By BETSY TAYLOR
ANAHEIM, Calif. — Four system executives discussed new organizational structures, innovative approaches to improve care and reduce costs, and staying true to mission at a transformative time in health care during a discussion at the 2013 Catholic Health Assembly.
The panel's moderator Susan Dentzer, senior policy advisor for the Robert Wood Johnson Foundation, queried the executives from Dignity Health in San Francisco, Ascension Health Alliance in St. Louis, Providence Health & Services in Renton, Wash., and St. Joseph Health in Irvine, Calif., on challenges they and other Catholic health care leaders face. These include new affiliations, frequently between Catholic and non-Catholic hospitals, which have resulted in a host of new business relationships as well as rapidly expanding systems.
Panelist Lloyd Dean is president and chief executive of Dignity Health, one of the nation's largest health care systems. He noted that affiliations and acquisitions made just for the purpose of becoming larger won't drive success in the long run. "Philosophically, we believe that just getting bigger for the sake of scale is not a sustainable strategy," he said. "Our philosophy is that we want to get better. If you get better, and you can show better outcomes, if you can realize economies of scale, if you can take best practices and move them around, that should help lead you to getting bigger."
He said as soon as a system struggles to attain those objectives on behalf of patients, it's a sign it has gotten too large, but he drew a laugh from the audience when he then joked about taking over the systems of the other executives on stage.
Another requirement in the current health care environment is to improve care while reducing costs, the executives said. John Doyle, the executive vice president of Ascension Health Alliance and president and chief executive of AH Holdings, told the audience about Ascension's partnership with Narayana Hrudayalaya Hospitals of India to build a $2 billion "health city" on Grand Cayman in the Cayman Islands. Ascension leadership previously has said the for-profit health city will be built over 15 years.
Ascension Health Alliance is working with the chair and managing director of Narayana Hrudayalaya Hospitals of India, Dr. Devi Shetty, a cardiac surgeon who Doyle said is known for his approaches to providing high quality and low cost care. Doyle said, "A certain truth has become clear to us, and that is: all the ideas are not resident within the United States."
To learn more about Shetty's approach to medicine, Doyle visited him in Bangalore, India, and Doyle said he "saw extraordinary things." As an example, he cited a heart valve repair surgery done on a neonate at a cost of $1,700 for the complex procedure, a fraction of what the intervention would cost in the U.S. He said Shetty has a goal to reduce that cost to $800.
While Doyle acknowledged labor costs less in India, he said he believes the system can learn from the Indian hospital's efficiencies and apply those innovations on Grand Cayman. Doyle said he has been greatly impressed by Shetty's commitment to charity care noting his hospital in India never turns away those who cannot afford to pay. Doyle said a 140-bed hospital, the first part of the project scheduled to open next year on Grand Cayman, will not be a Catholic hospital, but it will adhere to the Ethical and Religious Directives for Catholic Health Care Services.
Another example of the ways systems are looking to improve while cutting costs was offered by Dr. Rod Hochman, president and chief executive of Providence Health & Services. That system affiliated with Swedish Health Services last year and now operates in five states. In a project that pre-dates the affiliation, Providence realized that non-standardized care was increasing care delivery costs, he said. For example, in Seattle the system had 10 general surgeons operating on the same type of hernia 13 different ways, requiring 13 different trays of surgical tools. The surgeons were asked to meet and agree on one standard way they could all perform the surgery, which the surgeons did. Work to standardize these and other operating room procedures saved the system more than $3 million in its first phase and $7.5 million total thus far, according to a Providence spokesperson contacted after the session. Hochman told the assembly audience, "I think we are all very, very sensitive to the fact that we have to be part of the solution in terms of dropping costs of care."
The executives also said their systems advance their missions of care for the poor and vulnerable by collaborating with others in their communities to fill gaps in care and to meet other identified needs. Deborah Proctor, president and chief executive of St. Joseph Health noted that in Orange County, where the assembly was held and where her system is based, there is no county-wide system of care for the poor and sick.
When St. Joseph Health completed an affiliation with Hoag Hospitals to create Covenant Health Network earlier this year, the nonprofit systems maintained their respective Catholic and Presbyterian faith traditions, but came together to improvehealth care access in the region, Proctor said. "We've been very clear that this is not a growth strategy for us. It's been about [finding] a way to meet the needs of the community," she said.
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