With Ted Townsend, St. Luke's Hospital President & CEO
The Sky Did Not Fall - January 2015
Fortunately for all of us the sky did not fall in 2014. A year ago at this time the nation in general and healthcare providers in particular were all in a tither about whether the rollout of the Affordable Care Act (ACA) was going to be a boon or a boondoggle. The answer, of course, was yes. After a chaotic start to new insurance sign ups through healthcare.gov , and the-world-is-ending-as-we-know-it prognostications from virtually all sides of the political spectrum, we survived.
Here in Iowa you could even claim we thrived. The political compromises that resulted in the Iowa Health and Wellness legislation resulted in tens of thousands of Iowans gaining coverage that they didn’t have before, provided hospitals and physicians with reimbursements for services they couldn’t get before, and brought nearly a billion dollars of federal funds into Iowa that we wouldn’t have gotten before.
That said the year was not without its bumps. While thousands of Iowans were able to work their way through the new system, it wasn’t without considerable frustration for many of them trying to figure out confusing and complex choices. Insurance coverage information for providers was incomplete at best and changing month to month as individuals determined on their own if they were going to keep up with their payments to plans that were not a hundred percent subsidized. The state as a whole was still trying to determine which insurers were going to participate in the new marketplace, which elements of the ACA were actually going to be enforced on employers and insurers, and how accurately had these same insurers predicted their prices and costs for said coverages.
This latter issue was boldly demonstrated with the December takeover of CoOpportunity Health by the Iowa Insurance Commissioner. In a way CoOpportunity appears to be a victim of its own success. The two-state co-op enrolled roughly 100,000 Iowans and Nebraskans against an initial projection of less than half that. Depending on one’s perspective the problem came either from CoOpportunity underpricing itself, drawing more members with higher risks than anticipated, or from the federal government’s decision to allow people to keep existing insurance plans that didn’t meet federal ACA requirements, thereby depriving CoOpportunity the chance to enroll previously insured and presumably healthier members to offset the higher risk populations. Whatever the cause, the result was a clear example that implementing the ACA is not without peril.
To its credit, Iowa overall appears to be handling the transition well. Community groups of all stripes worked together across the state to help educate citizens about their new insurance choices and well over 100,000 did so. Charity care and bad debt for both hospitals and physicians across the state appear to be markedly reduced. There are still people without coverage, and they are still getting cared for in times of duress, but access is always either challenging, or directed to more expensive Emergency Room resources for people without adequate insurance, so the additional coverage for folks is helping them access care earlier and at, hopefully, at a lower cost . At the same time Iowa achieved a model that retains a modicum of individual responsibility for people of all income groups relative to their own health and payment for services. All in all, it’s typical Iowa: a practical, pragmatic set of solutions to what could have been either an explosive political stalemate or, even worse, an attempt to ignore that the problem existed at all.
For 2015 there will be new challenges. CoOpportunity’s early stumble leaves only one insurance carrier in the new government-mandated market space. To be a viable market we will need viable competition. We will need to decide, particularly if the Supreme Court rules against insurance subsidies in federally based insurance exchanges, whether Iowa moves ahead with establishment of an Iowa-based marketplace that reflects the specific needs of Iowans versus the hybrid we have today.
And while insurers and providers continue to reshape themselves for the much heralded era of population health, there are a host of other issues coming down the pike. Iowa is one of only four states without a law covering telehealth services, one of the fastest growing and most innovative ways to deliver more cost effective healthcare in the future. We still haven’t finished the transformation of delivering and paying for behavioral health services in a new and better way based on regional approaches versus ninety-nine different counties.
Iowa will need to respond to the possible adoption of an Interstate Physician Licensure Compact that will allow physicians licensed in Iowa to offer services, particularly telehealth-based services, in other states and vice versa for physicians licensed in other states that have already adopted the compact offering their services to Iowans. That last step alone could have a major impact on the availability of services, particularly to rural areas, in ways we can’t even imagine today.
Which of course leaves plenty of room for unintended consequences, unforeseen situations and conflicting ideas, the resolving of which appears to be a uniquely admirable quality of this state.
Take a bow, Iowa.
Why Mayo - July 2014
What is this new collaboration between UnityPoint Health – Cedar Rapids and Mayo Clinic all about?
I’ll admit, this journey started out as a competitive advantage, but over the last year our motivation has matured and changed a hundred and eighty degrees. We knew this collaboration would offer a clinical advantage to our patients but what came as a pleasant additional surprise was the value it brought to our physicians. In the end, we did this because our physicians saw the advantage of the best of both worlds; full utilization of local physicians and specialists, with the added value of layering on the Mayo Clinic expertise, all while keeping our patients here in Cedar Rapids. The fact that we could do this at no additional cost to the patient made it even better.
We’re already seeing the results. In the first month of the collaboration, before even half of our physicians are fully engrained on the program, we’ve had fifteen eConsults go to Mayo. Satisfaction is high on both the patient and local provider side. Our first eConsult was in cardiology. One of our senior physicians, Dr. Todd Langager, had a difficult diagnosis. He thought he was seeing a condition he’d only seen four times in his thirty-plus years of practice. He thought he knew what to do, but was hoping for confirmation before setting his patient and family on a course that has serious implications for them all. He gathered up his electronic notes, lab test results, the relevant digital images and patient history. Then he sent it electronically to Mayo. Eighteen hours later he had the eConsult result from a Mayo physician, who is a world-renowned expert on this disease. Dr. Langager had the correct diagnosis and was on the right track. There were a couple additional things he could consider also doing and, oh yes, on the AskMayoExpert website was a twenty-nine page patient education brochure he was welcome to give the patient about her rare condition. The family was ecstatic. They had a diagnosis. They had confidence that the best minds in the country were dealing with her difficult condition, and they had expert, reliable education materials in their hand within hours to help them.
And that was just the beginning. A local cancer patient who has been receiving care at Mayo for several years asked her Mayo physician if with this program in Cedar Rapids, might she be able to receive her care at home. The physician studied her record, consulted with an independent medical oncologist in Cedar Rapids, and agreed that, yes, she could. Now she has the best of both worlds, a Mayo level of expertise overlaying her care right here in Cedar Rapids.
Physicians have access to more than 1,400 care protocols from AskMayoExpert on their desktops. When their patient has a question about their care, would like a second opinion, or just some additional peace of mind, the physician can pull up the protocol right in the exam room and say, “Here’s how Mayo would treat this”.
And Mayo’s not being passive. Twice already physicians have queried the AskMayoExpert for information on a condition where there was not a published protocol. Mayo staff called within hours to say “We saw that you had an unsuccessful search on AskMayoExpert, what were you looking for?” In both cases Mayo proactively went to their physicians and provided additional information and guidance.
We have wonderful physicians here in Cedar Rapids. We have strong primary care, excellent specialists and we have the University of Iowa just down the road for cases that will need their level of services. Now we have something to add to even these resources for our community. This model fits our culture. It’s about disseminating knowledge so patients can receive more care closer to home. It’s about preserving and honoring local physicians’ care and enhancing them versus trying to replace them.
So far Care Network members are seeing that roughly four out of five people who historically may have gone to a Mayo site can be taken care of at home. That’s good for us and our patients. Getting through the year-long due diligence process to be selected to the Network was a challenge, but one UnityPoint-Cedar Rapids gladly accepted. When we recently attended the Network’s annual meeting we met folks from around the country, from all kinds of organizations large and small, from academic medical centers to stand alone community hospitals. What the Mayo folks said was our single common denominator was the quality of care we all already give. They weren’t going to put their name on anything less.
Sounds like a good “why” to me.
Doing the Right Thing- January 2014
Personally, I'm tired of hearing, reading and talking about the Affordable Care Act. Obamacare as it is colloquially known continues to roll through new phases of its implementation, with seemingly more glitches than selections and solutions, but roll forward it does. Most of the recent attention has gone to the foul-ups in the Healthcare.gov website where individuals were supposed to be able to find easy-to-use insurance options, prices, subsidies, and out-of-pocket costs. As ugly as that's been I don't think it comes close to what we're about to come to grips with in the new year. Whether you are a provider, employer, employee or patient, the biggest challenge will be sorting out who is covered for what and how any of the services people will want or need in 2014 will get paid for and by whom.
If you're on a group plan with an employer, and that plan hasn't changed in the last year, you will be among the fortunate, but for millions of others I expect more than the usual confusion. Here in Iowa the problem will be somewhat muted by WellMark's (our largest commercial insurance company) decision to allow individuals to carry forward their 2013 policy for another year and the State of Iowa's belated but welcome decision to auto-enroll roughly 100,000 Iowans who had previously been covered by the Iowa Care program. versus having to re-apply for the Iowa Health and Wellness plan. In other states many insurers cancelled millions of 2013 individual insurance policies because they didn't comply with 2014 requirements of the Affordable Care Act.
Then the President said they didn't have to, but state-by-state, insurance company by insurance company, and literally plan-by-plan, people had to go through a possible re-do of which plans could even be offered in which state, which year, all in a month's time for a process that each year takes, well, a year. You get the idea. After January 1 the first big problem will be even more confusion and the second big problem will be the money. Who has it, who's responsible, how and who do you ask for it and will it ever get paid.
All of which sounds terrible and perhaps depending on your point of view, terrifying as well. The good news is there's good news. At least here in the Corridor, here in Iowa, you can rest assured that people will get the care they need, when they need it. Partly that will be because it's part of Iowa's culture. Ours is a long and illustrious legacy of taking care of each other in times of need and that is exactly where we will find ourselves in 2014 when many are unsure about who has insurance coverage for what. That doesn't mean everyone will get everything they want when they want it, but it does mean cases of real need do not need to worry about being abandoned.
Beyond the culture it is also the principle business model that has evolved here. St. Luke's Hospital, both Mercy hospitals, and the University of Iowa not only have emergency rooms always open to anyone in need, but even more important all employ primary care providers who continue to take patients from all government payment programs and the new health insurance exchanges. That is access that is rare in many parts of this country and the same is true for any specialists we employ.
We can also be proud in this region that virtually all our private independent physicians, specialists and associated providers also continue to see patients from government payers. Again this is less and less true in growing sections of the U.S. We in the Corridor are among the fortunate.
We are not perfect, and none of us would claim healthcare is as affordable or accessible to all as we would like. But whatever Obamacare brings to us as a nation over the next few weeks and months, whatever the changes the President or Congress, or the states come up to help an incredibly complex and increasingly expensive health care system, the businesses and residents of our community can be assured your local providers will continue to meet these needs to the best of our ability.
Even when there is great confusion and uncertainty, you can count on us do the right thing.
The Leadership Challenge - August 2013
I have not seen the 2013 Disney movie about the Lone Ranger but as a Johnny Depp fan I'm likely to someday. The original radio show was long gone before I was born, though I suspect I've heard clips of it now and then in retro documentaries of one kind or another. What I do remember is the TV show, in black and white, most likely reruns since even this was gone by the late 50's. I learned later it was Clayton Moore who I saw as the face of truth, justice and good over evil. The Lone Ranger had a great horse, never wasted a silver bullet and had the first positive image I can remember of a Native American in Tonto his friend and sidekick.
So imagine my surprise the other day when an associate at St. Luke's stopped by to remind me I was the Lone Ranger. What he had really come to talk about though was Tonto, and in this case Tonto was our Chief Operating Officer, John Sheehan. After ten and a half years at St. Luke's John was taking an opportunity of a lifetime, returning home to Wisconsin as a Senior Vice President of their University's Hospital and Clinics and President of a new hospital near his home town of Sun Prairie. While we were proud of his selection, his loss was a big one for St. Luke's and even more to me personally since I've known John from when we first worked together at Geisinger Medical Center in Danville, Pennsylvania.
Over the years you learn a few things about leadership and what works and what doesn't. John was a tremendous leader who could teach us all a few leadership tips. He understood how to relate to all levels from the housekeeper to the board chair. He respected physicians and they respected him. He was productive, firm, and a doer. But even more he was a teacher and a team builder. During his tenure at St. Luke's there has been minimal turnover in leadership staff, a single strategic framework and all time high patient, associate and physician satisfaction. He didn't do it alone, but his was a firm hand on the saddle horn.
I may be suffering from selective memory here, but in my recollection it was always the Lone Ranger asking advice of Tonto, not the other way around. The Lone Ranger may have known right from wrong, had a vision of where they needed to go, but it was Tonto who knew the way to town. Great teams are made of complementary personalities and skills and that's where this homemade analogy seemed to work the best once I thought about it. Every organization needs its teams and its teachers. It is what separates the best from the rest, and it is what every CEO strives for: the right people, the right skills, the right chemistry. If you can hold these things together for a long time, even better.
In these times of great turmoil and change in the healthcare industry, it's a critical success factor. Here in Iowa with its own unique Medicaid expansion, a dearth of participants in the first round of the new insurance exchange, a constant stream of new regulations and incentives from Medicare and the growing sophistication of the patient as a more and more cost conscious consumer of healthcare services, putting together the right teams of people, made up of folks willing to work together over the long haul to make a positive difference in their communities is what most of us got in the business for.
It's why people who have the leadership skills like Tonto are a gift. They attract and keep the right kind of people. They build the loyalty of staff, patients and physicians because they know and trust who they're dealing with, and in the end they build a team of professionals behind them so that if ever the day arrives that they can't be there, someone else is in the saddle and the organization never skips a beat.
UnityPoint Health takes the lead in redefining the best way to deliver health care
April 16, 2013
Health care in the United States is changing. It's no secret that the Affordable Care Act requires providers to stop doing business as usual. Its goal is to increase coverage and improve services while lowering costs. But that's not the only reason health care providers are quickly evolving the way we treat patients. For those of us with a lot of skin in the game - such as hospitals and networks of providers - creating a better model of care is necessary because the current fee-for-service system that drives volume is simply unsustainable.
St. Luke's and the UnityPoint Health are uniquely positioned, as the fifth largest nondenominational health system in the country, to lead changes in health care that focus on care for a lifetime, not a visit, test, or admission alone. Our network of providers incorporates all levels of care, from hospital to doctor to home health, and spans a sizable geographical region. We can make a strong impact on the communities we serve. So we've decided to lead the change toward health management and disease prevention to improve care while lowering costs. In my view, it's what we wanted to do all along, but we've been working against decades of industry regulation and incentives, technology and specialty evolution and a culture of defeating death versus getting on with life.
It makes sense to reflect this degree of change in the name of our health system. UnityPoint Health, the name we chose to replace the name UnityPoint Health, tells the world we're approaching health care in a new and better way, focusing more on patients and coordinating their care. And because we are no longer just an Iowa organization, this name better represents our partners in Illinois than did our previous name.
St. Luke's Hospital will still be known as St. Luke's Hospital. We are affiliates of UnityPoint Health. All former St. Luke's Physicians and Clinics will now be called UnityPoint Clinics. All of our home care entities such as Hospice, Home Medical Equipment and Visiting Nurse's Association will be called UnityPoint at Home. We have developed a team-based approach with our clinic and home health partners over the years, and the name UnityPoint Health demonstrates the way our network has become a point of unity for our patients.
The name change is a result of two years of discussions and research. Our regional affiliates, board of directors, physicians, staff and most importantly our patients, came together to determine the best way to position our organization for the future. We developed a strategic plan focused on a new care coordination model, expansion and organizational growth. There will be no change in management, structure or staff involved in this brand change. Overall, UnityPoint Health employs more than 24,000 individuals throughout Iowa and Illinois, and each region will maintain its existing leadership and local boards of directors.
UnityPoint Health began in 1993, when Iowa Methodist and Iowa Lutheran in Des Moines merged. At the time, the merger created the state's largest provider of hospital and related health services. St. Luke's became an UnityPoint Health affiliate the following year. Over the decades, our health system has expanded its geographic reach throughout Iowa and into Illinois, and developed comprehensive services throughout the region. Today, UnityPoint Health is now one of the nation's most integrated health systems. Through relationships with 29 hospitals in metropolitan and rural communities and more than 200 physician clinics, UnityPoint Health provides care throughout Iowa and Illinois. There are 15 senior affiliate hospitals in Des Moines, Cedar Rapids, the Quad Cities, Dubuque, Sioux City, Waterloo, Fort Dodge and Peoria, IL.
At St. Luke's, we are redefining ourselves to become a fully integrated delivery system that includes doctors, long-term care, home health and a host of other services. We recognize we can best coordinate our patients' care with our own organized system of care. Unifying the distinct elements of our regional health care system in new ways will allow us to coordinate patient care more along the line of what's best for the patient and their family than "what do the regulations allow or insurance companies pay for." At the end of the day, St. Luke's true purpose and mission is to give the health care we'd like our loved one to receive.