Information systems are driving this part of the health care revolution. Until now, you’ve been the only one who knew your entire medical history. You saw your doctor for an earache, went to the ER for a broken arm, maybe visited an urgent-care center or a clinic for a high fever late one night. Chances are none of these providers ever spoke to each other about you. Digital medical records, now mandated by the state, allow any health care provider to access a patient’s history, input new information and keep your medical history up to date.
New York has another issue, according to Helgerson. We go to the hospital for everything. “Here in New York State, we rank 50th in the nation when it comes to inappropriate hospitalization,” he said. “That means people going into the hospital, into the emergency room, when it’s not necessary. If their chronic conditions were managed better they wouldn’t be there. I think it’s an overall reflection of the fact that the system isn’t achieving its ultimate goal, which is keeping people healthy. It’s also a key reason why we have high costs. Also, we rely more on nursing homes and hospitals than other states do.”
Helgerson came from Wisconsin, which ranks first or second in unneeded hospital visits. “I think what Wisconsin offers is a model for a more integrated health care system,” he said. “Providers, payers and in many cases patients work together in a more integrated fashion than they do in New York’s fee-for-service system.”
The state wants to change the way health care services are purchased. Rather than paying for a service, regardless of outcome, the new system will align incentives, outcomes and efficiencies. The hospitals are racing to prepare for the new system.
Assisting the provider community
“It’s a challenge for both the payers and the providers,” Helgerson said. “Right now, the providers have structured themselves as a reflection of the payer environment in which they work. That’s a big part of what we’ve been doing with the Medicaid redesign, not just changing the way we purchase healthcare services and payment systems that we use, but to try to assist the provider community themselves to prepare for this system that will hopefully lead to better outcomes and a more sustainable system. I tell audiences the goal is to try to turn health care into a team sport.”
As the system is currently structured, a hospital could go out of business if it coordinated with doctors and clinics in such a way that fewer patients were admitted as inpatients. But the local marketplace is going in that direction with a speed that hadn’t been anticipated.
The state, specifically the Department of Health, has veto power and a lot invested in the future of Benedictine and Kingston hospitals — state money financed the merger.
But Albany doesn’t see the fiscal challenges facing HealthAlliance in Kingston as evidence of failure.
“Health care providers, health care delivery, health care payments, these are not static,” Lefebvre said. “Since we invested public funds to help those hospitals merge their services to better provide for the community’s healthcare needs, things have changed. Now the board is stepping up to the plate and proposing further changes. … We would consider it a very successful governance move on their part to revisit it, re-evaluate it, and change if things are changing around them.”
CEO David Lundquist has said that HealthAlliance of the Hudson Valley is here to stay, but that it’s likely to become “smaller.” From DOH’s perspective, Lefebvre said, what happens to the actual bricks and mortar of a hospital is a decision better made by its board.
“A level of health care within that community is what we’d be looking at,” Lefebvre continued. “When we look at those situations around the state, we look at what the community needs. For instance, when North General Hospital in Harlem was going to close, the community definitely, definitely needed something there. A family health care clinic opening in that same location was the right answer there. DOH is really trying to get away from that bricks-and-mortar mentality, and instead look at what the community needs in terms of service provision.”
“I think that’s key,” Helgerson added. “Hospitals can be a very inefficient way to get health care. We have to stop thinking of health care as a hospital.”
