The schizophrenic life of the hospital CEO

Moderator: David Wennberg, MD, MPH, CEO, Northern New England Accountable Care Collaborative

There is a fundamental contradiction at the heart of the hospital business when a health system pivots towards population approaches to health. As isolated businesses, hospitals have been concerned with market share, volume of procedures, and service lines that can cover the costs of care for the uninsured. The not-for-profit status of a hospital doesn’t alter this basic dynamic – after all, without solvency, there is no mission.

The American health care system has evolved as a hospital-centric one, so that much of health care spending (and community employment) occurs in this setting. While hospital boards and administrators are interested in the health of the community, they view health through the prism of acute care, with the primary goal to fill beds. That prevention will always fail at some point, the obvious need for acute care continuously validates the worldview of hospital administrations. Though there is much talk about health care systems, including hospitals, transitioning from volume to value, how can hospital leadership move beyond lip service and truly embrace a re-organization that requires altered infrastructure, altered culture, and probably some inevitable down-sizing?

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Hospital CEO Panel Overview – David Wennberg

April 19, 2012   Avoidable Care Admin   No comments

This informal panel aims to be a relaxed but provocative conversation with three hospital executives who are experiencing and managing a transition from fee-for-service and volume-based goals to focusing on value and effectiveness. We’ll hear about their worries and frustrations, as well as their successes, hopes and goals for the future as they push for a high-value delivery system.

We have three excellent members of the panel:

• Nancy Howell Agee, President and CEO, Carilion Clinic
• Jeanette Clough, CEO, Mount Auburn Hospital
• Peter Slavin, MD, President, Massachusetts General Hospital

Mount Auburn and MGH are both early adopters in population based care – both are CMMI Pioneer ACOs and both participate in BCBSMA’s Alternative Quality Contract.  However, while early adopters they are both referral systems for Massachusetts and beyond meaning that they are in a high stakes transition from fee-for-service to population based value reimbursement models.

Carilion Clinic has chosen an different path.  Deciding not to participate in CMS’s ACO efforts they are focusing on the private payer side to change the reimbursement model while continuing to develop their multi-specialty clinic model to meet the care demands of the future.

While I will use the moderator’s prerogative to probe the risks and benefits of this transition if needed, I would prefer to have this panel be an open forum with the discussion driven primarily by members of the audience.

I look forward to seeing you all this week.


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