Monumental changes have transformed the health care industry. In the 1980s there were more than 100 Blue Cross companies – today there are fewer than 40. Hospitals and health systems are consolidating at an escalating pace, and implementation of the Affordable Care Act has turned the business models of health care providers upside down.
Hospital associations must evolve to meet emerging needs of our members. The Ohio Hospital Association is driving frank discussions with members about industry evolution, ACA impact and how to best meet their needs for game-changing member services. Four areas have emerged as our focus moving forward: price transparency, predictive analytics, cross-industry collaboration and advocacy.
Navigating price transparency. A constant challenge for the health care industry is price transparency. State legislatures and consumer advocacy groups are demanding various price predictors prior to treatment. OHA’s role is to help members understand that transparency isn’t going to be a choice – and to devise options that will best serve the patient, while addressing hospital concerns.
The biggest problem – there is no such thing as a standard price for health care services and procedures. Providers can’t know ahead of time if a patient will have any complications along the way. A healthy young adult facing knee surgery likely will not require the same level of care as an older adult with diabetes having the same surgery.
Other factors make meaningful price transparency difficult, including antitrust and other legal and contractual limitations – for both providers and payers – regarding information hospitals are permitted to share with the public. Given those concerns, OHA is proposing the solution not be one-size-fits-all patients, but truly consumer-focused by providing a reasonable estimate of out-of-pocket costs based on the individual patient’s insurance coverage and deductibles – and all in a reasonable amount of time.
Using data to improve patient safety and quality of care. As patient outcomes and readmission factors become a larger responsibility for hospitals, we are a safe repository for very competitive institutions to upload their patient data and a proven analytical team to use the data to provide improvement strategies.
Moving forward, we are focused on collecting more data and using new technology tools that make it easier for hospitals to submit their data and to see their patient outcomes in comparison to their peers.
Crossing industry lines to collaborate. Community health issues, such as obesity and infant mortality, require multiple collaborations to achieve long-term improvement in the health of our state’s residents. Additionally, reducing hospital readmissions requires improved transitions of care between hospitals, pharmacies, rehabilitation facilities and social services.
OHA has the ability to be the facilitator of collaborations because our day-to-day interaction with policy makers across the spectrum of state agencies and health care coalitions puts us at the nexus of conversations that may not happen inside each hospital. Associations are neutral parties who can provide the project management expertise to drive collaborations among competitor institutions and organizations.
Advocating with a united voice. Implementation of the Affordable Care Act means 800,000 Ohioans are newly insured this year through the federal exchange and Ohio’s expanded criteria for Medicaid eligibility. As the government becomes an even larger part of our member hospitals’ payer mix, the state legislature and Congress are constantly looking to put program guardrails and cost controls in place.
Each member hospital has its own priorities and agenda, yet the association’s industry-wide advocacy role is growing in value to members focused on tracking, understanding and influencing the new ways policy makers are working to redefine howt health care is delivered and financed.
At OHA, we’re committed to providing services to ensure a healthy Ohio. It is imperative we evolve to meet the needs of our members so they can provide quality patient care.
The Ohio Hospital Association, founded in 1915 as the nation’s first state-level hospital association, represents 220 hospitals and 13 health systems throughout Ohio. With a mission to collaborate with member hospitals and health systems to ensure a healthy Ohio, OHA is focused on three strategic initiatives: patient safety and quality, advocacy and economic sustainability. www.ohiohospitals.org.