Einstein’s classic definition of insanity – doing the same thing over and over and expecting a different result – often applies to health care. No matter how hard we work, and how many changes any given provider system like ThedaCare effects in our safety, quality, transparency, cost, outcomes and more, health care remains driven by a fee-for-service model that encourages payers to reward services, procedures and tests generated by providers, instead of the value providers deliver.
I’m happy to say that as our industry has engaged in the hard work required to improve the way we deliver care, improve patient outcomes and reduce cost, we have made progress. No question. Insurers and employers who self-fund their benefits are getting involved to link payment to value. But in many ways, the changes are incremental, localized and unique to each provider, each payer and each contract they agree to. These localized and unique attempts have proliferated but have not led to closing the value gap. That’s been disappointing for all of us. Purchasing decisions are still challenging and complex, there is still too much diversity around metrics and care delivery, and the fundamental drivers of payment still remain unchanged.
Now, a new opportunity with promise to stimulate transformation across the entire state has emerged. Wisconsin has been awarded $2.5 million to design a statewide, all-players-in-the-game plan for changing how health care is delivered and paid for. The award, which in Wisconsin is called the State Innovation Health Plan (SHIP), is part of a national program developed by the Centers for Medicare and Medicaid Services Innovation Center (CMMI). SHIP creates the pathway for engagement of a diverse group of industry leaders from across the state – providers, payers, purchasers and consumers – to develop and submit a plan within one year.
The work is being done through a private-public partnership supported by the governor’s office, the Statewide Value Committee – a group that’s been working on bringing together health industry players for several years – and the Wisconsin Department of Health Services. SHIP work groups made up of various stakeholders will focus on six specific areas needed to develop the plan: population health, behavioral health, clinical delivery redesign, health information technology, value measurement and payment modeling.
The goal is to scope innovative payment and care delivery models to improve health and quality of care while decreasing costs for consumers. It might sound like the same song you’ve been hearing for years, but it’s fundamentally different because it involves key stakeholders statewide. It’s an opportunity to integrate our previous efforts in one umbrella plan, a plan that will promote work in a single, unified direction. The approach should reduce complexity and give us a game plan to close the value gap.
It’s an audacious goal, but it’s time has come. Our rate of improvement is falling short of what our communities need, of what you need as an employer and as a consumer. I hope that as a result of this work, it will be easier for you to judge the value of your own health care, and the care you purchase for your employees. I hope you’ll be able to shop more wisely. And I hope that by improving care quality on a larger scale – a statewide scale – we can demonstrate that what we’ve been saying for years really is true: better quality care reduces the cost of care. When that happens in a bigger way, our industry will be that much closer to delivering value and being paid for it. What’s more, communities will be healthier – everyone will benefit.
Can you tell I’m excited? I am. At ThedaCare, we have a lot to be proud of. But despite everyone’s hard work, the gap has gotten wider. We have to keep pressing on, and SHIP gives us a great opportunity.
Dean Gruner is president and CEO of ThedaCare. To send your thoughts to Gruner, email pcbusiness@postcrescent.com.
