May 21, 2015
This morning, the House Energy and Commerce Committee voted unanimously – a rare event in these fractious political times – to send its 21st Century Cures legislation to the full House. Progress for this measure, which will accelerate the development and delivery of new treatments and therapies while also making advances in healthcare data access and interoperability, is good news for patients and the healthcare system.
An interesting and positive development in the Energy and Commerce markup actually concerns something that didn’t happen.
One of the amendments scheduled for consideration this morning would have fundamentally changed the Medicare Part D prescription drug program by empowering the Secretary of Health and Human Services to negotiate drug prices, a responsibility now being handled by private sector health plans and pharmacy benefit management firms.
This is a status quo that isn’t begging to be repaired. Just the opposite, in fact. These private sector pricing negotiations have yielded a Part D program that has maintained beneficiary monthly premiums at a stable, affordable level for the past five years. All the rhetoric in the world doesn’t change the fundamental truth that millions of seniors and beneficiaries with disabilities have affordable access to medication because of the way the Part D program is structured.
The drug pricing amendment was withdrawn before coming to a vote. Medicare Part D stays on a path that has consistently won approval ratings of greater than 80 percent among Americans 65 and older.
Some efforts withdraw, as the saying goes, so they can live to fight another day.
Ill-conceived ideas like this one, though, should just call it a day and stay permanently out of the way of Medicare beneficiaries and the medicines they need.
May 20, 2015
American healthcare is evolving in ways that are both beneficial and necessary. With an imperative to move toward a healthcare system that offers both high quality and cost-efficiency, the answer lies in finding better ways to keep people healthy.
In an interview with Hospital and Health Networks magazine, Ascension CEO Tony Tersigni (Ascension is the nation’s largest nonprofit healthcare system and a member of the Healthcare Leadership Council) explains how his organization is transitioning from “patient-centered care” to “person-centered care.”
This is one of the most enlightening quotes from the interview – “And so we see ourselves moving from physician-centered to person-centered, from transactional and episodic care to managed care by a team over time, from the idea of sick care to well-being. We’re moving from care that’s inaccessible and tied to bricks and mortar to care that’s going to be convenient and available 24/7/365.”
Here is the full text of the Tersigni interview.
What is this idea of person-centered care at Ascension?
TERSIGNI: We view person-centered care as our sacred promise to support individuals’ lifelong health and well-being through holistic care. It’s something that goes back to our roots. We have a 200-year legacy of caring for the whole person — body, mind and spirit. We recognize that each person represents a unique individual biologically, psychologically and sociologically. We believe, as care develops in the future, it’s going to become much more personalized than it has been in the past. Bottom line, the emphasis on person-centered care is our way of demonstrating the commitment that our founders have had for the last 200 years.
Why is this driving the conversation at your organization?
TERSIGNI: It is our strategic direction. I might say we’ve been on this path since 2002. At that time, we created our “call to action.” It is pretty basic and simple: We are going to promise the communities that we serve health care that works, health care that’s safe and health care that leaves no one behind. Then we figured that, in order for us to do it, we needed to have four different foundational blocks. One is hired people — the people who serve those we’re privileged to serve. The second is developing trusted partnerships along the continuum. Empower knowledge, which is much more relevant today than it was in 2002. And then having this vital presence everywhere around the community.
That’s basically been the foundation of what Ascension has been. As we look at other industries, individuals have choices and options in every aspect of their daily lives, and we know that access to more and timely information really increases their options. That’s really what we’re trying to bring to Ascension and health care, and that’s how we’ve refined that focus over time.
Is “patient” not encompassing enough?
TERSIGNI: Actually, you hit the nail right on the head. We chose person-centered care because, again, it’s really focused on the person and, in many cases, they’re not patients, especially if we speak about health education and wellness. We typically don’t think of them as patients, but really as consumers. While other systems are caring for patients, we make a conscious effort to talk about providing person-centered care that’s focused on persons not on patients.
Is that difficult in such a provider-centered industry?
TERSIGNI: We’re challenging ourselves to move into health care transformation, and we believe that the first phase is seeing person-centered care. What I mean by that is we’re seeing health services being redesigned around the person, helping individuals to become participants in managing their own lives. We’re seeing care teams becoming more multidisplinary and we envision they’ll ultimately include professionals like nutritionists, social workers, coaches and partners for health. We also see that the economic model will become population based and will reward value. We’re seeing that now. And so we see ourselves moving from physician-centered to person-centered, from transactional and episodic care to managed care by a team over time, from the idea of sick care to well-being. We’re moving from care that’s inaccessible and tied to bricks and mortar to care that’s going to be convenient and available 24/7/365. There’s a lot of transformation that we believe has come and is coming to our health care industry. We want to be on that bandwagon as we move forward, because we need to move toward evidence-based standards and away from what we’ve seen in our industry is a lot of unwarranted variation. It’s a monumental transformation.
How will being person-centered help in the shift to value?
TERSIGNI: We believe we need to bring health care and health services closer to the home. We need to bring information to the persons we serve on mobile devices they use in their daily lives. Last year, if you look at [Ascension’s] total $21 billion in revenue, 51 percent of that came from non-acute care services. While people see us as a large hospital system, which we are, we’re a lot more than that. We’ve recognized that the health care landscape is changing and there are opportunities for us. So what we’ve been doing along the way is really identifying the continuum of care, the partners that we need across the continuum, and looking at the longitudinal care that we’re going to provide under population health management.
Why is clinical integration key to person-centered care?
TERSIGNI: We believe that, through clinically integrated systems of care, we can enable quality improvements and increase cost-effectiveness. That’s basically what clinically integrated systems of care are. It says that we are going to use the resources within the community to raise the quality of care of the community, and, in many cases, it’s going to be partnering with others. That’s why, when I first stated our call to action, one of the foundational components is trusted partners. We know we can’t do it alone and so we’re going to need partners along that full continuum.
What do people want from person-centered care?
Tersigni: We’ve done a lot of focus groups over the last few years as we’ve refined our strategic direction, and they revealed four different areas. They want us to respect them, they want us to include them, they want us to connect them, and they want us to engage them. They say: Respect me. Those who care for me know me, understand what’s important to me and treat me with respect and communicate in a way that I can understand. They say: Include me. Those who care for me actually are listening to me, include my family and others I trust in my care, and work as a team in providing care that’s holistic — body, mind and spirit. I want to be connected to reliable health information that’s relevant to me and networks of people like me. People with chronic diseases want to be socially connected with other people who have those same chronic diseases so they can have a social dialogue in terms of what’s happening in their lives. The last piece is: Engage me. I engage in the decision-making with my trusted partners. Those are the four goals that we’ve been trying to achieve in the voice of the customer. It’s really all about creating a healthier community.
What is Ascension’s eventual destination point?
Tersigni: Our destination point is to develop the capabilities to take care of millions of lives from birth to death. That’s what person-centered care is all about; that’s what our call to action was when we created it; and that’s where our growth is focused. The bottom line for me is, while we’ve made great strides in accomplishing our call to action, our job is not done. We still have more to do in promising the communities we serve health care that works, health care that’s safe and health care that leaves no one behind.
May 01, 2015
Last week, Dr. Vivek Murthy, the new U.S. Surgeon General was officially sworn into office. In his speech to the ceremony attendees, Dr. Murthy described his mission for a stronger and healthier America. He discussed roadblocks to better population health such as a culture focused on treatment rather than prevention, the spread of incorrect health information and unhealthy behaviors that are entrenched in society and difficult to change. Addressing these issues, he said, is a shared responsibility requiring partnerships involving diverse interests and perspectives.
The Healthcare Leadership Council is proud to be a part of that partnership. In fact, one of the Surgeon General’s first public appearances in Washington, DC was at a forum HLC hosted on anti-obesity initiatives. At that forum, he joined with HLC member companies – Weight Watchers, Takeda Pharmaceuticals, Health Care Service Corporation and the Cleveland Clinic – to discuss the steps that are being taken to help more Americans understand the importance of and how to achieve healthy body weight. Dr. Murthy spoke compellingly about the need to create a culture that encourages healthier lifestyles.
The good news is that important strides are being made in developing that culture. In communities throughout the country (note Oklahoma City’s collective million-pound loss spotlighted at the HLC anti-obesity event), we’re seeing successes in establishing improved health and well-being. Healthcare companies, including many of our HLC members, are taking innovative steps to incentivize better nutrition and exercise habits. Many of these success stories are detailed in our publication, The Future is Here: Transforming American Healthcare Through Private Sector Innovation.
The need for progress is great. As was mentioned several times at our recent event, the percentage of Americans classified as obese has nearly tripled since the 1960s. This is taking an enormous toll not only on our well-being as a society, but also on the economic sustainability of our healthcare systems. We need to learn from the successes that have been established, and then build on them. On that note, we’re certainly aligned with our new Surgeon General.
March 18, 2015
On March 2, the Healthcare Leadership Council, as part of its National Dialogue for Healthcare Innovation (NDHI) initiative, brought together over 70 leaders from organizations and institutions that design, implement and are affected by the U.S. healthcare system. The purpose was to clearly define what constitutes value in healthcare and to begin crafting a pathway that will allow patients and consumers access to life-changing healthcare innovations within a structure that is affordable and financially sustainable.
The Summit on Value and Innovation was just the first step in what will be an ongoing dialogue designed to identify and address the existing barriers to health system improvement. Summit participants have expressed their intention to continue working toward the goals and objectives they outlines on March 2.
Here are some highlights of the comments and coverage of the NDHI Summit:
“Last week I had the opportunity to sit at the table with some of the nation’s top thought leaders. We convened at the Newseum in Washington, DC, for the Healthcare Leadership Council’s National Dialogue for Healthcare Innovation; it was like a health policy nerd red carpet. Center for Medicare Director Sean Cavanaugh was there. Leapfrog Group CEO Leah Binder was there. America’s favorite bioethicist–oncologist–provocateur Zeke Emanuel was there. The chief executives of providers, payers, pharmaceutical companies, government agencies—all there. And what were they there to do? Define “value” in health care.”
–Neel Shah, M.D., Executive Director, Costs of Care in the AAMC Wing of Zock blog
“In order to improve value, we needed to identify some of the obstacles that could thwart progress. Regulatory and policy challenges; trust between stakeholders; insufficient time for measurement and lack of tools for patients to make healthcare decisions were among the barriers we cited.
“To surmount those obstacles, we honed in on several key initiatives: piloting a payment model that incentivizes value and shares risk among stakeholders; mapping the patient journey to better understand how we as stakeholders can work together, rather than focusing on our individual part of a patient’s healthcare experience; and developing medication adherence programs to educate patients on their disease, therapies and treatment goals.”
–Greg Irace, Senior Vice President of Global Services, Sanofi US
Several participants said that the Medicare Advantage system does a good job of aligning incentives to produce high-quality care and good value. Barry Arbuckle, president and chief executive officer of MemorialCare Health System, which operates hospitals and provider groups as well as a health plan in the Los Angeles area, said, “If I could push every Medicare patient into Medicare Advantage, I’d do it tomorrow.”
Medicare Advantage is “a fundamentally better system. The financials are aligned. We have incentives to do disease-management programs. Frankly I don’t have that in Medicare, because I get paid when they get sick. And if they’re sicker, I get paid more,” Arbuckle said.
It’s more challenging to address these issues for the commercially insured population, Arbuckle said. Having a long-term relationship with members is crucial to the success of creating better health-care value, he said.
–Coverage in Bloomberg BNA, March 3, 2015
February 02, 2015
Recently the Institute of Medicine released a report on sharing clinical trial data. This report comes at an opportune time, when talk of health information technology, interoperability and big data are at the forefront of health policy conversations. IOM discusses using data collected in trials to maximize knowledge gained and avoid duplicative trials. The rationale is that this would create greater efficiency among research, and assist in more quickly determining best practices and improving patient care. Interestingly, the IOM report was followed last week by an announcement by HHS and the Office of the National Coordinator of Health Information Technology regarding the creation of a new roadmap aimed at creating an interoperable structure for improved data sharing across the entire healthcare system.
The Healthcare Leadership Council has been increasingly involved with its members in discussing the future of data sharing, and how it will have an effect on all stakeholders in healthcare. A number of HLC members have joined innovative data sharing initiatives. As mentioned in the Wall Street Journal, a data-sharing website clinicalstudydatarequest.com, launched by GlaxoSmithKline, has been joined by several HLC members- Boehringer Ingelheim, Eli Lilly, Novartis, Sanofi and Takeda Pharmaceuticals. Researchers can request anonymised data from clinical studies to further their research.
Also highlighted in the Wall Street Journal piece is Johnson & Johnson, which is providing the Yale Open Data Access (YODA) Project with clinical trial data for its medicine, medical devices and diagnostics tools. Another HLC member, Medtronic, is engaged in the YODA project as well. Medtronic was the first company to contract with YODA, and has a great interest in seeing what fruits open science and transparency will bring. These collaborations between educational institutions and healthcare companies present tremendous potential for healthcare improvement.
The IOM report also discusses barriers to data sharing, such as infrastructure, technology, workforce and sustainability, which certainly need to be taken into consideration. Collaboration across the sectors is vital for creating the perfect environment in which to exchange data efficiently and advance medical knowledge. Precise policies establishing productive and principled frameworks for these collaborations will help unlock the true potential of data analysis to elevate healthcare quality and cost-effectiveness.