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Expert Panel Gives Insights on Local Health Care

December 02, 2008
BCBR Article Expert panel gives insights on local health care By Business Report Staff November 14, 2008 -- BOULDER - Five executives from the health-care industry in the Boulder Valley participated in a panel discussion at the Boulder County Business Report's "Pulse - The State of Health Care" during a Health-Care Heroes awards luncheon held Nov. 6 at The Boulder Country Club in Boulder. Panelists were David Hamm, president and chief executive officer of Exempla Good Samaritan Hospital in Lafayette; Dr. David Ehrenberger, chief medical officer of Avista Adventist Hospital in Louisville, and a practicing physician; Michael Moran, chief quality officer at Boulder Community Hospital; Darryl Edmonds, general manager of CIGNA Healthcare; and Jeff Harrington, vice president of finance and network of care for The Children's Hospital. Christopher Wood, publisher of the Business Report, moderated the discussion. The following is that discussion, edited for space. Chris Wood: What new programs and initiatives are your organizations planning for 2009? Michael Moran: We opened our cancer center at our Foothills campus over a year ago and have seen a tremendous amount of support from the community for that program. We are continuing to evaluate additional cancer services to bring to that location. We also are in the process of enhancing our autistic program for children and our team that focuses on evaluation, assessment and treatment of that population. We all know that is a growing problem in our nation. And we are spending a lot of time and effort dealing with improving efficiencies for making sure patients are safe and improving quality at same time. David Hamm: We will be four years old as a hospital the first of December this year, so we continue to grow as we serve East Boulder County and beyond. We are bringing an additional 30 beds into our hospital the first of December for more capacity. Primary areas we serve are in cardiology, orthopedics, general surgery. We are focused on quality. We have plenty of opportunity to work on quality initiatives. David Ehrenberger: A bricks and mortar sort of thing we've done is an orthopedic joint and spine center of excellence. What underlies it is more important, and that's demonstrating that we are a center of excellence. We do that by data and new leadership. We have a new quality director, Kim Crawford, who has a national reputation. He's doing an awesome job. We have a new clinical information system to get some data. More interesting for me, is how we can advance quality of care to our patients. We are interested in clinical integration using a community health record. That means there is a patient in the community and we have one record with information from gynecologist, orthopedist, etc. That kind of foundation for data will drive quality, safety and efficiency. Good for the patient and accountability for providers. Daryl Edmonds: CIGNA purchased Great West Healthcare. That transaction closed April 1. We have continued to work with the integration of contracts between hospitals, physicians, ancillary providers. That work will continue into 2009. Secondly, we are launching an individual product that addresses a local, statewide and national issue - the need to provide insurance to the 46 million uninsured Americans. And we will strive to maintain a high percentage of members who are pleased with satisfaction of our plans. Jeff Harrington: A year ago we moved to the new Anschutz Medical Campus. We then embarked on an aggressive plan to expand our network of care. We just expanded in Broomfield by moving existing people to a brand new 46,000-square-foot facility. Our goal is to bring pediatric services out to the community. Quality of care is a benchmark we look at every day. Our five-year strategic plan focuses heavily on quality. We still have growth possibilities and will expand our main campus with 24 new beds. And we will look at our partnerships with nonprofits. And expand our community health record throughout the community. Wood: Give me your overview of the state of health care locally and the competitive environment not only within Boulder and Broomfield counties but also the Denver market as it pertains to Boulder and Broomfield counties. Hamm: We are fortunate to live in the part of the country where there are more of us who have the ability to be outside and be active, so I think about the importance of taking care of ourselves, and we live in a place where that is possible. As far as competition, we don't compete with any of these guys. I think we've all mentioned quality. We hope we become more accountable to you - the consumer of health care - to be transparent about our quality efforts, where we need to improve, where we are making gains, so you understand how we make a difference. Ehrenberger: I don't know necessarily about the state of health care in our counties. I do know that it is unorganized in terms of delivery to populations. It's still a cottage industry in many ways. It is strongly siloed and dysfunctional in terms of flow of information. It is excellent in its silos. But we need to be proud of something bigger. If you look at the department of health's statistics for Boulder and Broomfield counties, what we'll see is that around prenatal care we do better than the state average pretty substantially, and pretty mediocre average in terms of the state for heart disease and death from breast cancer as examples of diseases that are highly influenced by how well the system and community works together to deliver better care. Competition is great, because it drives people and organizations to work toward better care. We must change to learn a new mantra. We must collaborate around quality, should never compete around quality _ outcomes sure, but not systems. We should be working together. Fundamentally, the state of health in our counties is a measure of the vitality of our innovation and collaboration. We won't get there until we change how to talk to each other and support our primary-care physicians, make sure they don't fail, because we are headed to the precipice. Edmonds: From a national perspective, depending on how you count the statistics, roughly a third approaching 50 percent of the population to day is either overweight or obese. By 2010 to 2012 that will be north of 50 percent. About 27 million people have diabetes, and the prediabetic population is about 54 million in the country. If we don't think we have a problem today, we soon will have in the years ahead. Colorado is one of two states in the country that is the leanest. The other is Vermont, don't ask me why, must be the syrup. In Colorado the percent of population that is overweight or obese is approximately 17 percent, one of lowest in the country. Boulder, Colo.? Approximately 10 percent. The average annual increase in health care is 12 percent. It doesn't take long to realize that is not sustainable. So how do we mitigate trend? The single-biggest issue is we have disease that is going to overwhelm the health-care system. Boulder won't face that to the degree the rest of the country will, because of the level of fitness of people around here. We're seeing employers starting wellness programs going beyond walking programs and changing what's in the vending machines. Harrington: Immunizations are up, that's good news. Cigarette smoking and use of illicit drugs by teenagers is slightly down, teen pregnancies are slightly down in Colorado. We focus on preventive care, and number one reason for death in our hospital is child abuse. We really focus on trying to get the word out that we can prevent these deaths through education, etc. More kids are living in poverty and are uninsured in Denver and Colorado. But we've allowed more to take advantage of programs for the uninsured. Moran: From a structural standpoint in Boulder County we have great community-based hospitals that are nonprofit, locally governed paying attention to patients needs. The community health center network. Access to insurance is an issue in our country. This network provides a valuable vehicle to help those people receive health care. Our private practitioners do their fair share of attending to people who have difficulty paying for services, but that is going to just get bigger. Wood: David Ehrenberger, you said earlier that many primary-care physicians' practices were heading for the precipice. Could you elaborate on what you see? Ehrenberger: The current way that primary care is provided nationwide is based on a system of reimbursement that will currently guarantee failure. The battle for sustainability is being lost. That is the opinion of the American College of Physicians, the largest organization of physicians in the country. In a white paper issued two years ago titled "The Impending Collapses of Primary Care." It pointed to a dysfunctional payment methodology that does not reimburse preventive care adequately. Does not incent management effectively, systems of care for chronic diseases. Because of people getting into their prime, this will become more of an issue. We need to reinvent the system. We can't keep our doors open in private practice if you can't pay your bills. Wood: With Barack Obama becoming president in January, what do you think we can look forward to in terms of health-care reform next year? Ehrenberger: It's admirable that Mr. Obama is advocating for a national health plan to be accessible widely. It's admirable that the pre-existing conditions would be excluded. It's admirable that the offerings to the health-insurance exchange would be steeply adjusted for income. I hope these things proceed, but I have a cynical viewpoint. It's chipping away at the block, not reinventing the fundamentals of our health-care system that are broken. So I don't have a lot optimism. Health-care reform will happen because of local efforts. An example, Avista is working with Boulder Community Hospital, Boulder Medical Center, Longmont United, Clinica Campesina and private physicians to extend the reach of the community health record. But I don't look to our national leaders to solve health-care problems. It will be a partnership with local efforts that prove the building blocks of health-care reform. Edmonds: Three months ago I would have said health care would have been the No. 1 issue, but now the economic issue will be squarely on the radar screen. So states will be looking at ways to insure more people. We continue to see more effort in CHIPS program. We need to continue to provide access. I think the programs for Medicare will be funded amply and then a number of years underfunded, and we will see come cutbacks in the federal program. Additionally, if there is an initiative to provide coverage for every citizen, which is admirable if we can support that, we will see a push to get individuals into any form of insurance, whether it's an individual or employer program. We could see more dropped coverage from employers. My final point, there are 50 states in the country, and each state will try to approach the situation a little differently. That's a great thing. We will be more likely to find pieces that work. I think that solution if far better than one national system that says this is the way it's going to be. Harrington: Not much else to add. I agree states will need to solve the problem. The federal government has no focus on it right now. Moran: It is going to be a significant issue as part of our economy. Simply because the growth of health-care costs as a percentage of our GDP, and by any other measure, we as a nation are spending more on health care than any other industrialized nation with no necessarily better outcomes. That alone will force us to take it on, and even though the campaign dealt with access, there is a big body of knowledge out there about how we can reduce costs, and it's things we have already identified that other countries are doing that we're not. And the reason we haven't done it is because we haven't had the vertical will because of the partisanship we've had in our government to address these difficult issues. So I think what might force that to happen in the future is we have no choice but to address this issue and perhaps there will be political will to take on those special interests. Hamm: On the federal level we don't have a solution. So I think we take parts of each state's innovative initiatives. Wood: What are we doing locally to maintain our high standards of quality care? Edmonds: One element is eliminate the variability of services, and one of the best ways to do that is the electronic medical record to eliminate redundancy and be sure someone can read the prescription that was typed in from a physician or physician's assistant. That goes a long way. The electronic age is upon us and how do we best utilize it? A lot of work in that can be done. Harrington: The electronic medical records at Children's are completely integrated now in the EMR and trying to expand that to our pediatric specialists. Data, and understanding evidence-based medicine to highlight the quality of work we do and working on eliminating in a key. Another key is improving access to outpatient care and reducing unnecessary admissions. Moran: I believe there is a sea change occurring in health care with regard to quality and efficiency in hospitals. It's not about maintaining but about improving quality. We have a number of measures nationally, and probably locally where we're showing improvement. It took a while. We need to share information to figure out why there is such a dramatic difference in outcomes among hospitals. Now that information is being shared with widespread Internet access, we can truly collaborate across the nation. Hamm: We should be proud of what we have, and we should never rest on that but continue to strive for improvement. The electronic medical record should allow us sharing opportunities. These are positive things that have evolved over the last 10 years. Ehrenberger: The health care we deliver to individuals who have insurance is unparalleled in the world. Our challenge is to share that sophistication and improve on it so we can cover those folks who aren't covered and to maintain our current level of excellence and move beyond it. That will require three things - the right tools, advancing the principals of quality and teamwork.