Bold Predictions about Health Care Reform

by Holly Hayes

Marc Bard, chief innovation office in Navigant’s health care practice, and co-author of the book “Accountable Care Organizations, Your Guide to Strategy, Design, and Implementation” made six predictions about health care reform last week. The predictions are listed in the blog CommonHealth Reform and Reality and are in response to some specific changes in Massachusetts health care reform.

Two predictions include:

More tension in the system

In today’s’ environment, for the most part, providers of care are contractually pitted against payers of care. They’re a little like dogs and cats. They’ve never gotten along terribly well for obvious reasons, and they generally didn’t mind battling each other.

Now, what is being proposed in Massachusetts creates somewhat of a zero-sum game, doctor against doctor and doctors against hospitals; and that’s a less comfortable battle. And, it’s potentially going to be even less comfortable because with the ACO, there’s going to have to be more support for primary care, and if you’re operating with a fixed global payment budget, that means that the high-end providers, the high-end physicians and hospitals, are going to take the greatest haircut. That’s reality.

Massachusetts medical culture will change to be more team-oriented.

Eastern Massachusetts health care is physician-focused rather than system-focused. We focus on doctors, we train them, we teach them, we develop them, rather than teams. And we’re going to have to move to a much more team-oriented approach, which means we’ll have to start really valuing the role of care coordinators and other disciplines rather than putting the burden on the doctors. So I think what we’ll also see is that it’s going to affect some academic pursuits: We’re going to have to move to training more primary care doctors, and that is not something that Boston historically has focused on.

In a previous post, we cited the report “Unmet Needs:Teaching Physicians to Provide Safe Patient Care” issued by the Lucian Leape Institute at the NPSF. The report concludes that “[U.S.] medical schools are not doing an adequate job of facilitating student understanding of basic knowledge and the development of skills required for the provision of safe patient care.”

The report’s 12 recommendations center on three main themes:

Medical schools and teaching hospitals need to create learning cultures that emphasize patient safety, model professionalism, encourage transparency, and enhance collaborative behavior. They should have zero tolerance policies for egregious disrespectful or abusive behavior.

Medical schools should teach patient safety as a basic science and ensure that students develop interpersonal and communication skills through experiences working in teams with nursing, pharmacy, and other professional students.

Medical schools and teaching hospitals need to launch intensive faculty development programs to enable all faculty to acquire sufficient patient safety knowledge and to develop the interpersonal skills in teamwork and collaboration that permit them to function effectively as teachers and role models for students.

What are your thoughts about how we can enhance medical school training to prepare physicians for the collaboration needed for health care reform and to be partners in successful Accountable Care Organizations (ACOs)? We welcome your thoughts.

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Holly Hayes is a mediator at Karl Bayer, Dispute Resolution Expert where she focuses on mediation of health care disputes. Holly holds a B.A. from Southern Methodist University and a Masters in Health Administration from Duke University. She can be reached at holly@karlbayer.com.