Health Care: Changing for the Better

Michelman Inc. CEO Steve Shifman got an up close and personal look at some of the issues in health care recently when he was hospitalized for an emergency appendectomy.

While he says his care was excellent, he was amazed at the communication issues.

“As a business owner and someone who works on aligning everybody’s interests for a common objective, I was amazed at the information they had and then astounded that there wasn’t better communication among the practitioners,” he told attendees of Cincy Magazine’s fourth annual Healthcare Summit in early December.

Cincy partnered with the West Chester-Liberty Chamber Alliance to host 2013’s event, which was sponsored by Humana. Three Hundred people attended.

Shifman, a panelist for the forum, says there was a breakdown in communication between his nurses and the operating room in preparing him for surgery.

And after surgery, his nurses had difficulty locating his surgeon to OK his release.

“I know as a consumer, I’m paying for every minute I’m staying in the hospital and I was in the hospital a good three-to-six hours longer than I needed to be because they couldn’t find the surgeon to say I could go home,” says Shifman. Such gaps in communication contribute to rising health care costs, says Dr. Derek van Amerongen, vice president and chief medical officer for Humana of Ohio, and moderator of the panel that included Shifman; Dr. Yousuf Ahmad, president and CEO of Mercy Health; Greer Glazer, dean of the University of Cincinnati’s College of Nursing; and Craig Brammer, CEO of the combined operations of the Greater Cincinnati Health Council, the Health Collaborative and HealthBridge.

Dr. Ahmad says electronic records systems such as EPIC are improving communication.

Cincinnati has been a pioneer in many initiatives, like HealthBridge, a 15-year-old effort by area hospitals and others to spur development of information technology to transmit clinical data, Brammer says.

“There’s no question that Cincinnati is uniquely positioned to navigate the next few years effectively,” he says. There is competition for health care, he says, “yet a long history of providers working together.”

One example: “We have more certified patient-centered medical home practices per capita than any market.”

Dr. Ahmad says that Mercy was the first provider in the area to launch an Accountable Care Organization, which provides incentives for hospitals and physicians to improve care while keeping costs down.

“It’s fundamentally different and scary,” he says. “But it’s the right way to go.”

At the same time, there are more tools for consumers.

Brammer outlined the features of yourhealthmatters.org, a website that tracks the performance of every physician practice in the region based on outcomes. “You can track the trajectory over time to see if that practice is getting better.”

The panelists agreed, however, that there is work to do.

“Right now, we still have a system where physicians are paid by the number of patients they see and hospitals are paid by the number of patients they admit. Until you fundamentally change that, it’s very difficult to get the entire system to change,” says UC’s Glazer.

She says UC’s College of Nursing is embracing change, adopting technology like robots and iPads to improve education, and working in teams, the way care is increasingly being delivered.

CEOs are increasingly caught between trying to manage expenses and the rising cost of care for their employees.

Shifman says Michelman came to realize it made more sense to focus on educating employees on health and wellness.

“We invested in it,” he says. “We totally engaged our organization and it’s proven to be a big benefit.”

The company has invested in health-club memberships for employees and brings yoga and strength trainers on site several times a week for employee sessions.

The food menu at Michelman has changed, too. “Donuts are gone, and we offer granola, bananas and yogurt,” he says.

As a result of the changes, Michelman’s premiums have risen less than 10 percent the last few years and the company saw no increase in premiums the last two years.

More importantly, he says, the company has seen a decline in absenteeism and employees are more engaged.

The company’s wellness program is now “an [employee] attraction and retention tool,” he says.

Dr. van Amerongen asked each panelist how changes in health care would affect their organization over the next five years.

“I have no idea what will happen with Obamacare and the insurance exchanges,” Shifman says, adding: “In five years we’ll have vastly more informed employees. We look at our health and well-being programs as a differentiator for our company.”

Health care classrooms will be totally different, Glazer says. Instead of being in hospitals, clinical training will increasingly be in places like Walgreens or out in the community, she says, “where younger people want their primary care. They want it convenient and low-cost.”

Brammer sees Cincinnati’s programs as a competitive advantage for local employers in the future. “We’ll know we got there if we have measurably better outcomes, measurably better quality of care and measurably better total cost of care.”