Integrating change

Have you ever heard the saying: “People do not change until the pain of staying the same exceeds the pain of changing?”

Rick Bisson

I was at a state health association conference recently where Steve Berkowitz MD, president of SMB Consulting, used this quote in his “Integrating the Integration: How to Successfully Manage the Challenges of Clinical and Financial Integration” presentation.

Berkowitz is a big thinker, outlining big actions, through bold statements, and is out in front in the push to improve the delivery and financial stability of healthcare. In his travels to facilities across the country he’s observed that every healthcare system is unique. But every system is dealing with the same issues.

From a historical perspective, Berkowitz summed up the market corrections brought about to the industry in the 1990s. He then outlined the market corrections taking place in 2013 and moving forward. In painful detail he illustrated the bleak status of our current decreasing payment structure juxtaposed by greater demand from an aging population laden with chronic conditions.

When the conversation transitioned to solutions, Berkowitz focused on the need to balance price transparency with quality transparency. He went on to credit the sea change in data and pricing transparency to the impact of increasing personal deductibles in our individual health plans.

These increasing deductibles combined with continued years of double digit premium increases have opened our eyes to how our families are managing our healthcare expenses. In my case, 10 years ago I had very little concern for the tests or procedures I or my family members were scheduled for. Today I’m asking what for, how much and what are the alternatives. Soon I anticipate I’ll shop around for these services to find the best price matched with the highest quality.

Berkowitz described the current and future role that competition will play in healthcare. Years ago healthcare was largely provincial. We visited our local, family physician and depended on our local hospital for advanced care. Today a cost and quality conscious consumer researches their options.

Health ratings and awards are splashed in banners on the homepages of most hospitals. Combine these with measurements and standards for Meaningful Use and you can see how healthcare is shifting to a market driven economy.

To drive this point home, Berkowitz offered a quote from Judith Hibbard, professor of health policy at the University of Oregon who stated in a “Health Affairs” 2003 article that “What we concluded was that even when hospitals know their performance is not good, that’s not sufficient motivation for them to do something. Making it public made a big difference in motivating them to improve.”

As consumers and workers in the healthcare industry we recognize the evolution of this public influence.

For me, the highlight of Berkowitz’s presentation came when he gave an example illustrating the impact financial transparency is having on rewriting the book on competition in healthcare.

Picture this: you need a hip replacement so as a new age healthcare consumer you research your options locally, regionally and beyond. You discover a facility in the Caribbean with the highest rated physicians for 25 percent of the standard cost. In addition, the price includes airfare for three and hotel accommodations on the beach. Picture yourself sipping a tropical beverage in a cabana on the beach while your loved one is recuperating in a concierge based hospital – works for me.

I encourage you to check out more of Dr. Berkowitz’s comments. His diagrams and comments present a very clear and direct road map to improve the quality of healthcare in America. Here is a link to his website. Scroll to the bottom of the page for a video that will give you a flavor for his solution:

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