Elite Clinics Seeking to Respond to Health Care Disruption

A physical therapy session at the Stephanie Tubbs Jones Health Center in Cleveland. The center now focuses on preventing disease and managing chronic conditions.

The old medical model of primary care, specialty diagnosis, and hospital-based fee-for-service treatment may be going the way of the family doctor making house calls.

Now patients can, without an appointment, show up at a local pharmacy, enter a kiosk equipped with a stethoscope, a blood pressure  cuff, and a two-way video screen that lets a patient talk directly to a doctor.  And this  is available from whom you ask?  None other than the nationally-renowned Cleveland Clinic in an attempt  to respond to the revolutionary disruptive changes now confronting the U.S. health care industry beset with ever-escalating costs, uncertain outcomes, a wieldy bureaucracy, and push back from insurers to cut costs and provide better health care.

It happened to the steel industry, the auto industry, the computer industry, and how the health care industry.  As services  escalate in price without concomitant value, customers and insurers are demanding lower-cost, more efficient, and effective medical care.

That means, among other things, elite clinics,  such as the Cleveland Clinic, are going to have to  change their mission from treating the “sickest of the sick” to provide a broad range of primary care options, like chronic disease, and not just sophisticated heart valve replacements.

Part of the new model will involve going from fee-based payment systems to outcome-based payments, with care providers allowed a share of the savings if they meet assorted quality goals, so-called accountable care.  And the push is extended to caring for large groups of people who have a wide variety of medical needs.

The disruption is already affecting care givers’ bottom line.  Hospital admissions are down; clinic revenue has slumped; hospitals are merging in an effort to cut costs while revenue dries up.

What will be the major, visible changes in addition to more  urgent care facilities popping up in neighborhoods?  Hospitals and clinics will shrink specialties.  Primary care  physicians will make more specialty decisions and specialty physicians will do more outcome-based treatments charging less for procedures such as hip replacements, which have become increasingly standardized.

Companies may begin to offer their own health plans with physicians on staff, paid salaries, to manage employee health.  Computer systems will contain patient records so outcomes can be more easily seen and efficiently managed (i.e. lower costs) with treatment protocols; and clinics partnering with insurers to broaden their health care reach, such as the Cleveland Clinic is doing with the North Shore-Long Island Jewish Health System to provide cardiac care.

Dr. Jason Snitzer showed Connor Huynh, 7, his medical record at a Kaiser Permanente office in Santa Clara, Calif. Credit Noah Berger for The New York Times

Insurers, such as Kaiser Permanente, have sophisticated electronic records and computer systems that — after 10 years and $30 billion in technology spending — have led to better-coordinated patient care. And because Kaiser is paid a fixed amount for medical care per member, there is a strong financial incentive to keep people healthy and out of the hospital, the same goal of the hundreds of accountable care organizations now being created.

Why is all this happening?

According to Dr. Delos M. Cosgrove, a 74-year old former heart surgeon who took over as CEO of the Cleveland Clinic ten years ago, “the disruption is going to happen.  We want to be able to respond.”

 

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