need and
the outcomes they deserve IOM
2003; Mayberry, Mili, and Ofili
2000). For example, Hispanic adults
with diabetes are far
less
likely to
receive recommended preventive ser
vices, and African-American women
are more likely to die after they are
diagnosed with breast cancer, than
are their white counterparts AHRQ
2009; American Cancer Society
2011). s health insurance cover
age expands, each provider will be
challenged to provide the best pos
sible care to a patchwork of patient
populations with different beliefs,
lifestyles, family structures and sup
port, and healthcare experiences.
Planning for equitable care
involves developing ongoing rela
tionships with community organiza
tions that can support providers
About the
Author
Richard J Umbdenstock, FACHE, is
president and CEO of he American
Hospital Association (AHA), which
leads, represents, and serves more
than
5 000
member hospitals, health
systems, and other healthcare orga
nizations as well as 42 000 indi-
vidual members. Previously,
he was
the elected chair
of
he AHA board.
Umbdenstock's career includes expe
ence
in
hospital administration; hea
system governance, management, a
integration; association governance
management;
HMO
governance; an
healthcare governance consulting. H
has written several books and article
for
the healthcare board audience an
has authored national survey reports
for the AHA and its Health Research
Educational Trust as well as for
the American College of Healthcare
Executives. He received a bachelor's
degree in politics from Fairfield
University (Connecticut) and a mast
degree in health services administra
tion from the State University of Ne
York at Stony Brook. He
is
a Fellow
o
the American College of Healthcare
Executives. He serves on the boards
of he National Quality Forum and
Enroll America, cochairs the Council
Affordable Quality Health Care (CAQ
Provider Council, and serves on the
National Priorities Partnership and o
the Center
for
Transforming Advance
Care
steering committee.
efforts to build cultural competency
in delivering
that
care. Providers
must anticipate community needs
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FUTURESC N
SURVEY RESULTS: Equity of
Care
How likely is it that the
following will
be seen
in
your hospital by 2 19?
Very Somewhat
Likely Likely
( )
( )
I I
9 4
Your hospital's suategic plan
will
include
goals
for improving quality of care for culturally and
linguistically diverse patien t populations.
2
52
Your hospital will see a reduct ion of 5 percent in
the
disparities
in
quality of care among racially,
culturally,
and
linguistically diverse pat ient populations.
ACHE
48
38
SHSMD
3
4
Both
a
l
43
38
he race/ethnicity diversity ofyour hospital board will represent your community.
ACHE
SHSMD
2 43
Both
The race/ethnicity diversity ofyour hospital's leadership team will represent your community.
Note: Pcrccnagcs maynot
total to aacdy
100 due
to
rounding.
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What Practitioners
Predict
Strategic:
pllllllll
will
address
diwrse patient
populations
The majority (82 percent) of CEOs responding to the
survey
think
it likely that goals for improving the quality of care for diverse patient populations will be part of their
organization's strategic plan by 2019.
are
disparities will be reduced by half
Almost three-quarters
of
survey respondents believe
that
disparities
of
care
among racially, cultunlly and linguistically diverse patient populations will be reduced by half in their organizations by
2019.
Gcnmning boards
nd
leadenbip
will
idlect
the community
A majority of those answering the survey {nearly 86
percent
of ACHE
respondents and 70 percent
of SHSMD
respondents) predict
that
by 2019
the
racial/ethnic diversity
of their board will reflect their community. Similarly, 83 percent ofACHE respondents and more than 63 percent
of SHSMD respondents predict that the racial/ethnic diversity of the hospital's leadership team will represent their
community by that time.
A majority of those answering
the survey (nearly 86 percent of
ACHE
respondents and
70
percent
ofSHSMD respondents) predict
that by 2019 the racial/ethnic
diversity of their hospital's board
will reflect
that
of their community.
Similarly, 83 percent
ofACHE
respondents and more than 63 per
cent of SHSMD respondents pre
dict that the racial/ethnic makeup
of
the
hospital's leadership team
will represent their community.
The
governing board is crucial
because it establishes the overarch
ing direction of the hospital
or
healthcare system. A board whose
makeup reflects that of its com
munity has a far better chance of
understanding its community's
unique needs. This insight helps a
hospital's leadership team strategi
cally shift the approach to care, spe
cifically in the area of equity.
Implications for
Hospital
Leaders
What does achieving equity in care
mean for hospitals
and
healthcare
systems?
It
results in better care
and better outcomes, higher patient
satisfaction, and a deeper and more
meaningful connection to the com
munity. Equity of care also has a
strong business imperative; a study
by the Joint Center for Politi.cal
and Economic Studies found that
eliminating healthcare disparities
for minorities would have reduced
direct medical care expenditures
by
229.4 billion between 2003 and
2006 { aVeist, Gaskin,
and
Richard
2009).
s
healthcare transitions to
a value-based system of care, hos-
pitals must ensure that their out
comes improve.
Hospitals can act immediately
to
address equity of care by devel
oping consistent processes
to
collect
and use REAL data. For example,
they can ask patients
to
self-report
their information
and
train staff,
using scripts,
to
appropriately
dis-
cuss patients' cultural and language
preferences during the registration
process. Hospitals should gener-
ate data reports stratified
by
REAL
group
to
examine disparities. REAL
data can be used to develop target
ed interventions to improve qual
ity of care (e.g., scorecards, equity
dashboards) and can help create the
case for building
access
to
services
in underserved communities.
In the area of cultural com
petency, hospitals should educate
all clinical staff during orientation
about how to address the unique
cultural and linguistic factors affect
ing the care of diverse patients
and communities and require
all employees to attend diversity
training. Hospitals should also
provide culturally
and
linguistically
competent services (e.g., interpret
ers, diverse community health
educators) and features (e.g., a
bilingual workforce, multilingual
signage). In the area of diversity,
a hospital should acti.vdy work
to
diversify its board and leader
ship team to include a voice and
perspective that reflect its com
munity. Accountability through
the use of regular reporting
on the
racial
and
ethnic makeup
of
the
leadership team will support action
able approaches. Diversification
strategies include the creation of a
community-based diversity advi
sory committee, engagement
of the
broader public through community
based activities and programs, and
use of search firms.
The mission of the AHA and
its members is to advance the
health of individuals and com
munities. We are accountable to
the community and committed
to health improvement. We can
not succeed unless we diminate
healthcare disparities.
s
a partner
in the Call
to
Action, we will keep
the drumbeat steady and work
closely with our members to foster
success in the realm of equitable
care. Equity in care
is
more than
the right thing to do; it's the smart
thing to
do for
patients, for com
munities, and for hospitals.
ll
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