futurescan 2014

8/10/2019 Futurescan 2014

1/13

INTRODUCTION

The title for this

introduction derives

from Sheldon B.

Kopp's book, f

You

Meet the Buddha on

the Road Kill Him

The premise, as you may surmise,

is this: One can and should accept

guidance, but one must always

remember to seek his or her own

truth. Kopp (1972, 56) writes:

The most important

things

that each

man must

learn

no

one

can teach him.

Once he

accepts this disappointment

he

will

be able

to stop depending on

the guru

who

turns out to be just

another

struggling

human

being.

This wisdom applies to healthcare

leaders in 2014. Consider the

following:

While some healthcare systems

have been formed seemingly in

2

FUTURESCAN

2 1 4

IF YOU MEET

THE BUDDH

the quest for scale for its own

sake, others have prudently

asked, Scale to do what? How

will it help

us

provide improved

patient care?

Some healthcare organizations

have rushed to sign up as

Medicare accountable care

organizations {ACOs). Others,

some with well-established

insurance company subsidiaries,

have been more cautious, asking,

Are we prepared to assume

actuarial risk for an attributed

population with no lock into our

network?

Marketing executives and

some provider organizations

see insurance exchanges as

an immediate opportunity

to increase volume. But their

counterparts in other enterprises

are skeptical. They ask, How

long will it actually take for half

a dozen federal agencies {and a

similar number at the state

level)

to implement this program? How

long will it take to reach full

enrollment?

Some leaders are reluctant to

trade in their legacy T systems

by Don Seymo

About the

Author

Don Seymour, president ofDon

Seymour Associates in Wincheste

Massachusetts, has been a strategy

adviser to hospital boards, CEOs, an

medical staff leaders since 1979 A

frequent presenter on subjects relate

to senior leadership in healthcare or

nizations, Seymour is on the facultie

of he American College of Healthca

Executives and the Governance

Institute. Additionally, he

h s

made

presentations

to

the American Hosp

Association, numerous Fortune 100

companies, and a variety of other

national, state, and regional groups.

He h s served s executive editor

of

Futurescan

since 2004 A past

president

of

he Society for Healthca

Strategy Market Development,

he received its Award for Individual

Professional Excellence in 2008

for a platform that will truly

support clinical integration and,

in the long run, population

health management. Others

argue, The time is now. The

culture change alone may take

ten years to get it right.

While some leaders don't have

the fortitude to battle for clinical

integration and the employed

physician model, others readily

embrace the challenge: It's the

right thing to do, and it won't get

easier

if

we wait.

Every pilgrim must chart his or

her own journey to enlightenment;

every healthcare provider must

assess its own values, strengths, and


2/13

limitations and then establish

and

pursue its own vision.

Enter

Futurescan

Occasionally,

readers ask,

How

often have

you been right? It's a reasonable

question. We strive always to he

both

accurate and correct,

but

we haven't kept score.

Our

edito

rial policy has focused more

on

raising issues that every provider

faces on its journey and provid

ing guidance: and insight. We lack

the:

wisdom and hubris to

think

that

we are the Buddha;

we:

arc

simply humble acolytes struggling

with the challenges and opportu

nities inherent

in

the healthcare

environment.

This year's edition

of

uturescan

continues in that tradition. We

hope it enlightens your path

as

you

ddve

into the following eight opin

ion pieces.

On coordinating care for

popu

lation health: Forward-looking

hospitals are engaging in challeng

ing but necessary changes that pro

mote population health. Whether

improving the overall health

of

their population through better

care coordination

or

working with

community partners to improve

the health

of

the broader com

munity, hospitals are committing

resources to promote population

health. Participating in a health

information exchange and sharing

health data with other providers

will allow hospitals to effectivdy

address population health trends.

Hospital and healthcare system

Icade.rs recognize that advanc-

ing population health will enable

them to thrive

in

a value-based

landscape. With strong collabora

tions, formal structures that enable

care coordination, and the ability

to

leverage health data, hospitals

can create population health initia

tives that will lead to success in

the evolving care

environment.

Heather Jorna and Stephen A

Martin Jr.,

PhD

On meuuring

the suca:ss

of

population health: In the end, we

must have a paralld strategy fur

keeping healthy people healthy and

for managing the small percent-

age of patients who drivt: the vast

majority

of

total costs in each

of

our

local systems. Some vexing ques

tions remain that we will have to

answer

in

the next

five yea.rs.

For

example: who owns the patient? Is

it

the attending physician, the ACO,

the multispecialty group practice?

Who

is the real driver in improving

the health

of

the population? Will

this improvement

ll

occur at the

local, regional,

or

national levd?

How w ll

we measure our

success?

Will the Triple

Aim

he rdevant

in five yea.rs or will the Leading

Health Indicators become the front

runner?-David B. Nash,

MD

On

p.by.idan alignment:

Although physician employment

can simplify or diminate many

regulatory challenges, it is not a sil

ver bullet for physician alignment.

Because physician employment

transactions can carry hefty capital

investment costs and new practice

expenses, large-scale employment

is an impractical solution for many

hospitals. Employment needs

to

he a carefully titrated ingredient

in

an overall physician alignment

strategy. Moving the dial on

value will require expanded reliance

on aligned primary care: physi

cians, and you w ll need to face the

financial headwinds that currently

hamper progress. The creation

of

worthy financial incentives to fund

and reward the transformation

required to better manage popula

tions at the primary care interface

will be essential. Getting there will

he hard, so start this work

now.

Brian A Nester,

DO

On

provider affiliations:

The

imperative for hospital leaders

will be in honestly assessing and

understanding

how

their organiza

tion can best serve its mission and

the population entrusted

to

its

care. Does the organization hav

the resources (financial, human,

reputational, and intellectual) to

he a controlling consolidator

in

this market, or

is

the organiza

tion better suited to play a mor

defined, participating role in th

broader continuum? Does the

organization truly understand

h

all of the fragmented componen

must come together

and

oper-

ate as a whole to achieve optima

performance against the metric

population health? Is the organi

zation better suited to lead

or

to

participate in a more defined rol

-Mark Parrington, FACHE

On rdmbunemcnt and cwt

m

agement:

With such phenomen

changes in the healthcare marke

hospital and healthcare leaders h

no

choice but

to

seek new oppo

nities for growth while

also

driv

greater affordability for consum

ers and patients. We will have to

reinvent oursdves and devdop n

markets and niche industries to

meet our patients' expectations f

quality care that is also affordabl

t

will not be the biggest among

who will survive; it will be the m

creative and resourceful. Bringin

value to

patients-focusing on o

mission and not our margins-

w ll

drive innovation that leads

sustainable business in healthcar

s

hospital leaders,

we

can be th

solution that America

deserves

Bernard J. Tyson

On

in.funnation tcdanology

interoperability:

Some leading

organizations, small and large,

have begun

to

derive benefits fr

coordinated care supported

by

robust

IT

infrastructure, such

a

single-source clinical solutions.

who

has

the data will rule will

be the mantra

of

the future. Mo

imponant,

he who has the data

and can tum it into meaningfu

information will be positioned f

long-term success.-John

P

Ho

FACHE,

and

Michad S. Wallac

FACHE


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4/13

5

REIMBURSEMENT AND COST MANAGEMENT

THE QUEST

FOR

AFFORDABILITY

N

HEALTHCARE

Healthcare in the

United States is at

a critical inflection

point.

W ith healthcare costs expected to

reach an unsustainable 20 per

ce

nt

of

the co

untry s

gross domestic

pro

duct

by 2020 the entire

in

dus-

tr

y is rightfully, under intense

scrutiny. T he res ulting transfo rma-

tion

of

the heal thcare industry w

ill

require healthcare leaders to care

fully consider

reve

nu

e growth and

cost manage ment amid declining

reimbursement for care.

There h

as

n

eve

r been a more

exc

iting time to be in h

ealthcare-

or a more challenging one. We must

look closely

at

one of o

ur

country s

biggest

and

most p

ress

ing prob

lems the affordability

of

health

care and lead the way ro

so

lution

s.

W hether

we

approach the next

decade with co nfidence or trepida

tion one t

hi

ng is certain: T his is no

time

fo

r b

us

in

ess as

usu

al

.

T he collecti

ve

view

of

co ns

um

ers employers and the

gove

rnme

nt

is

th

at

th

e cost

of

care is too high. As

an industry healthcare and irs lead

ers need

to

be m

ot

ivated to actively

redu

ce

costs and be prepared to

face

lower reim

bu

r

se

ment rates that are

intended to d ri

ve

costs down.

Affordab

ili

ty wi

ll

certainly be

the domin

ant fo

rce for change

in the heal thcare mark

et

over the

next decade and is one of the big-

gest drive rs

of

the reimbursement

trends discussed in this article. H ow

we manage costs

and

cont

in

ue to

evol

ve

our b

us

iness

mod

el

w

hile

still delivering high-quality p

at

ie

nt

care w ill determine our viability

as

we

look ahead at the changing

healthcare la

nd

scape.

Clearly, the new focus on costs

will be long-term. Both in theory

and in

pr

actice organizations that

own more pieces of the healthcare

dollar can more effectively man

age costs while maintaining high

quality standards of care. Certainly,

moving to a bundled-payment

approach- sharing more risk along

y

erna

rd

J

Tyson

Ii A

1

Bernard

J

Tyson is

CEO

of Kai

se

r

Foundation Hospitals and Kaiser

Foundation Health Plan, Inc. During

his nearly 30-year career at

Kai

ser

Permanente, which serves more

than 9 million members in eight

s

ta t

es and the District ofColumbia

Tyson has successfully managed all

major aspects of the organization.

He h

as

served in roles from hospital

adm inistrator to division

pr

esident ,

leading

Kai

ser Permanente s busi

ness in Californ ia and other regions.

In his prev ious position as executive

vice president for Health Plan and

Hospital Operatio

ns

,

he

was respon

sible for both the care and cov

era

ge

ofmembers in one of he nation s

largest health plans and hospita l sys

tems-

38

Kai

se

r Permane

nt

e

owned

hospi tals and more than 600 medic

al

offices ac ross the United States. A

San Francisco Bay Area nat ive Tyson

r

ece

i

ve

d a bachelor of scien

ce

degr

ee

in health serv

ice

management and a

mas ter

of

bu siness degree in hea lth

service a

dmini

stration from Golden

Gate University in San Francisco. H e

earned a leadership certificate from

Ha

rva

rd Uni

ve

rsity. He serves on the

boa

rd

of di rectors of the

Am

erican

Heart Association and as chairman

of

The E

xe

cuti

ve

L

ea

dership Council.

the continu

um

- is intended to

create greater efficiency and d ri

ve

down the cost

of

care.

Othe

r powerful curre

nt

s

of

change offer

po

tenti

al

solutions.

HE A LTH

CAR

E T R END S A ND I MP L I CA T I O N S 2 0 4 2 l q 2 7


5/13

FUTURESC N SURVEY RESULTS.

Reimbursement

and

Cost Management

How likely is it

that

the following

will

be seen

in

your hospital's

area

by 2019?

Very

Somewhat Somewhat

Very

Likely Likely Unlikely Unlikely

() () () ()

I I

I

8

42

Your hospital will have financial arrangements in place with physicians

to

support bundled payments.

How likely is it that the following will be seen in your hospital by 2019?

ACHE

..uJ l I

. .

M'7.Jll n

27

38

SHSMD

40

43

-

oth

31

40

Your hospital w

ill

s

upport

a provider capitation model (receiving a

se

t payment for members

of

the

covered populati

on

for a peri

od of

time).

32

42

At

leas

t

15

percent

of

yo ur hospital's patients will be under an at-risk (capitated) contract.

53 30

Your hospital will h

ave

made greater inve

st

ments in alternate sites

of

care delivery (e.g., satell

it

e

outpatien t facilities).

Your hospital will be

fi

nancially sustainable with fewer inpatient admissions.

74

22

Your hospital's strategic plan w

ill

h

ave

a goal

of

reducing u nnecessary admi

ss

ions.

Note: Percentages may

not

total to exactly I

due

to roundi

ng

ti

l i l


6/13

Wh act

diet

Organizations will support bundled payments. Nea

rl

y 90 percent

of

respondents think it likely that by 2019

th

eir

hospital will have arrangements in place with physicians in their area to support receiving bundled payments.

Hospitals will support a capitation model. Most survey respondents (66 percent

of

ACHE respondents and 83 per

cent of SHSMD respondents) predict that by 2019 their hospital will support a provider capitation model. Further,

about three-quarters

of

survey respondents predict that at least 15 percent

of

their hospitals patients will be under an

at-risk contract by that time.

Hospitals will invest in alternate care delivery sites. Most (83 percent)

of

the CEOs surveyed believe that by 2019

their hospital will have increased its investment in alternate sites

of

care delivery, such

as

satellite outpatient facilities.

Hospitals will

be

financially sustainable

with

decreased

inpatient

admissions. Among CEOs responding to the sur

vey, 82 percent predict that by 2019 their hospitals will be financially sustainable with reduced inpatient admissions.

Strategic plans will target

reducing

unnecessary admissions. Almost ll practitioners (96 percent) believe that their

organization s strategic plan will, by 2019, include goals for decreasing unnecessary admissions.

Technology is mobilizing healthcare

as never before, and the expecta

tions of a younger, more diverse,

and more sophisticated workfor

ce

demand innovation. We can har

ness this momentum to create a

profoundly different healthcare

delivery and financing system.

But our true north should be

our

pat

ients and customer

s,

who

deserve real value from new

or

revised ways of providing healthcare

and servi

ces.

We must navigate to sustained

improvement in healthcare in

th

e

United States, and I see the follow

ing trends shaping that journey.

Trends

Providers will shift from fee

for-service

and

volume-based

measures

to

a provider capitation

model, where risk

and

patient

populations

are

managed i -

ferently

than

costs are.

The

cur

rent fee-for-service model, which

rewards more use with more

revenue, w

ill

go away in many

markets. Enrollment in managed

care plans

ha

s increased steadily

since the 1990s, and this shift away

from fee-fo r-service will accelerate

as

patients and purchase rs recognize

that more healthcare services do not

equate with better health outcomes

(Kaiser Family Foundation 2012).

The uturescan survey results show

that nearly 90 percent

of

hospital

CEOs believe that by 2019 their

hospital will have arrangements in

place with phys icians in their area

to support bundled payments.

The

ri

se

of

accountab

le

care

organizations and other pay-for

performance strategies is creating a

demand for more transparency and

is driving hospitals and physician

groups to align and take on more

risk as they struggle to improve per

formance and compete fo r market

share. As a result, the healthcare

industry continues to bustle with

mergers and acquisitions, showing

a 15 perce

nt

increase in activiry in

the first h

alf

of2 13

(de

la

Merced

2013). This receptiviry to greater

acquisition activiry and partnership

opportunities is reflected in the

uturesc n

survey data.

But managing costs

is

differ

ent from managing care, as

we

saw

in the late 1980s and early 1990s

when

HMO

s expe

ri

enced tremen

dous public backlash because some

plans we re incentivizing physi

cians to

re

strict care and withhold

services . Hundreds of plans either

closed or were acquired by com

petitors (Christianson, Wholey, and

Sanchez 1991).

Successful risk-based models

will keep central what

is

best for

patients and wi

ll

align payme

nt

incentives to promote value instead

of

volume of car

e.

T he uturescan

survey results indicate support for a

provider capitation model by 2019.

Hospitals

and

healthcare systems

will develop greate r specificity

around

appropriate admissions.

Hospital admissions for both

government-sponsored and com

mercial populations have dropped

significantly in many markets and

are projected to drop in all mar

kets over the next

five

to ten years

(Grube, Kaufman, and York 2013).

The

trend

of

declining admissions

is

likely here to s

tay, as

hospitals

and healthcare systems adjust to

declining reimbursement rates and

revenue for inpatient services as

well as new reform regulations that

do not pay for hospital readmi

s-

sions

(fo

r

ce

rtain diagnos

es)

.

Of

the CEOs responding to

the uturescan survey, 82 percent

predict that by 2019 their hospital

will be financially sustainable with


7/13

reduced inpatient admissions. And

almost all (96 percent) believe that

their organizations strategic plan

will, by 2019, include goals for

decreasing

unn

ecessary admi

ss

ions.

Hospital leaders will focus

on

wellness and prevention to further

reduce preventable hospitalizations

and to direct care to the right set

tings. Inpatient care will

not

be the

default choice for care. Hospital

leaders will have to provide more

oversight

of

the appropriateness

of care and apply care standards

according to evidence-based

medicine.

The treatment

of

routine

back pain

is

a

perf

ect example of

how hospital leaders can influ-

ence adherence to best practices.

According to a recent H arvard

University study, many doctors are

not

following

th

e es tablished guide

lines for care, which stress a le

ss-

is

more approach that includes core

exercises, increased activity, and

physical therapy (Mafi

et

al. 2013).

Instead, ph

ys

icians are exposing

patients with back pain to unneces

sary X-ra

ys

and potentially addi

c

tive prescription pain medication.

They are also referring greater

numb

ers of patients to specialists

who are likely to perform spine

surgery, despite little evidence that

s

ur

gery is

an

appropriate first-line

treatment fo r low back pain. f

physicians consistently

fo

llowed

the es tablished guidelines, patients

wo

uld receive

bett

er and safer care,

and hospitals c

ould

save pay

or

s a

significant portion of the 86 bil

lion annual cost of treating low

back pain.

Hospitals will invest in alterna-

tive sites o care delivery and will

develop a financial model that is

sustainable with fewer inpatient

admissions. Technology is chang

ing the traditional footprint of care

delivery so rapidly that it is hard

to predict wh

at

th

e delivery model

might l

oo

k like in eve n five years.

Technology is making health

care increasingly mobile and

enabling patients to access care in

convenient and customized loca

tions, such as work sites and retail

centers, as well

as on

mobile devic

es . s care becomes more mobile,

patients' expectations around care

and

se

rvice will become

mor

e

sophisticated. Savvier consumers

mean increased expectations for

connectivity and access. Decisions

about where care is provided will

be made from the patient

s

perspec

tive

in

stead of the provider

s. New

delivery configurations will have

profound effects on hospitals' staff

ing and workflows. Consequently,

hospital and healthcare leaders will

have to champion new staffing and

scheduling models that

turn the

old provider-centric paradigm on

its head.

The acute care hospital will

become the care setting for only the

most critically ill, while outpatient

care settings enabled by technol

ogy will provide preventive care

and

wellness, ambulatory, and

post-acute care

se

rvi

ces

in comfort

able, customi

ze

d, a

nd

c

on

venie

nt

environments.

Hospitals will invest in technol-

ogy, specifically electronic medi-

c l

records EMRs), to reduce the

cost o care. Ho spitals will invest

in EMR

sys

tems

to

manage care for

their patie

nt

populations, especially

high-risk patients. In addition,

hospitals will leverage EMRs to

coordinate p

at

ient care among

the physician

s

office, hospital,

laboratory, pharmacy, and patient

s

hom

e

nd to eliminate the pitfalls

of incomplete, missing,

or

unread

able paper cha

rt

s.

EMR technology offers caregiv

ers imm

ed

iate access to patients'

critical medical information, result

ing in better care. It also provides

patie

nt

s with access to convenie

nt

,

time-saving features such

as

online

scheduling,

pr

escription filling,

and

connecting with their doctors via

secure e-mail.

Implications for ospital

eaders

No matter where one lands

on

the

payment

continuum

- bundled

payments, shared risk, partial capi

tation,

or

full risk- assuming more

risk will require healthcare organi

zations to invest substantially up

front in the infrastructure for pre

ventive care and care management

and to tolerate longer payback peri

ods

on

investments.

This

up-front

financing could prove to be a bar

rier to infrastructure investment for

small- to medium-sized healthcare

providers.

Succe

ss

ful hospita

ls

will

empower physicians to manage

care decisions and coordinate care

throughout the continuum, includ

ing pharmacy, outside medical,

post-acute,

and

end-of-life care and

prevention and wellness services .

Physicians will use real-time data

to

und

erstand and

man

age the care

of individuals, clinical c

ohort

s, and

communities.

And th

ey will prac

tice

ev

idence-based medicine, using

proven clinical protocols to consis

tently yield the best care.

The increased emphasis on

care management and quality will

re

quir

e leaders

and

organizations to

be more interdependent

than

eve r

before. Vigilant oversight of transi

tional care is critical, and coordina

tion of care will ex tend into the

co

mmuni

ty as hospitals increasingly

partner with communi

ty

health

advocates and other

se

rvices to

reduce admissions and address the

social, economic, and behavioral

drivers of hospital use.

With such phenomenal changes

in the healthcare market, hospital

and hea

lth

care leaders have no

choice

but

to seek new opportuni

ties for growth while also driving

greater affordability for consum

ers and patients. We will have to


8/13

reinvent ourselves and develop new

markets and niche industries to

meet our patients' expectations for

quality care that is also affordable.

t

will not be the biggest among

eferences

us who will survive; it will be the

most creative and resourceful.

Bringing value to patients- focus

ing on our mission and not our

margins-will

drive innovation

that leads to sustainable business in

healthcare. As hospital leaders, we

can be the solution that America

deserves. Ill

Christianson, J.B., D.R.

Who

l

ey and

S.M. Sanchez. 1991. State Responses to

HMO

Failures.

Health ffairs 1

(4):

78-92.

De la Merced, M.J. 2013. Merger Activity Was Down but Not

Out

in First Half.

The

New York

Times

Dea/Book

Published July

1.

http://dealbook.nytimes.com/2013/07101 merger-activity-was-down-but-not-out-in-first-half/.

Grube,

M.,

K. Kaufman, and R. York. 2013. Decline

in Ut

ilization Signals a Change

in

the Inpatient

Business Model.

Health ffairs

Blog Posted March 8. http://healthaffairs.org/blog/2013/03/08/

decline-in-utilization-rates-signals-a-change-in-the- inpatient-business-model/.

Kaiser Family Foundation. 20 12. State Health Facts: Total

HMO

Enrollment. Published June.

ht

tp://kforg/

ot

her/state-indicator/total-hmo-enrollment/.

Mafi, J.,

E.

McCarthy,

R.

D a v ~ : m d t a n d o n 2013. Worsening Trends in the Management and Treatment of

Back Pain.

J M Internal Medicine

173 (17):

1573-81.


9/13

7 EQUITY OF CARE

ELIMIN T ING HEALTHCARE

DISPARITIES THE CALL TO ACTION

Racial and ethnic

minorities now make

up about one-third of

the US population,

but

by 2042 they

will

become the majority.

While

all

patients are equal, they

are not the same.

They

may

for

example,

be

exposed to different

environments and workplace haz

ards, have different diets, interact

differently with healthcare provid

ers

and

face

different challenges

in complying with medical advice.

For these reasons and many others,

some still unknown, patients from

traditional racial and ethnic minority

groups often receive a lower qual-

ity of healthcare, even when the

comparisons control for income and

health insurance status

IOM 2003;

Mayberry, Mili, and Ofili 2000).

Healthcare disparities can lead to

increased medical errors, longer hos

pital

s t a ~

avoidable hospital admis-

36 FUTURESCAN 2 1 4

by

Richard

J

Umbdenstock F CH

sions and readmissions, and the over

or underutilization of procedures.

The

RE L

Challenge

Despite our best efforts, we know

that race, ethnicity, and language

preference (REAL) continue to

affect the likelihood that patients

will receive the care they need and

the outcomes they deserve IOM

2003; Mayberry, Mili, and Ofili

2000). For example, Hispanic adults

with diabetes are far

less

likely to

receive recommended preventive ser

vices, and African-American women

are more likely to die after they are

diagnosed with breast cancer, than

are their white counterparts AHRQ

2009; American Cancer Society

2011). s health insurance cover

age expands, each provider will be

challenged to provide the best pos

sible care to a patchwork of patient

populations with different beliefs,

lifestyles, family structures and sup

port, and healthcare experiences.

Planning for equitable care

involves developing ongoing rela

tionships with community organiza

tions that can support providers

About the

Author

Richard J Umbdenstock, FACHE, is

president and CEO of he American

Hospital Association (AHA), which

leads, represents, and serves more

than

5 000

member hospitals, health

systems, and other healthcare orga

nizations as well as 42 000 indi-

vidual members. Previously,

he was

the elected chair

of

he AHA board.

Umbdenstock's career includes expe

ence

in

hospital administration; hea

system governance, management, a

integration; association governance

management;

HMO

governance; an

healthcare governance consulting. H

has written several books and article

for

the healthcare board audience an

has authored national survey reports

for the AHA and its Health Research

Educational Trust as well as for

the American College of Healthcare

Executives. He received a bachelor's

degree in politics from Fairfield

University (Connecticut) and a mast

degree in health services administra

tion from the State University of Ne

York at Stony Brook. He

is

a Fellow

o

the American College of Healthcare

Executives. He serves on the boards

of he National Quality Forum and

Enroll America, cochairs the Council

Affordable Quality Health Care (CAQ

Provider Council, and serves on the

National Priorities Partnership and o

the Center

for

Transforming Advance

Care

steering committee.

efforts to build cultural competency

in delivering

that

care. Providers

must anticipate community needs


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4662377 2014/09/25 107.201.164.117


11/13

FUTURESC N

SURVEY RESULTS: Equity of

Care

How likely is it that the

following will

be seen

in

your hospital by 2 19?

Very Somewhat

Likely Likely

( )

( )

I I

9 4

Your hospital's suategic plan

will

include

goals

for improving quality of care for culturally and

linguistically diverse patien t populations.

2

52

Your hospital will see a reduct ion of 5 percent in

the

disparities

in

quality of care among racially,

culturally,

and

linguistically diverse pat ient populations.

ACHE

48

38

SHSMD

3

4

Both

a

l

43

38

he race/ethnicity diversity ofyour hospital board will represent your community.

ACHE

SHSMD

2 43

Both

The race/ethnicity diversity ofyour hospital's leadership team will represent your community.

Note: Pcrccnagcs maynot

total to aacdy

100 due

to

rounding.


12/13

What Practitioners

Predict

Strategic:

pllllllll

will

address

diwrse patient

populations

The majority (82 percent) of CEOs responding to the

survey

think

it likely that goals for improving the quality of care for diverse patient populations will be part of their

organization's strategic plan by 2019.

are

disparities will be reduced by half

Almost three-quarters

of

survey respondents believe

that

disparities

of

care

among racially, cultunlly and linguistically diverse patient populations will be reduced by half in their organizations by

2019.

Gcnmning boards

nd

leadenbip

will

idlect

the community

A majority of those answering the survey {nearly 86

percent

of ACHE

respondents and 70 percent

of SHSMD

respondents) predict

that

by 2019

the

racial/ethnic diversity

of their board will reflect their community. Similarly, 83 percent ofACHE respondents and more than 63 percent

of SHSMD respondents predict that the racial/ethnic diversity of the hospital's leadership team will represent their

community by that time.

A majority of those answering

the survey (nearly 86 percent of

ACHE

respondents and

70

percent

ofSHSMD respondents) predict

that by 2019 the racial/ethnic

diversity of their hospital's board

will reflect

that

of their community.

Similarly, 83 percent

ofACHE

respondents and more than 63 per

cent of SHSMD respondents pre

dict that the racial/ethnic makeup

of

the

hospital's leadership team

will represent their community.

The

governing board is crucial

because it establishes the overarch

ing direction of the hospital

or

healthcare system. A board whose

makeup reflects that of its com

munity has a far better chance of

understanding its community's

unique needs. This insight helps a

hospital's leadership team strategi

cally shift the approach to care, spe

cifically in the area of equity.

Implications for

Hospital

Leaders

What does achieving equity in care

mean for hospitals

and

healthcare

systems?

It

results in better care

and better outcomes, higher patient

satisfaction, and a deeper and more

meaningful connection to the com

munity. Equity of care also has a

strong business imperative; a study

by the Joint Center for Politi.cal

and Economic Studies found that

eliminating healthcare disparities

for minorities would have reduced

direct medical care expenditures

by

229.4 billion between 2003 and

2006 { aVeist, Gaskin,

and

Richard

2009).

s

healthcare transitions to

a value-based system of care, hos-

pitals must ensure that their out

comes improve.

Hospitals can act immediately

to

address equity of care by devel

oping consistent processes

to

collect

and use REAL data. For example,

they can ask patients

to

self-report

their information

and

train staff,

using scripts,

to

appropriately

dis-

cuss patients' cultural and language

preferences during the registration

process. Hospitals should gener-

ate data reports stratified

by

REAL

group

to

examine disparities. REAL

data can be used to develop target

ed interventions to improve qual

ity of care (e.g., scorecards, equity

dashboards) and can help create the

case for building

access

to

services

in underserved communities.

In the area of cultural com

petency, hospitals should educate

all clinical staff during orientation

about how to address the unique

cultural and linguistic factors affect

ing the care of diverse patients

and communities and require

all employees to attend diversity

training. Hospitals should also

provide culturally

and

linguistically

competent services (e.g., interpret

ers, diverse community health

educators) and features (e.g., a

bilingual workforce, multilingual

signage). In the area of diversity,

a hospital should acti.vdy work

to

diversify its board and leader

ship team to include a voice and

perspective that reflect its com

munity. Accountability through

the use of regular reporting

on the

racial

and

ethnic makeup

of

the

leadership team will support action

able approaches. Diversification

strategies include the creation of a

community-based diversity advi

sory committee, engagement

of the

broader public through community

based activities and programs, and

use of search firms.

The mission of the AHA and

its members is to advance the

health of individuals and com

munities. We are accountable to

the community and committed

to health improvement. We can

not succeed unless we diminate

healthcare disparities.

s

a partner

in the Call

to

Action, we will keep

the drumbeat steady and work

closely with our members to foster

success in the realm of equitable

care. Equity in care

is

more than

the right thing to do; it's the smart

thing to

do for

patients, for com

munities, and for hospitals.

ll


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