Jim Tallon: Opportunities in a Changing Health Care World
The 2012 Annual Report Message
The year covered by this annual report has been the most remarkable, by any health policy measure, in the 40 years in which I’ve moved from health planner to elected official to president of the United Hospital Fund. That’s a bold statement, and a very personal one, but the milestones are evident.
It’s a year that launched the implementation of the most sweeping federal health care legislation in 50 years.
A year in which health care policy was marked equally by the momentous Supreme Court decision on the Affordable Care Act and the daily debate of the presidential and congressional campaigns.
A year in which New York has begun implementing profound changes in its $54 billion Medicaid program—reforms that cap spending growth and commit to care management for nearly all of its 5 million beneficiaries.
And a year in which those at the front lines of health care delivery have increasingly accepted the challenges of and opportunities for fundamentally altering the way in which services are organized and delivered.
We’ve written elsewhere about the scope of the ground-up changes occurring in New York’s and the nation’s health care: The move from individual physician-patient relationships to care provided by teams of clinicians. The coordination of primary care and hospitals, of hospitals and long-term care, of providers and insurers. The move away from fee-for-service payments based on single visits to payments for episodes of care or for the entirety of care over time. The explosion of health information technology and its meaningful use in medical records, and in allowing us to better understand our health status. And a broader focus on not just individuals’ illnesses but also on overall population health.
The changes have been large—and bigger, faster change is on the way. Yet while there is eagerness to alter health care’s direction, we attempt to do so within a sobering economic climate. In effect, either we will take the lead in creating positive change or our fiscal constraints will compel us, in the not too distant future, to make some less palatable choices. That realization—shape or be shaped—has guided my 19 years at the Fund.
During that time, I’ve tried to create and sustain the organization that I wished for during my years in the State legislature—an independent, New York-based group that could provide timely and accurate information, identify opportunities for improvement, and have the skills to assist both health care providers and government policymakers in implementing those changes.
In the following pages we explore the activities that advance three broad Fund goals: explaining the forces and choices operative in health care; pointing to specific ways in which services can be improved; and making the connections that demonstrate the essential role of partnerships in effecting real change. Those themes play out in six major Fund initiatives, five developed and evolving over the course of more than a decade and a sixth very much a product of the sea change of the past few years.
- Building on our long-standing commitment to expanded insurance coverage as a fundamental element of health system improvement, our Health Insurance Project is now actively supporting New York State in implementing the health insurance exchange called for by the Affordable Care Act, and paving the way for other improvements essential for making insurance more accessible and affordable for all New Yorkers.
- We’ve long identified public insurance as central to the care of low-income people, those with chronic illness or disabilities, and those who require long-term care. Our Medicaid Institute has been helping State officials understand the opportunities for better coordination of care for individuals with multiple, complex needs and resulting high costs. Now we are exploring ways to provide better and more cost-effective care through an initiative called “health homes,” and how to achieve those same results for persons with high health care needs and the added complexity of eligibility for both Medicaid and Medicare.
- Improving health care quality and patient safety has also long been pivotal to the Fund’s work. In collaboration with hospitals in the New York region we have been able to dramatically reduce rates of infection and help hospitals tackle the pressing issue of preventable readmissions. And our work to train a cadre of quality improvement leaders is a model of how to create a culture of quality.
- Expanding the traditional boundaries of health care—making vital connections to the wider community in which health care is sited—is the focus of two other long-standing Fund initiatives, on families and health care and “aging in place.” Recognizing the unexpected, sometimes overwhelming, challenges family caregivers face when they must take on responsibility for seriously ill family members, our Next Step in Care Campaign has developed an extensive array of practical guides and tools for them. We’ve also worked closely with health care providers to help them work more effectively with families, benefiting patients, caregivers, and providers alike.
- This year, we’ve opened a new front in our campaign to forge connections between health care and community organizations to support aging New Yorkers. Together on Diabetes tests an exciting approach to improving the health status of seniors diagnosed with diabetes. One of the major challenges facing an aging population, diabetes is also one that’s amenable to better management and health outcomes, through strategic collaborations, outreach, intervention, patient engagement, and support—exactly the approach the Fund has developed and is piloting today.
- Our newest initiative—Innovation Strategies—draws on and has implications for all the others. It recognizes that opportunities are created when health care leaders think differently about how care can be organized and paid for. Our goals: to identify promising innovations, bring together the people shaping them, and help grow model projects to full-scale standard of practice. Early on, we’ve focused on new kinds of practices that provide better-coordinated, more efficient, more cost-effective care for both individuals and larger populations—models like patient-centered medical homes and accountable care organizations. We are also working with State officials to review New York’s complex certificate of need laws, with the goal of developing a new approach to community health planning across the state.
For me, personally, this new look at our CON laws brings me full circle: 40 years ago, when I took my first steps into health policy, it was as the leader of a regional health planning agency in upstate New York. For many of us in health care, I suspect, efforts to create a better-performing health care system often feel as if we’re coming full circle over and over again. And yet…
As you read through our 2012 annual report, it’s important to recognize the many ways in which the Fund, small as it is, has broken that cycle to have a major impact on the way we are meeting the challenges of health care in New York. This has truly been a remarkable year, for the Fund just as for the state and the nation. Despite political debate and economic constraints on a grand scale, change is being made—locally, from the ground up, in ways that are significantly improving how we deliver and pay for care. There is much cause for optimism—and much opportunity—as the Fund continues to move forward with its historic mission of shaping positive change in health care for the people of New York.
See the entire 2012 Annual Report.