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954.964.1660 I www.SFHHA.com

A message

from our President SFHHA 11th Annual Health Care

Summit: Chasing the Triple Aim
The Score Is In
BY BARBARA FALLON
As part of the budget reconciliation process currently
underway in Washington, D.C., the U.S. Senate has been Systemic accountability for ambitious health care delivery improvement at all levels is
waiting, as required, for the Congressional Budget Office at the heart of the Triple Aim. In advance of highlighting insightful advice, several
(CBO) to score the American Health Care Act (AHCA) keynote speakers took a look inward at how their own organizations measure results,
recently passed by the House of Representatives. integrate technology planning and examine their patient experience roadmap around the
Well, the CBO did say that the AHCA would reduce the three dimensions of Triple Aim. You will notice some common threads in their quest to
federal deficit by $119 billion by 2026. And, as they saying meet the Triple Aim … Patient Focus, Clinical Outcomes and Cost Containment.
goes, “the Devil is in the details!” So, how do you generate
$119 billion in savings? Our experience has shown us, in
both this state and federally, that the only ways you can C. Kennon Hetlage, FACHE
save money is to reduce what you pay per episode of care, Jaime Caldwell EVP West Operations
reduce the services that you cover, or reduce the number of Memorial Healthcare System
persons who are eligible. Let’s see what the AHCA does to create these savings.
Again, by 2026, 23 million fewer people will be able to afford health insurance.
Looking comparatively at the Affordable Care Act (ACA), we will have an estimated Memorial Healthcare System’s methodical attention to
51 million uninsured lives in 2026 under the AHCA versus the 28 million that are timeliness, efficiency, safety, and effectiveness results in
currently uninsured under the ACA. And, because of other provisions in the AHCA, increased engagement, improved outcomes and reduced
there will be a significant increase in the number of uninsured in the 50 to 64 age waste. The enterprise tracks quality and safety metrics
group. benchmarked against national indices. This includes
Overall, Medicaid spending will be reduced by $834 billion over ten years and the monitoring of specifics such as ER throughput and
number of people eligible for Medicaid coverage will decrease by 14 million by 2026. tracking medical errors to balancing overall utilization of
In addition, the current premium and cost sharing subsidies available through the costly, sophisticated high tech diagnostic and therapeutic C. Kennon Hetlage
ACA are reduced in the AHCA and will be age based. This is one of the many factors pathways vs. more conventional low tech yet effective care
leading to the growth in the number of uninsured in the 50 to 64 age group. techniques. In terms of per capita costs, the strategic goal is to infuse the highest value
The AHCA will also allow states to request waivers to change the minimum essen- within the most cost effective price range rather than to be at rock bottom costs. That
tial benefits required under the ACA; most likely reducing them. States receiving a means staying ahead of the curve and recognizing financial and quality incentives for
waiver will also be able to allow insurers to charge more for persons with pre-existing utilization of satellite primary care clinics, urgent care facilities and ambulatory surgery
conditions. centers designed to provide high quality minus the overhead of hospital inpatient deliv-
The first attempt to replace the ACA will have a significant impact on residents ery.
who are least able to afford health insurance. In fact, with the changes allowing the Technology planning is an integrated exercise of discerning review by executive staff,
dramatic increase in premiums for older Americans, comprehensive plans will medical specialists and information technology experts to plan judicious capital budgets
become unaffordable. While plan cost may be reduced overall, those reductions will with a forward thinking regimen that optimizes prudent business investment in both
occur because some of the current minimum benefits may be waived. If there was clinical and information proficiency. This includes current plans to build significant
concern under the ACA that many purchasers on the exchange did not fully under- capacity for in and outpatient care based on predicted community needs and reimbursed
stand what was covered under the plans they were purchasing, think about the added methods of quality delivery.
confusion of changing the minimum benefits! A cost acceptable plan becomes a plan The patient journey roadmap is evolutionary with significant efforts to address patient
that covers fewer needed services. expectations over the past decade. The Joint Replacement patient journey is the proto-
While the AHCA does increase the disproportionate share payments to hospitals type we emulate. We collect and analyze data and share information from the orthopedic
by $43 billion to cover the cost of increased uninsured patients, this won’t be nearly office visits through the surgery and up to 30 days post-op and rehab.
enough and will put us back to caring for medical emergencies rather than ensuring While we model a patient and family centered culture with attention to:
that Americans are receiving adequate primary care and wellness counseling. caregiver/patient ratios, patient engagement, information outreach with patients and
The requirements of budget reconciliation mean that the Congress has to have a families, on-line appointmenting, and patient call-backs; we continually monitor patient
mutually agreed upon solution by early fall, or the process starts again. Look for a satisfaction because transparency also impacts our overall reimbursement and reputa-
very active summer with the health care ping pong game between houses of congress tion particularly during a transitional healthcare environment. We empower patients to
keeping us busy. Keep informed and let your elected representatives know how you interact with us and then use observations to continually build an infrastructure for pop-
feel! ulation health management by observing community based health issues.
Continued on following page
2017 BOARD OF DIRECTORS NEW MEMBER:

Chantal Leconte Drew Grossman Patricia Greenberg
Chair, South Florida Hospital Member at Large President, National Healthcare Associates Super Restoration
and Healthcare Association CEO, Coral Springs Medical Center Michael Gittelman
CEO, Joe DiMaggio Children's Hospital
Charles Felix CEO, Bascom Palmer Eye Institute
Lincoln Mendez Member at Large Charles Michelson
Immediate Past Chairman Publisher, South Florida Hospital Partner, SFHHA COMMITTEES
South Florida Hospital News & Healthcare Report Saltz Michelson Architects
and Healthcare Association James Ball Education Committee
CEO, South Miami Hospital David Zambrana
COO, Catholic Health Services CEO, Jackson Memorial Hospital
David Wagner Healthcare Finance and Management Committee
Vice Chair, South Florida Hospital Ana M. Viamonte Ros, MD Wael Barsoum, MD
and Healthcare Association Director Medical Staff Development CEO, Cleveland Clinic Hospital
CEO, Kindred Hospital, Hollywood Baptist Health Mark Doyle Health Information Technology Committee
Mary Zalaznik Maria Currier CEO, Memorial Hospital Pembroke
Secretary, South Florida Hospital and General Counsel Partner, Dr. Patrick Taylor Marketing and Public Relations Committee
Healthcare Association Holland & Knight, LLP CEO, Holy Cross Hospital
Sr. Vice President Operations, VITAS William Duquette Dr. Ann Wehr Membership Committee
Jeffrey Welch CEO, Homestead Hospital Sr. VP/CMO, AvMed
Treasurer, South Florida Hospital and Steven Ullmann Quality and Patient Safety Committee
Healthcare Association Director, University of Miami Lissette Exposito
CEO, Palm Beach Gardens Medical Center Health Policy Management CEO/President, Orange ACO
Orange Care Group Safety and Security Committee

14 June 2017 southfloridahospitalnews.com South Florida Hospital News