5 Strategies to Use Regardless of What Happens to the ACA

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Affordable Care ActEditor’s Note: Health Catalyst welcomes guest posts by outside experts with analytics insights. Dr. Tommy Prewitt from HORNE LLC is a guest commentator. This article was originally published at the HORNE Healthcare Delivery Institute blog.

As we discussed last week, I believe the Affordable Care Act is likely to fail. Perhaps there will be a significant, unpredictable event will cause the system to crash. Or, the system may slowly crumble, leaving vestiges of the ACA to die a slow death. Exactly what happens really doesn’t matter. What does matter is this: what are you going to do today, right now, in your hospital? Here are some ideas.

1. Rethink your model of care.

For hospital execs, this requires moving from an administrative/financial model to a clinical process model. The money is in the clinical enterprise where 20%, 30%, or even 50% of the activity is waste. As you eliminate this “quality waste,” your outcomes improve and costs decrease. As we have consistently discussed in these pages, the high quality, low cost providers will win. This is already happening in certain markets.

2. Allocate 20% of your financial resources toward care innovation.

As you shift to a clinical process model, you must support the clinical improvement teams (“troops on the ground”) that are doing the hard work of improvement. They need resources, particularly time. Your job is to get them what they need, not decide if they need it. Ask Andre Delbecq. Improvement leadership training can make a big difference too. Dr. Deming said that to change the culture of an organization, you have to train the leadership. This is why we have a training program.

3. Get serious about data analytics.

For the most part, healthcare data analytics are reporting systems for benchmarking. That is fine if you are only interested in rank-and-spank quality assurance, but QA doesn’t improve quality. To improve, you need a system that provides data that help you improve quality, reduce cost, and manage populations. This would be a good place to spend your 20%.

4. Avoid buyer’s remorse.

I worry about strategies that involve a large hospital buying smaller, weaker, vulnerable hospitals as a way of feeding the mothership. What happens when a hospital bed becomes a liability instead of an asset? I have seen this strategy go very badly, and that is under full fee-for-service.

5. Win the race to the bottom.

An alternative strategy is to become the lowest cost provider in your area. The first hospital to post fixed charges for episodes of care will win. If you don’t do it, somebody else will.


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