Population health became a popular topic of discussion Thursday when executives of four hospital systems in the Upstate participated in a discussion about “The Health of Health Care in the Upstate,” given by GSA Business Report.
Population health is the taking of health care services to the community instead of waiting for the community to come to you, according to Dr. Spence Taylor, president of the Greenville Health System.
“The whole perspective changes with a population health model,” he said. “It’s not a matter of you sitting at a hospital and waiting for patients to come see you. You have to get out in the communities and preemptively strike to try to see if you can keep people healthy.”
A focus on population health moves a health care system from a fee-for-service model, characterized by AnMed Health CEO Bill Manson as “the more we do the more we get paid” to a different situation for providers.
Taking health care to the community is how medical care began, according to Keith Newnam, vice president of population health management at Bon Secours St. Francis. Over time those services moved to medical offices but now are moving back into the community. He said hospital systems are all investing in home care and in relationships with skilled nursing facilities and building relationships outside the traditional brick and mortar. Technology has contributed to the changes, he said.
“The days of going in for a procedure and staying there for three to four days are over. Now many of those procedures are done as outpatient and that’s because of the development of technology,” he said. “The ability to care for patients and the ability to follow up with patients has improved. We really want to deliver care at the least expensive location.”
Newnam said the most expensive place to receive care is in a hospital’s emergency department.
“Why take time off and drive to a clinic to talk to someone when you can actually show them a rash on your arm, get an assessment, and move forward,” he said. “I believe that’s the direction of health care…serving the community in a comfortable and economical way.”
The hospital administrators also addressed the Affordable Care Act, which Newnam said helped push the new direction of health care delivery. “We have invested in relationships and programs to help us drive down health care costs” that have included telemedicine.
Bruce Holstien, president and CEO of Spartanburg Regional Healthcare System, said the health care act wasn’t necessarily a bad thing, but it was the U.S. Supreme Court ruling allowing states to opt out of the Medicaid expansion that hampered the success of the ACA.
“What we’ve done to ourselves here in South Carolina and in a lot of the red states, we’ve lost about $250 billion over the last eight years in Medicaid expansion,” he said. “For South Carolina the number is closer to $200 million a year that we should’ve been bringing in in federal money.”
Manson said the assumption behind the law was that if the number of covered individuals increased significantly, health systems would substantially reduce the number of uninsured patients they would see.
“The Supreme Court ruling basically unhinged that for the states that decided not to expand,” he said. “There was a quid pro quo component of the legislation that said in return for the expanded coverage, we’re going to reduce Medicare reimbursement to those same hospitals $150 billion over the next few years. The problem in South Carolina is we got 100% of the cuts and none of the expansion.”
Manson said that has “significantly decreased” AnMed’s reimbursement from government sources, and that the hospital has had to shift more cost to business in the community and across the state.