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Dome - An Urgent Call to Integrate Health Care Delivery

Dome October 2013 VOL 64
Issue No. 8

An Urgent Call to Integrate Health Care Delivery

By: Ronald R. Peterson
Date: October 1, 2013

Ronald R. Peterson President, The Johns Hopkins Hospital and Health System Executive Vice President, Johns Hopkins Medicine
Ronald R. Peterson President, The Johns Hopkins Hospital and Health System; Executive Vice President, Johns Hopkins Medicine

The health care headlines these days are dominated by the impact of the Patient Protection and Affordable Care Act (ACA)—which even President Obama himself has started referring to as “Obamacare.”

Beginning on Oct. 1, insurance plans and prices became available to those who wish to see if they can obtain more affordable health care coverage by enrolling in it under the Maryland Health Connection, the state insurance exchange established under the ACA.

This and other sections of the law that gradually are being activated surely mark a significant sea change in America’s health care marketplace—but the forces behind this new wave have been roiling health care waters for a long time.

We at Johns Hopkins Medicine have kept a close watch on the rapidly changing nature of the health care market. That’s why one of the six key priorities in our new strategic plan focuses on promoting our development into a more integrated health care delivery and financing system.

In our sometimes rarified world of academia, we may talk about seeking to become the “model of an academically based integrated health delivery and finance system,” but the reality is that in order to survive well in this new world of health care, we are going to have to become just that—like it or not.

Today, health care is moving away from the old-fashioned, volume-driven, fee-for-service, fragmented health care delivery approach we’ve known for decades. It’s moving towards a more value-based, more population health-based system that focuses on providing care economically for the people of a specific region or socioeconomic group.

Some of the major insurance companies have been developing incentives to encourage primary care physicians to avoid sending patients to us if possible; we’re viewed as a somewhat high-cost health care provider because we’re a major teaching institution. The competition is intensifying, with our main competitors in the Baltimore-Washington region—the University of Maryland Medical System and MedStar—further consolidating their own places in the market.

We’re going to have to become more efficient through integration of our services. We also must determine how we can effectively influence a sufficient critical mass of patients to come to Hopkins and remain within our system once they’re with us. Without the savings that service integration will provide, and the revenue to be obtained from a steady flow of patients, supporting our tripartite mission of health care, research and education will become increasingly difficult.