Opinion

For True Healthcare Reform, Look To Ohio

Healthcare transformation is alive and well in Ohio. We know because we’re keeping score.

At Mercy Health, the largest healthcare system in Ohio, we’re transforming the way we deliver care. Hundreds of miles from the Supreme Court and Congress, this state of 11.5 million people is the laboratory where we’re making value-based healthcare a reality — not a concept or a mandate.

The centerpiece of healthcare reform is the conviction that patients should get the right care at the right time and that providers –  whether physicians, hospitals or post-acute settings – must do a better job of coordinating care to improve outcomes and lower costs. Policymakers are trying to implement incentives and penalties in service of that goal. But providers are driving innovation, validating what works and implementing it to scale.

The old saying tells us that “What gets measured gets done.” So at Mercy we measure in an accountable way. We chart hospital readmissions, reductions in preventable harm and our patients’ success in preventive care. We measure enrolled lives in our partner health insurance plans and how many of our physicians are in primary care. We grade ourselves on patient experience and the engagement of our workforce. We hold ourselves to high standards for community benefit, investing in the communities we serve. We do all of this in the name of better care for our patients.

And we get results. Consider:

  • We have flattened the cost curve – During the last decade, average employment cost per case (WEIPA) has increased less than 1% per year.
  • We are covering lives – Along with our insurance partner HealthSpan and other payer partners, we cover 200,000 lives in pay-for-performance or shared savings contracts, including 75,000 in our accountable care organization, Mercy Health Select.
  • We are preventing hospital visits – Because we migrate the best care protocols across our system, we are using cancer screenings and other tests to drive down the use of our own services.

These are not new standards. But they are the differentiating factor for true reformers, those systems that are embracing value-based care. We believe this transparency is the only way to make lives better and make healthcare easier. Our ability to hit scorecard targets determines incentive bonuses for hundreds of our leaders.

Yes, we still measure admissions and volume, because that’s how we get paid. We still measure the gap between Medicare and Medicaid funding and the true cost of care. But if we are to transform the system, we must create a clear-eyed look at how we are performing.

Some healthcare systems have chosen to consolidate and expand nationally, a bigger-is-better model that relies on increasing revenue and cutting costs to justify each merger in the name of transformation. At Mercy Health, we have chosen a state-based model.

We are a top provider in each of our nine markets, from Paducah, Ky., and Cincinnati in the south to Toledo, Youngstown and Cleveland to the north. We have built enough scale to make reforms stick. We operate 23 hospitals and more than 450 places to receive care, with 32,000 employees and 5.3 million patient encounters in 2013. HealthSpan, our Cleveland-based insurance partner, offers insurance plans statewide, with 13% share on the Ohio Health Insurance Exchange.

We are fully aligned with Ohio’s aggressive reforms, including a $75 million State Innovation Model testing grant and bundled payments for six targeted episodes to start in 2016.

We have much left to do on behalf of our patients. As a system, we are investing more than $200 million a year in insurance, technology and Health Select, our clinically integrated network. With our insurance partner HealthSpan, we will link provider and payer, sharing data, improving care and reducing cost.

All of these investments are aimed squarely at long-term transformation. We need the help of federal and state governments to ease the path to reforms that work, increase access through Medicare and Medicaid reforms, while allowing health systems to sustainably pivot to value-based care.

When we accomplish that pivot, we will know, because we’re keeping score.

Michael D. Connelly is president and chief executive officer of Mercy Health, Ohio’s largest healthcare system.

 

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