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The vision for patient-centered health care

Rochester Business Journal
March 22, 2013

I've previously explored the need for health care reform and the type of health care delivery system that likely will emerge as we aim to reduce waste while improving the quality of care and patient health. What will the new patient-centered delivery model offer, and what will it mean to consumers, insurance companies, employers and health care providers?
 
Consumer decision-making power: With consumers increasingly paying a larger portion of their health care expenses, they are rightfully expecting more information than ever about the cost, quality and patient satisfaction ratings of providers, facilities and procedures before they make decisions. The future health care delivery model will hold physicians, health care organizations and insurance companies accountable for making this information both transparent and easily accessible to the public.
 
Taking this a step farther, another innovative consumer decision-making tool in development is the "insurance exchange"; think of it as the Expedia of health care. An insurance exchange is a Web-enabled comparison tool that will equip consumers and employers with a comprehensive, side-by-side comparison of health care plans, annual premiums, deductibles and co-payments, covered services and costs, quality ratings and network providers.
 
Insurance exchanges will give consumers and employers greater choice, along with the ability to carefully and easily evaluate what is most valuable to them based on a holistic view of all important considerations. As a result, the power and influence over health care decisions and associated costs will gradually shift to consumers. This will create a more rational competitive market where successful health systems will grow and expand based on actual demand for value, quality and proven results.
 
Expanded provider networks: Another dramatic change to expect is industry consolidation-creating more integrated and accessible care networks with broader geographic reach and a full continuum of care. As we shift from a fee-for-service delivery model to a truly patient-focused system, the lines are quickly fading between inpatient and outpatient care; between rural, suburban and urban health networks; and between stand-alone practices and fully integrated health systems. The pace of this change will accelerate further as providers and health systems attempt to keep up with increasingly strict government mandates for standardized disease management practices, complex and frequent quality reporting demands, expensive clinical and administrative technology requirements (such as electronic medical records), and greater accountability for patient outcomes.
 
Many successful examples of formal and informal partnerships and affiliations already exist in our region. These partnerships are enabling the best of both worlds for patients: personalized, compassionate in-community care, with direct access to world-class clinical expertise and state-of-the-art medical technology and specialty services. At Rochester General Health System, we have a growing number of private practice affiliations and non-system hospital partnerships, including those with Cayuga Medical Center in Ithaca, Cleveland Clinic, United Memorial Medical Center in Batavia, Clifton Springs Hospital & Clinic, and the Ros-well Park Cancer Institute in Buffalo, to name just a few.
 
Building a full continuum of coordinated care, however, is about much more than consolidation. It's about maintaining accountability for managing a patient's health across all of his or her care experiences. Today, patients can have different medical records at several unaffiliated health care facilities with only a piece of their overall health information contained on each record. They also may have redundant and costly lab and imaging work completed for different procedures. And they can have different medications prescribed by different providers without a single record documenting all prescriptions. By expanding and integrating affiliated provider networks, service lines and care facilities, we can ensure that a patient's total health can be seamlessly and efficiently managed as safely and proactively as possible.
 
Greater shared accountability: Finally, in the not-so-distant future every stakeholder-patients, physicians, employers and insurance companies-will be held more accountable for contributing to good health. Insurance companies will have a full range of consumer incentives and penalties in their plans to encourage and reward healthy behavior while discouraging unhealthy habits, like smoking. More employers will offer robust wellness programs that make it fun and easy for employees to commit to healthier lifestyles. And physicians and health systems will be universally responsible and rewarded for successfully managing patient health based on standardized quality measures and improvement goals.
 
In Rochester, we are not simply responding to this future. We are imagining and shaping it every day-with measurable and meaningful progress already well under way. 
 
Mark C. Clement is Rochester General Health System president and CEO. This is the third of four articles examining health care reform that will appear over the next several months.


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