Healthcare leaders discuss reform, value-based care, teamwork

Healthcare leaders discussed healthcare reform, the transition to value-based care and how to address the physician shortage Monday at the opening keynote session of U.S. News & World Report's Hospital of Tomorrow conference.

U.S. News Chairman and CEO Mortimer Zuckerman delivered opening remarks, speaking of unsustainable costs and the need to transition from the fee-for-service model to value-based care to keep those costs under control. "There'll be a natural resistance to the value-based approach, but sooner or later there's going to be a popular uprising over costs that will force change," Zuckerman said. "There will be a new order that will call for a major restructuring of how healthcare is organized, delivered and reimbursed."

Toby Cosgrove, M.D., (pictured right) president and CEO of the Cleveland Clinic, also emphasized the value-based care model and spoke of his organization's success with it and the importance of caregiver engagement with patients. He gave examples of steps Cleveland Clinic has taken to make the experience "less threatening," including the use of color-coding clinician uniforms, greeters and wall art, open medical records and doing away with visiting hours.

"We don't think we can get optimal care to patients without involving them in their care," Cosgrove said.

Cosgrove's remarks were followed by a panel discussion of healthcare reform and the evolving nature of care. The panel discussed the troubled rollout of HealthCare.gov and its implications for the healthcare reform law.

The problems do not necessarily spell doom for the law as a whole, according to Donna Shalala, Ph.D., president of University of Miami and former U.S. Secretary of Health and Human Services. "Look at the states that are doing it themselves. They already have a platform for Medicaid. The ones that are doing their own exchanges have them up," she said. "I think we've got enough time [that] they're gonna get it right."

Another major, unpredictable change made by the Affordable Care Act was the "shift in risk," said former Senate Majority Leader Bill Frist (pictured left). "Risk used to be in the purview of government, of the big payers out there," Frist said. "But with Obamacare, the risk is shifted to the providers, the hospitals, the doctors. Hospitals don't know how to manage risk, they never have had to do it."

Both the panelists and closing speaker Gregory Sorensen, M.D., CEO of Siemens Healthcare North America, spoke of the importance of moving toward a coordinated, team-based healthcare model, and its inherent challenges. "It will be a mindset change. There's a definite hierarchy, and those hierarchies get in the way," Sorensen said. "[But] people have learned that you can build a system that delivers consistent high quality if you can build teams."

"[We need] physician assistants and nurses and pharmacists and other care providers working as a team," Shalala said. "We've got to get over the hierarchy, we have to take on the scope-of-practice rules, state by state if necessary, because that's what restrains us from creating these teams."

"Doctors don't like teams," Frist said. "Our professional ethics is not to be team-based. We like to say that it is… but that's not the way doctors are trained."

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