Taking the temperature of health care part 3: Skepticism and mistrust
Editor’s note: This is the third article in a five-part series on the cost of health care in western Wisconsin. Get caught up on the series here.
Whether you are purchasing health insurance for your employees, buying your own insurance privately or on the government marketplace, participating in a healthcare sharing ministry, or opting not to purchase health insurance, it has become a frustrating, stress-inducing experience.
The blatant politicization of the health care system holds consumers hostage leading to anxiety and uncertainty. Even with insurance, practically every health care decision today has also become a financial decision and that makes people more than a little uncomfortable. Patients can pay thousands of dollars for care and barely benefit from their insurance.
Are we approaching a point where the cure is becoming worse than the disease?
To find out, RiverTown Multimedia asked the CEO's of four local hospitals to answer five questions about the state of health care in our backyard. Here is Part Three of the discussion.
- Steve Massey, President and Chief Executive Officer, Westfields Hospital & Clinic
- Alison Page, Chief Executive Officer, Western Wisconsin Health
- David Miller, President River Falls Area Hospital, Allina Health
- Thomas Borowski, President Hudson Hospital & Clinic
To many, it feels like the equation, in which “do no harm” was the primary principle guiding the delivery of healthcare placing the patient at the top of the priority ladder, is now reversed. Patients are forced out by a system they cannot afford, a system which caters instead to corporations and shareholders, a system in which the patient’s voice is supplanted by politicians, executives and accountants. There is this sense of an incestuous relationship between everybody who isn't the patient, between hospitals and pharmaceutical companies, between pharmaceutical companies and insurance companies, between hospitals and insurance companies.
When a patient receives a medical bill and they see, here is what your procedure costs, here is the price negotiated between the provider and the insurance company and here is what you pay, we all want to know what happened in that negotiation. Knowing it will be different for different patients, even with the same insurance leads to skepticism and mistrust.
How would you propose to regain patients’ trust and return them to their rightful place at the top of the ladder?
AP: Imagine, you go to the grocery store to buy your needed groceries for the week. The groceries aren’t marked. You ask the manager for a list of prices, and she gives you one. Some items have exact prices and some items have ranges for each item. Then, you get to the checkout … and, things do not ring up as priced. You also notice that the groceries being rung up for the person in line in front of you ring up at different amounts than your groceries. Well ... welcome to health care.
Prices are irrelevant in healthcare today. The number that matters is what an insurance company will pay. Prices are “adjusted” to optimize revenue from insurance companies based on the terms of the contracts that exist between the hospital / clinic and the insurance company.
Here's what is artificial about comparing prices between hospitals. Two different health care providers compete in the same region. Provider A negotiates a great payer contract with an insurance company that will pay them 95 percent of whatever they charge for a given procedure indefinitely. Provider B negotiates a payer contract that is not as favorable. It will lock in a price for procedures at today's price and pay that price plus the consumer price index (CPI) increase each year after. Both contracts are with the same insurance company but can result in very different charges for the same procedure. The question becomes, how much are insurance companies willing to reimburse you for a particular procedure which leads to different prices. They might be two very different numbers from the same insurance company. The terms of those contracts are absolutely confidential and cannot be shared or discussed with anyone.
SM: I would say transparency is much better than it was a decade ago. It's a reaction to the market in terms of what consumers are looking for. Today there is a subset of the population that really are savvy, they want to know how much things are going to cost.
You can go on a website and look up what things cost. You can call up now to any hospital in western Wisconsin, and I know that we've talked about this between CEO and CFOs, whether you are part of a large system or not, if you want to know how much something costs based on your insurance, not just in general, that they can get that to you. They can't get it to you like (finger snap), it's not like you're going to Walmart and you can look at the price tag, but we're all working to get that response back to you in a very short amount of time so you can make an educated decision. That's part of it, you have to be an educated consumer.
DM: At River Falls Hospital, we believe in “Whole Person Care.” That means we look at the whole person — mind, body, spirit and the community or social factor — not just their medical diagnosis. This takes on many forms, from incorporating mindfulness practices into someone's care routine, to providing a person living with chronic illness the tools to live their best life as they define it. I am proud of Allina Health for putting the human (not patient) at the center of everything we do. You can see and hear patients telling these stories all throughout the Metro within the Allina Health system.
SM: I do feel like the patient is at the center of the conversation. I've been with Health Partners now for six years and before that I worked at Allina and Fairview. We're spoiled in terms of the level of healthcare we have up in the Minnesota / Wisconsin market. We're further ahead of a lot of different regions of the U.S. in terms of transparency with how well we're performing. Quality metrics allow patients as consumers to go out and see how a clinic is performing in terms of how well they take care of diabetic patients or what percentage of patients receive their immunizations when they should. They can grade us even before they see us. That doesn't happen in all parts of the U.S.
Our organization, and I think Allina, Fairview, all the health systems in the Twin Cities liken back to the triple aim (improved health, improved experience and total cost of care). You can't just focus on the clinical outcomes. It's so foundational in terms of how we approach our annual planning. At the end of the day, we focus on experience, cost affordability and then the clinical outcome from a patient perspective.
TB: It's a very complicated situation. Total cost of care for us is growing exponentially in terms of complexity and cost. Being part of that triple aim, we're all focused on working together, building relationships based on trust and partnering together to see how can we drive the cost of care down which will then have a positive impact on our patients. There's a number of strategies underway to do that but the patient has to be at the center. Listening to the feedback, focusing on quality, safety and the patient experience is a big part of it.
AP: The more that you can take the money factor out of the care being delivered by providers and by an organization, the better. Our model here is the Mayo model. In the old world, doctors were paid on production. If they saw more patients, ordered more tests, they made more money. Doctors here are paid a salary. We research the market median (for a specific doctor's specialty), the middle of that market, and that's what we pay the doctor. We want our doctors to focus on patients’ needs and what's the right thing to do for this patient today and not look at how much revenue they're making. That has been the case here since the beginning of 2013. Most people who go into healthcare, doctors, nurses, are nice people who want to help people. The general public might be stunned but, a lot of time gets spent in healthcare organizations talking about money, about how much money they’re making and this and that. We've taken that out of our equation and it's working.
TB: More and more compensation is being tied to performance measures in terms of quality, safety, service, and those types of things.
SM: Our HP philosophy is, not to have our physicians earning in the 99th percentile of income when you look at doctors’ salaries. If you talk to our medical leadership, our goal is to be in the 50th percentile. How we judge and how we evaluate performance, it isn't about how much we are doing, it's about the triple aim. The driving factor is not a profit motive. We've never sat down with a physician and said, “You are not ordering enough CT's.If you don't order more CT's, you're going to be fired.” That is not a conversation that has ever happened.
Employers are getting more and more involved with insurance products. There are several large employers in the Twin Cities that want very narrow networks as a way to save money. They want to mandate where their employees and their dependents can go for care because they want to be able to maximize negotiations. A lot of times, the negative feedback or fallout comes back to the hospital or the clinic or the insurance company in general, when really it's employers that are driving some of that as a way to control overall cost not just for employees but for themselves as well as they are often covering 50-90 percent of the cost of the insurance.
AP: It is insurance companies and health care systems that want to create narrow networks so they can control greater market share and demand higher payment. Employers want access to great care, close by, at a good price. They don’t care if it is a narrow network. In fact, most would support choice for their employees.