Posts Tagged ‘Citizens Health Initiative’
Tuesday, July 27, 2010
What Leadership Role for Foundations in Health Reform?
Jeanne Ryer and Jim Squires from the Endowment for Health conclude our series today on Leadership in an era of Health Reform. We want to thank all or our guest writers who have made a contribution to this series. We are going to take a summer breather on this site for the month of August and plan to be back to you in September to continue our Health Care Town Hall discussion. It promises to be an eventful and exciting year ahead, and we look forward to shaping a public dialogue that will be a creative force in the months and years ahead. Enjoy the rest of your summer.
What Leadership Role for Foundations in Health Reform?
Jim Squires and Jeanne Ryer, NH Endowment for Health
Across the country, foundations are working to understand their role in the implementation of the Affordable Care Act, from the large nationals, to state health foundations like ours, to local and community foundations. Many foundations are coming to grips with the new reality that implementation of this historic policy will take place, for the most part, at the state level. The nation and each state must now implement major policy change that, though long in the making, doesn’t have a ready recipe for how to make it all work.
Foundations, especially those focusing on health, have been leaders in the health reform effort all along – commissioning research, developing policy options, communicating on both the process of change and the urgency for it. But with implementation comes new opportunities for leadership and, perhaps, demands for new approaches.
Certainly foundations can continue to do what they do best – find non-profit and academic partners to develop needed research, new programs, and work with the safety net. But new approaches and new partners are needed, and foundations can take even more of a public leadership role.
The Endowment for Health will use its voice to support public policy on the state level as New Hampshire fulfills the promise of heath reform – affordable access to quality and cost-effective care. The national health care infrastructure started more than sixty years ago was never fully developed. Like an interstate highway or electrical grid, if the roads and lines don’t connect, the system doesn’t work for everyone who needs to use it. Even in New Hampshire, our health care system has had similar disconnects. Now, we have an opportunity to fix that, and the recent passage of Affordable Care Act presents exciting opportunities for our state.
Over the years, New Hampshire has built in a number of health insurance protections for its people. As a state, we should make sure we maintain the gains we have already made. The Endowment for Health will work to assure that New Hampshire does the very best it can to maintain and build upon existing levels of coverage, not just comply with the minimum requirements. We need to make sure that coverage is affordable and accessible and fulfills the promise of the Affordable Care Act. We also need to make sure that New Hampshire residents have access to quality care when they need it and that we have the right health providers in the right places to serve them.
New Hampshire has also worked hard to develop a quality health system, with our network of community hospitals and providers, community health, mental health and oral heath centers, and our academic medical center. The past few years have seen great gains in work on patient-centered medical homes and payment reforms that will begin in earnest with an accountable care organization pilot announced last week. These gains can also be seen in the steady efforts to improve transparency and public understanding of both quality and costs and to develop our public health system.
The Endowment for Health will use its bully pulpit to keep these efforts front and center in our public conversation. Our state needs to move to full implementation of practices that are shown to produce high quality, cost-effective outcomes for all of our residents – not just small scale models at isolated demonstration sites..
New Hampshire also needs to maintain its tradition of public dialogue in shaping our State’s implementation of health reform. We all need to work together in a unified and coordinated effort and to assure an open and inclusive process to develop the needed policies and programs.
We have an unprecedented opportunity for our state to finish the job it has already started. For more than twenty years, New Hampshire has made steady improvements in its health system. State implementation of federal reform will move us forward. You can count on the Endowment for Health to take a key role in making sure New Hampshire gets the health system we all need and deserve.
Tuesday, July 20, 2010
Making Health Reform Work
Beth Roberts, Vice President of Northern New England for Harvard Pilgrim Health Care of New England
The recently enacted federal health reform law (formally known as the Patient Protection and Affordable Care Act of 2010) sets forth two very ambitious goals for our nation’s health system – cover the uninsured and slow the growth in health care costs. Delivering on those goals will require an ongoing commitment by all stakeholders. Insurers, such as Harvard Pilgrim, have an important role to play.
Insurers will play a critical role in working with state and federal policymakers to set up the new state-based Exchanges that will offer coverage to individuals and small businesses. The Exchanges are a key element of federal health reform as they are the only distribution channel through which low to moderate income individuals will be able to obtain subsidies and small employers will be able to obtain tax credits. Insurers will need to bring their expertise in product design to the table to ensure that the coverage offered through the Exchange is structured in a way that is as affordable as possible while meeting the health care needs of consumers. The day-to-day operations of the Exchange have the potential to be complicated. Insurers will need to work closely with state and federal officials to make the Exchanges as easy as possible for individuals and small businesses to navigate and keep administrative costs low.
The health reform law establishes a number of pilot programs designed to reduce health care costs by encouraging physicians and hospitals to provide more coordinated care. While these pilot programs are focused on Medicare, insurers will have an important part to play in helping providers make these new innovative payment arrangements work for the under-65 population as well. Harvard Pilgrim is proud to be working with other insurers and health care providers in New Hampshire on payment reform and medical home pilots similar to those contained in the federal health reform law. A key contribution that insurers make to these programs is reporting relevant data in a timely, accurate and consistent manner to help care providers make informed decisions. We will need to continue to expand our efforts in these areas if we are going to provide better care at a lower cost.
Insurers are looked to by their employer customers and by the broker community for advice on how health reform will impact their coverage and what changes they need to make. Right now, the primary focus is on a number of new mandates (dependent coverage, first dollar coverage for preventive services, etc) that will go into effect on September 23. Insurers are also helping employers and brokers sort through the recently issued rules around “grandfathering” which dictate whether employers are exempt from some of the law’s provisions. As we move forward with health reform, employers will rely on their insurers for help to understand their obligations under the employer mandate and their employees’ obligations under the individual mandate.
Making health reform successful will require a lot of hard work. Insurers, such as Harvard Pilgrim, are ready to roll up their sleeves.
Tuesday, July 13, 2010
Health Care Leadership at the Community Level
Sharon Beaty, CEO, Mid-State Health Center, Plymouth, NH
Since health care is becoming a concern for the broader community and no longer strictly the purview of hospitals and doctors, it will become important that the community have members willing to provide leadership ensure the accessibility of quality health care at the community level. These leaders may have to be developed and educated by local medical providers, who may have some discomfort and relinquishing what is perceived as control of their market.
The development of the Patient-Centered Medical Home and Accountable Care Organizations, being piloted at national, state and local levels, encourages the involvement of patients in their care. Patients will, in the longer term, be encouraged to take some responsibility for overall health care costs as national initiatives move forward. Leadership may evolve from what was once “the hospital’s job” to become the domain of a more diverse group that may include town leaders, school officials, and other not formally-defined positions, including members of organizations’ boards, staff members, physicians and even the patients. Indeed, the community health center model that continues to be a model of choice for the national Health Resources and Services Administration actually requires that at least 50% of board members in these primary care organizations be patients of the health center.
The intersection of patient involvement and community needs will require leaders at the local level to participate in decisions that will affect how care may be delivered. To borrow from the State Integration Plan (a guide for the integration of the medical and public health systems when appropriate) being developed by the Citizens Health Initiative in New Hampshire, there are certain qualities that are desirable in local leaders who should be involved in this process.
These “champions” for health care should be passionate about health care and understand the effect that quality of care has on the larger community; indeed, health care is a significant driver of economic development, including local employment as well as the attraction of new businesses and expansion of the tax base. Controlling cost of care at all levels of the care continuum will be a requirement as we implement the new federal legislation being developed.
Other qualities include having vision and an entrepreneurial spirit. To lead health care in the new paradigm, it will be a requirement to be creative and to “think outside the box.” We will not be able to travel the old, comfortable paths–we must break new trails. When new paths become necessary, the leader must have the influence to encourage movement of the parties involved to travel those new roads to success. Having a great idea will be helpful only if the idea can be communicated and accepted. The ability to communicate well will be increasingly important.
In addition to some understanding of the system, or willingness to be educated, the leader must be willing and able to dedicate time and energy. To succeed, the leader should be knowledgeable, personable, encouraging, positive, and supportive, and able to put the needs of the broader community ahead of self interest. The ability to lead occurs only when the followers trust the leader and believe that the interests of the population are paramount.
As always, everything eventually comes down to trust: the community’s trust in the leader to have the interest of the community at heart, trust in the leader from the clinicians and other professionals in the system, and trust by the health care community that the new systems will work. Lastly, the leader must have enough confidence to trust in his/her own abilities and instincts and enough humility to accept input from others when required.
Tuesday, June 29, 2010
Professional Autonomy and Teamwork: Will Health Reform Change the Balance?
This is part of a series of blog entries focused on leadership in the new health system landscape, resulting from the passage of the health reform law. Stakeholders from across the health system have been invited to share their thoughts on the leadership role for their respective industries.
John H. Robinson, MD, CPE
President, New Hampshire Medical Society
Although the Patient Protection and Affordable Care Act (PPACA) enacted in March spent most of its ink on health insurance coverage issues, a moderate nod was given to efforts to transform health care delivery systems in the direction of improved quality and cost-efficiency. Such efforts as Patient Centered Medical Homes (PCMH) and Accountable Care Organizations (ACO) will require major changes in the way physicians practice, particularly primary care providers, putting significant stress on an already troubled profession. Any success in reforming health care delivery will be largely dependent on leadership by clinicians. Conversely, the lack of an engaged clinical leadership elevates the risk of failure such as with previous reform efforts that were largely led by the payer industry at the behest of purchasers.
Redesign of the structure of reimbursement systems for health care providers is necessary to provide adequate incentives to reorganize the delivery system, but it is not sufficient for true reform. True reform will require exhaustive assessment of the flaws in the system and seizing on the identified opportunities to make it work better for our patients. Reform will require compilation and review of data about current patterns of care but also about the drivers of optimal patient experiences and about frequently non-productive communications between and among all the clinicians and support staff involved in the care of a patient. Acting on this information will require major behavior changes for clinicians. Those adjustments, in turn, require change leadership, which will likely be effective only if it includes clinicians who fully understand the nuances of individualized patient circumstances and the administrative burdens of operating a practice.
Physicians will need to transform the culture of their interactions with all other clinicians and with non-clinical service providers. Historically physicians have placed a significant premium on professional autonomy. Starting with the competitive nature of medical school admissions processes and continuing through highly selective post-graduate training programs and on toward traditionally small practice arrangements which have an entrepreneurial flavor, physicians are acculturated toward individuality and personal accountability. This professional ethic has decided benefits; it generates well-earned self-confidence which, in and of itself, can be therapeutic to a patient faced with confusing and frightening medical problems for which he or she needs experienced and reliable professional guidance.
But such a premium on professional autonomy comes with costs. The premium on autonomy in the medical profession has, I think, impeded the development of collaboration and teamwork directed at improving the overall efficiency of a system of health care. This is beginning to change as seen with the specialty of anesthesiology, which has adopted a systems approach to safety in the operating room the way airlines have for safe travel. But the change will be difficult for some and impossible for others. Physicians who are more disposed toward an ethic of true teamwork will have an easier time in the transitions ahead.
Coordination of health care and collaboration with other service providers requires more than just membership in a group either informally (we’re both on the same hospital staff) or formally (we both signed the same provider network contract). The goal of improved quality and efficiency of health care requires membership in a fully functioning team. Webster’s defines teamwork as “work done by several associates with each doing a part but all subordinating personal prominence to the efficiency of the whole”. Characteristics that differentiate a group from a team include interdependence, common goals and understandings, creative contribution of ideas, trust and openness, good conflict resolution, participative decision making, commitment and clear leadership. As Casey Stengel said, “Getting’ good players is easy. Getting’ ‘em to play together is the hard part”.
Cultivation of an ethic of teamwork for health care requires good clinical leadership. Clinical leadership, in turn, is not just a question of possessing excellent diagnostic and therapeutic acumen. It involves the development of a clear vision and compelling message, excellent two-way communications skills, good negotiation and conflict resolution skills, and dedication to the task at hand — all grounded in a solid foundation of clinical knowledge and respect for patient values. Not all of these are characteristics are particularly nurtured in the traditional medical professional ethic, although they may be possessed in nascent form by many physicians.
In the end it will be the clinicians who feel compelled to step outside of their daily practice routine to take a leadership role that will determine the success or failure of the grand experiment of health care reform at hand. And it is my fervent belief that leadership must come from the clinical community if failure is to be avoided.