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Managed Care Partners - Health care reform: What's best for the 'best of the best'?

Managed Care Partners Fall 2010

Health care reform: What's best for the 'best of the best'?

Date: October 31, 2010

William Baumgartner
Even with all the changes on the horizon, says William Baumgartner, Johns Hopkins will continue to intertwine health care with research and education.

It’s not your typical closed-door meeting. One Tuesday night a month, for more than a year now, a committee has met quietly at Hopkins, without fanfare, to bring a sea change to the delivery and practice of medicine.

The Health Care System Reform Coordinating Committee (HCSRCC) first came together in 2009 as a proactive response to the health care bill then being shaped on Capitol Hill. Edward Miller, CEO of Johns Hopkins Medicine, and Ronald Peterson, president of The Johns Hopkins Hospital and Health System, tapped William Baumgartner and Patricia Brown to form and run the new committee. They charged the two—they’re vice dean for clinical affairs and president of Johns Hopkins HealthCare, respectively—to go beyond the scurrying it will take to have the institution comply with the new Affordable Care Act.

“We were asked to change the medical delivery system and cut costs while providing the same—or better—care,” says Baumgartner, “no matter what happened with federal health care reform.”

So the co-chairs invited some 20 of Those Who Get Things Done from across Hopkins’ Baltimore Washington network to meet regularly. The group includes clinicians, department heads, representatives from nursing, legal affairs, medical affairs, Home Care, ambulatory and information services, finance and more. Brown describes the sessions as “always energized and passionate. Everything is on the table. There are no sacred cows.”

We’ve asked Baumgartner for highlights of what the committee is working on.

MCP: You see a major structural change in Hopkins health care.
Baumgartner: It’s a transformation. We know we’ll move to follow some sort of accountable care organization (ACO) model. Structurally, it amounts to having a group of primary care and specialist physicians work together for a designated group of patients. They share responsibility—accountability—for a patient’s care.

MCP: This sounds like an HMO.
Baumgartner: Perhaps, but on a larger, more complex scale—one with quicker access to Hopkins’ translational research and one that integrates the teaching aspect of our medical school. Our tripartite mission.

MCP: We hear the buzzwords: seamless, patient-focused, system-ness.
Baumgartner: Yes. The seamless covers transitions, mostly, that we all want to do better: moving a patient from primary care to specialists, from an outpatient to an inpatient setting. Patient-focused means always putting patients first—from keeping them healthy to less traditional help like enabling their access to Hopkins if it’s needed. For systemness—now there’s a word—we’ll mold our Hopkins hospitals and outpatient facilities into a true system where each has a role. How many cath labs should we have? Are some procedures better done in the community or centrally? What services are best restricted to certain hospitals?

MCP: Other than lowering cost, tell us one net effect of this streamlining on the status quo.
Baumgartner: We expect reduced admissions to The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center. Fortunately, we have a backfill strategy to bring in patients from outside our local region. They’ll come because of expertise not readily available elsewhere.

MCP: Has your committee gone beyond brainstorming?
Baumgartner: Yes. We’re first focusing on ways to reduce hospital readmission rates. And we’re working toward an enterprise-wide electronic medical record.

MCP: Are others doing what we are?
Some smaller health care systems, like Kaiser, have really embraced this. But not all academic medical centers intend to. Some want to stay tertiary/quarternary referral sites. We’re going a new way, though, because we feel it’s right. We have all the fundamentals in place to make it work, including 270 primary care physicians across cities and communities. Our Johns Hopkins HealthCare and Home Care have already been managing patients and doing a good job. The time is right.