HMPI

University of Miami’s Business of Health Care Conference: Managing Through Uncertainty

Karoline Mortensen, Steven G. Ullmann, and Richard Westlund, Miami Herbert Business School, University of Miami

Contact: sullmann@bus.miami.edu

Abstract

What will you learn? The University of Miami held its 12th annual Business of Health Care Conference. Panelists discussed post-pandemic financial challenges, patient confidence in and access to care, AI and telehealth, and other key issues shaping the health sector.

What is the evidence? The authors summarize the discussion at the panel.

Timeline: Submitted: May 4, 2023; accepted after review: May 16, 2023.

Cite as: Karoline Mortensen, Steven Ullmann, Richard Westlund. University of Miami’s Business of Health Care Conference: Managing Through Uncertainty. 2023. Health Management Policy and Innovation (hmpi.org), Volume 8, Issue 1.

Download PDF

“Managing Through Uncertainty” was the theme of the University of Miami Center for Health Management and Policy’s 12th annual Business of Health Care Conference. Returning to an in-person venue with nearly 700 registrants on February 24, 2023, the conference focused on revenue models, technology, equitable access to care, and other relevant issues in the nation’s health care sector.

One of the highlights of the University of Miami’s annual conference is the convening of high-level panelists from the various sectors of the healthcare industry. This year’s panel included Matthew Eyles, president and CEO of America’s Health Insurance Plans; Halee Fischer-Wright, MD, president and CEO of the Medical Group Management Association; Ernest Grant, PhD, immediate past president of the American Nurses Association; Rachel Villanueva, MD, immediate past president of the National Medical Association; Lori M. Reilly, Esq., chief operating officer of the Pharmaceutical Research and Manufacturers of America; and Molly Smith, group vice president, Public Policy, American Hospital Association. The panel was moderated by Patrick J. Geraghty, president and CEO of Guidewell and Florida Blue.

Dr. Fischer-Wright started off the dialogue by emphasizing the need to sustain the practice of medicine in the face of uncertainty. “The pandemic showed the shortcomings of the fee-for-service model, as revenue came to a halt when patients stayed home to avoid COVID,” she said. “Only action by the federal government saved many practices. Now, we must put in safeguards so patients can get the quality care they need everywhere in the country.”

Hospitals are also wrestling with post-pandemic financial issues, including rising costs and staffing shortages, said Smith. “We need to look at new staffing models for healthcare and how different professionals can work together,” she said. Dr. Grant agreed, adding that nurses need to be at the patient’s bedside with the ability to practice to the full limits of their licenses. Dr. Villanueva noted that the pandemic highlighted structural issues of inequity relating to access to care. “Going forward, we need to be sure that health equity is as important as access to high quality care and make evidence-based decisions to support that goal rather than ‘feel-good’ programs,” she said.

Eyles pointed out that one of the few positive aspects of the pandemic was the increase in healthcare coverage to more than 300 million Americans, with a corresponding drop in the uninsured rate. However, there is still a need to close the gaps in care and deal with high costs in the healthcare system. “The pandemic showed the healthcare system could innovate and change more quickly than anyone thought possible,” he said. “Now, the question is whether we can sustain that change and address issues like a deep mental and behavioral health crisis throughout America.”

A significant question brought up by both Drs. Villanueva and Fischer-Wright was the impact from the end of the federally designated COVID special emergency period in April. Concerns include providers leaving the workforce, healthcare facilities having financial difficulty, and the effect of those trends on access and quality of care for patients.

Technology and Care

When Geraghty asked the panelists about the role of technology in addressing the uncertainties of healthcare, Dr. Fischer -Wright said it can augment relationships between providers and patients. She noted that telehealth visits increased from 1 to 90 percent of all consultations during the pandemic. The trend was driven by patient and provider concerns, as well as a policy shift enabling Medicare reimbursement for telemedicine, followed by private insurance companies. While this augmented the provider-patient relationship, the number of telemedicine consultations has now dropped down to 10 percent of all medical visits.

Both Dr. Fischer-Wright and Dr. Villanueva spoke to the unevenness of adoption of telehealth due, in part, to the uneven distribution of broadband, wireless, and smartphones. Dr. Villanueva added that “race” is a social concept that impacts how patients access care and the services they receive. “We have to find a way to overcome these biases and ensure everyone receives equally high-quality care, and treat each patient as an individual.”

Interoperability continues to be an issue affecting multiple sectors of the health care industry. Dr. Fischer-Wright indicated integrated electronic health record (EHR) data could lead to better patient outcomes and greater understanding of community needs. But she stated that there was growing patient concern regarding security and privacy, adding, “We may be going backwards.” In any technology field, Eyles indicated the need for high standards in data management as well as data sources that can be trusted.

Concerns about Distrust

This issue of rising distrust in science and medicine was another important discussion topic for the panelists. Geraghty brought up the need for educational conversations with patients and family members regarding science and healthcare data at a time when imminent care needs are not being experienced. Dr. Grant agreed, adding, “Year after year, nursing is the most trusted healthcare profession. We are part of the community, and we need to lead the charge when it comes to education.”

As Dr. Villanueva pointed out, trust is impacted negatively when patients don’t have the educational background or health literacy to understand medical issues and instructions, and it is incumbent upon the physician to take the time to explain things in a manner that the patient can understand.

Other aspects of patient and family distrust, as noted by Smith, include the difficulty of navigating the healthcare system. She noted that individuals who find it difficult to make appointments and access appropriate care are less likely to have positive feelings towards providers.

Reilly indicated that the COVID pandemic did bring about pharmaceutical industry partnerships with community organizations and emphasized the importance of maintaining and furthering these relationships, including clinical trials that include participants from undeserved communities.

The panelists agreed that the timely development of COVID vaccines and medications was a global success for the pharmaceutical sector. But they emphasized the importance of avoiding complacency and being prepared for the next pandemic. Reilly was also concerned about an increase in secondary infections that are resistant to antibiotics. “In our lifetime, it is possible that we might not survive strep throat,” she said.

Reilly added that pharmaceutical companies have stewardship programs regarding antibiotics, but there is a need for support from the federal government. It was noted that antibiotics are more difficult to make than other medications, and new therapies may need to be held in reserve for future use. Smith agreed and indicated that the costs of developing new expensive medications need to be built into the healthcare system.

The Potential for AI

A discussion of Artificial Intelligence (AI) also ensued. Geraghty and Eyles indicated that AI can create opportunities for innovation but there are also challenges regarding effective implementation. For example, AI systems can provide guidance for better outcomes for patients, providers, and payers, but personal privacy protections are limited.

Dr. Fischer-Wright also indicated that AI can be helpful in many ways and is especially helpful in mental and behavioral health. Reilly added that AI tools are also useful in pharmaceutical development and can improve the success rate by searching a library of compounds more quickly in the early process of development.

Smith indicated that AI can help address the nationwide issue of workforce shortfalls. But she and Dr. Villanueva agreed that AI will not replace personalized care for the nation’s diverse patient population.

As was evident in the discussions, the issues involving patients, providers and payers are complex. While much has been learned as a result of the pandemic, the future is uncertain. But it is clear that strong leadership will be critical in managing the ongoing uncertainties of the nation’s healthcare system.

The Business of Health Care: Technology and Access

Karoline Mortensen, Steven G. Ullmann and Richard Westlund, University of Miami Herbert Business School

Contact: sullmann@bus.miami.edu

Abstract

What is the message? The annual conference of the University of Miami Center for Health Management and Policy addressed the impact of technology and access on patients and providers, workforce shortages, value-based care, and the substance abuse epidemic.

What is the evidence? The insights draw on the knowledge of executives, policy makers, and scholars with a deep base of experience in U.S. healthcare.

Timeline: Submitted: May 3, 2022; accepted after revision: May 3, 2022.

Cite as: Steven G. Ullmann and Richard Westlund. 2022. The Business of Health Care: Technology and Access. Health Management, Policy and Innovation (HMPI.org), Volume 7, Issue 2.

A condensed version of this paper was adapted for the May 2022 issue of South Florida Hospital News.

Download PDF

The University of Miami Center for Health Management and Policy at the Miami Herbert Business School held its 11th annual Business of Health Care Conference on April 1, 2022 with the theme, “Technology, Access, and The New Normal.” The audience, with more than 1,000 registrants from the region, the nation, and around the globe, reflected a wide geographic and sector diversity.

A key, unique feature that distinguishes this conference is a panel discussion among leaders of the major professional healthcare organizations who represent a broad spectrum of the sector. This year’s panel participants included Joseph Fifer, president, and CEO of the Healthcare Financial Management Association (HFMA); Matthew D. Eyles, president and CEO, America’s Health Insurance Plans (AHIP); M. Michelle Hood, executive vice president and COO of the American Hospital Association (AHA); Rachel Villanueva, MD, president of the National Medical Association (NMA); and Ernest Grant, PhD, president of the American Nurses Association (ANA). Patrick J. Geraghty, president and CEO of Guidewell – Florida Blue, moderated the discussion, and answered pressing questions as well.

There were four areas of discourse and insights within the conference theme of technology and access: the impact of technology and access on patients and providers, workforce shortages, value-based care, and the substance abuse epidemic.

Technology and Access: Impact on Patient and Provider

Telehealth was the initial point of discussion, with a focus on the positives and negatives regarding access to care. The greatest benefits seen by the panelists were the beneficial impacts on primary care and behavioral health, and access to those services. It was mentioned that this was particularly important for the purposes of increasing access to care in rural areas.

Ernest Grant (ANA) indicated that nurses have been using telehealth very effectively to help monitor patients. Further, telehealth can be used as a vehicle to bring together the entire care team. Joseph Fifer (HFMA) indicated, it was an “amazing step” to see the sudden growth of telehealth in an industry not known for making quick changes. But with all the positive aspects of telehealth as discussed by the panelists, there were also several caveats indicated, and even warnings. Fifer indicated that his organization’s members are evaluating processes and workflows to focus on best practices, adding, “we need to be sure that our processes center on the consumer rather than organizing around ourselves.” Matthew Eyles (AHIP) indicated that his member insurance providers want reimbursement allowances for different structures under telehealth. He indicated that “mandates would be harmful to innovation in telehealth.” All of this discussion may be irrelevant if Congress does not extend federal reimbursement for telehealth, currently scheduled for expiration on December 31, 2022.

The panelists noted tensions between the benefits and drawbacks of telehealth as it relates to access. Dr. Villanueva (NMA), representing the professional association for Black physicians, noted there is the strong feeling of the benefits of telehealth from the provider community, but there are barriers to providing access to residents in underserved communities. She stressed that “patients in underserved communities may not have computers, smartphones, access to broadband or the digital literacy needed to access telehealth services.”  Rachel Villanueva added that physicians need to look at meeting healthcare needs from the patient’s perspective and in communities with limited access, this may mean audio rather than video telehealth services.

Workforce Shortages

Workforce shortages are impacting the ability of patients to access care, provider ability to maintain or improve the quality of care, as well as the costs and revenue streams associated with the provision of care. The issue of nursing shortages has existed for decades but has been exasperated by the COVID-19 pandemic, said Dr. Grant. He noted that the combination of nurses taking retirement – a reflection of the aging nursing workforce – at the same time that the Baby Boomer generation is also retiring, is putting stress on the healthcare system and causing a critical situation. Dr. Grant suggested that another contributing factor causing nurses to leave the profession is many do not feel safe in their working environment, nor do they feel valued for their contribution.

Looking ahead, one of the issues impacting the future of the nursing workforce is a shortage of clinical nursing faculty members, as well as clinical or educational space to train. As such, applicants to nursing schools who would meet admission criteria must be turned away. Michelle Hood (AHA) indicated that this is another area where technology could help by utilizing simulation in combination with clinical and didactic education at academic institutions. Hood mentioned cross-training of skills for current professionals, as well as utilizing artificial intelligence and other technologies, and adjusting and updating care models as possible interventions. Noting that collaborative teams are critical to appropriate provision of care, Dr. Villanueva indicated that workforce diversity is important as well. “Only 5 percent of physicians today are Black, and medical education and policy leaders need to address that disparity in order to improve health outcomes for all Americans.”

Value-Based Care

Opening the discussion on value-based care, Pat Geraghty (Florida Blue) noted the importance of an alignment of incentives on behalf of patients, providers, and health plans. For instance, keeping patients physically and mentally healthy can reduce the overall cost of care, while providing incentives for providers. This approach can support appropriate technological innovations as well as greater equity in delivery of health care services.

Despite all the potential benefits of value-based care, the panelists agreed that there has been a slow growth of adoption of value-based healthcare systems, especially compared with the pervasiveness of traditional fee-for-service models. Noting that fee-for-service models still make up 82 percent of all plan types, Eyles said that providers who relied on fee-for-service models during the pandemic generally had worse financial outcomes than those with value-based arrangements. He emphasized the importance of examining how a health plan model connects to the provider payment model and how it interrelates with workforce reimbursement issues.

The uncertainty of costs and reimbursement models in today’s healthcare environment is another issue impacting value-based arrangements, according to Fifer. He said, “there is fear of taking a financial risk. When an organization is losing money, careers are at risk.” As costs in healthcare increase, financial risks also increase. He said there has been a 30 percent increase in overall hospital expense per adjusted discharge since February 2020, mostly due to the increased cost of hospital staffing. It was noted that for a 500-bed hospital that would mean $17 million of additional labor expenses since the pandemic. Hood indicated that providers serving larger Medicare and Medicaid populations have different financial risk profiles compared to facilities whose patients typically have commercial insurance. Indeed, Dr. Villanueva noted that in underserved communities, where patients tend to have a greater incidence of chronic disease, doctors tend to be in solo or small group practices and find it very difficult to move to a shared risk value-based model.

The Substance Abuse Epidemic

Regarding the epidemic of substance abuse in this country, the panelists initially focused on the opioid epidemic, both prescription-related issues and the deadly synthetic drug fentanyl. Dr. Villanueva indicated that “opioid use is a pandemic that has gotten worse in our community,” referring to the underserved Black population. “We see this as a chronic condition as well as a matter of policy,” she added.

Eyles noted the importance of analyzing prescriptions within a health plan network. He indicated the power of providing data to a clinician who is overprescribing as well as delivering information to plan members. The panelists agreed that there is indeed a significant purpose for prescribing opioids for pain management. It is not that opioid usage should be halted, but rather prescribed and managed appropriately for each patient.

The substance abuse epidemic is broader than just prescribing patterns and patients. Hood indicated that the American Hospital Association has a behavioral council for the issue of opioids in the workforce, as well as substance abuse in general. In fact, several panelists noted that the healthcare workforce itself is at increased risk due to ongoing stresses that can lead to anxiety and depression. However, the panelists noted that there are other forms of substance abuse that should also be addressed, such as alcohol. As the panelists agreed, the stigma associated with addiction is a major issue with alcohol and other forms of substance abuse. Therefore, they said it is vital to destigmatize abuse and allow it to be seen for what it is – a medical and behavioral health issue.

As the University of Miami Center for Health Management and Policy begins to plan for the next Business of Health Care Conference in 2023, we anticipate continuing the discussion with valuable insights from the leaders of these professional associations as we have done for the past decade of this conference’s history.

Insights from the 10th Annual Business of Health Care Conference at the University of Miami

Karoline Mortensen, Steven G. Ullmann, and Richard Westlund, Miami Herbert Business School, University of Miami

Contact: sullmann@bus.miami.edu

Abstract

What will you learn? The Miami Herbert Business School of the University of Miami held its tenth annual Business of Health Care Conference. This year’s designated theme was, “Policy, Politics, and the Pandemic- U.S., and Beyond.” The lead panel discussion focused on Policy and Patient Care: A View from Health Care Leaders. Key topics included vaccine hesitancy, value-based care models, telehealth services, stress and burnout, and Biden administration initiatives.

What is the evidence? The authors summarize the discussion at the panel.

Timeline: Submitted: May 28, 2021; Accepted after review: November 5, 2021

Cite as: Karoline Mortensen, Steven G. Ullmann, and Richard Westlund. Insights from the Tenth Annual Business of Health Care Conference at the University of Miami. 2021. Health Management Policy and Innovation (hmpi.org), Volume 6, Issue 2.

The University of Miami recently held its tenth annual Business of Health Care Conference. This year’s designated theme was, “Policy, Politics, and the Pandemic- U.S., and Beyond.” With a national and global audience of more than 1,200 attendees the conference sessions, focusing on such areas as global response, economic impact, and policy issues as seen by former secretaries of the U.S. Department of Health and Human Services, provided significant in-depth insights.

One of the important aspects of this annual conference, organized by the Miami Herbert Business School, is the convening of a panel of high-level health care leaders. This conference is the only venue in which the heads of the major health care organizations come together in one place at one time to discuss issues affecting the health care sector and reflect upon the impact of the health care industry on the economy and society at large. This year there has been even greater impact due to the COVID-19 pandemic.

Panelists for the session, “Policy and Patient Care: A View from Health Care Leaders,” were Susan Bailey, MD, president of the American Medical Association; Matt Eyles, president and CEO of America’s Health Insurance Plans; Joseph Fifer, president and CEO of the Healthcare Financial Management Association; Halee Fischer-Wright, MD, president and CEO of the Medical Group Management Association; Ernest Grant, president of the American Nurses Association; and Lisa Kidder Hrobsky, group vice president, federal relations of the American Hospital Association. The panel was moderated by Patrick J. Geraghty, president and CEO of Florida Blue and its parent company, Guidewell.

The Biden Administration’s Response

Kicking off the discussion, the panelists emphasized the success of the Biden administration’s vaccine rollout. With nearly 200 million doses distributed by mid-April, and now, with 50 percent of the population fully vaccinated, the administration had doubled its initial target for May 1, said Eyles. “We still need to focus on vaccine equity, reaching the most socially vulnerable communities across the country, and making care more affordable.”

Another important step was passage of the $1.9 trillion American Rescue Plan (ARP) stimulus package. “We can’t overestimate the importance of the financial support for our hospitals and health systems,” said Hrobsky. Noting that elective surgeries and routine care visits were canceled or postponed, she said the nation’s hospitals were projected to have lost $320 billion in 2020 alone. She added, “Relief from the federal government has been a lifeline for providers across the country.”

The Biden administration also increased access to coverage through the Affordable Care Act (ACA) with lower premiums and an extended enrollment period. “Making premiums more affordable for a broad swath of the population will help transform the market,” said Eyles. Geraghty noted that in Florida, for example, there are now 320,000 more residents eligible for a subsidy as compared to last year, and those subsidies are larger than before.

Eyles added that there is also increasing recognition among federal and state policy makers that the ACA is here to stay, although there is still some uncertainty with regard to a pending U.S. Supreme Court ruling. Hrobsky added, “Now we need to make those ACA provisions permanent as part of the social infrastructure.”

Fifer, Grant and Bailey agreed that insurance coverage improves individual and family health, which in turn, contributes to a better economic climate. “People live sicker and die younger without insurance,” said Bailey. “We believe everyone should have affordable and accessible insurance and the American Rescue Plan has taken a big step forward in that direction.”

Stress And Burnout

One of the concerns discussed by the panelists was burnout and emotional stress experienced by physicians and nurses. The American Nurses Association launched a “nurses’ resilience” site and is seeking increased funding from Congress for healthcare workers.

Bailey indicated that burnout among physicians was high and was of concern before the pandemic. The problem was only compounded by the pandemic. She indicated that burnout is a systems issue, not a reflection of the individual. As per Bailey, “Many physicians are reluctant to ask for help due to the stigma. So, we are helping institutions understand there are things they can do to reduce the stresses on physicians, such as scheduling their coverage and having adequate supplies of personal protective equipment (PPE).” The burden of documentation was also mentioned in the discussion.

Fischer-Wright spoke to the concern regarding the significant increase in retirements of physicians and nurses with the potential for significant negative impact on delivery of health care nationally, with particular concern for the rural communities.

Having said that, several panelists indicated that both medical and nursing school applications are on the rise. “The media has shown how heroic and meaningful it is to take care of a patient at those crucial moments of life or death,” said Bailey. “Despite all the stresses, being a doctor is still an incredibly rewarding profession.”

Grant added that there is a strong uptick in the people interested in entering the nursing profession. The problem is that there is not enough capacity in terms of faculty, buildings and clinical spaces. As Grant indicated, investments are needed in the academic infrastructure.

Reflecting on the upsurge in student interest, Bailey said, “Today’s young people are altruistic, going into the health care professions for all the right reasons. It’s great to see this trend.”

Telehealth Services

One of the very few silver linings coming out of the pandemic was the growth in acceptance of telehealth as a source of safety, convenience, and access fostered further by Medicare now reimbursing for telehealth encounters.

Geraghty noted that telehealth has become very popular for remote mental health visits, especially if the patient already had a relationship with a therapist. “It will be interesting to see how that model fares as we move forward,” he said.

There was consensus that for telehealth to be truly effective in the future, health care providers need to become comfortable and proficient with the technology. Further, with the realization that COVID-19 in general has only highlighted the impact of health disparities in our society, until broadband is widely available in disadvantaged communities, health care access through telehealth will continue to be a reflection of health disparities in this country. Panelists agreed that now more than ever, broadband internet access is a social determinant of health.

Value-Based Care Models

The panelists turned their discussion to the pandemic’s impact on value-based care. Fifer said providers who shared financial risk with an insurance company have done better than practices dependent on fee-for-service methodologies. However, having dozens of value-based care models muddies the waters. “Providers don’t know how the value computations are made, and don’t like financial surprises,” he added. “CFOs like the predictability of fee-for-service arrangements.”

Hospitals are focused on immediate financial concerns, rather than experimenting with new reimbursement models, according to Hrobsky. She added that large health systems typically have more options than rural hospitals in regard to payments.

“COVID-19 has pulled providers out of value-based care,” said Fischer-Wright. “When medical practices have a 90 percent drop in volume, they have no bandwidth for trying something new. Right now, many medical practices are in survival mode, rather than moving to Maslow’s self-actualization phase.”

For physicians, value-based-care can be problematic. “Who decides value? How do you measure it? How do you reward it?” said Bailey. “Small practices can’t negotiate with payers and are forced into a take-it-or-leave-it situation.”

Vaccine Hesitancy

Vaccine hesitancy is one of the pressing health issues of 2021, said Geraghty, who asked the panelists for their thoughts. Bailey said the American Medical Association has seen an improvement in vaccine confidence in almost all demographic groups.

While many nurses have also been hesitant about vaccines, the American Nurses Association has provided extensive educational materials about how they work, Grant added.

Fifer noted that a handful of adverse reactions to the Johnson & Johnson and AstraZeneca vaccines have been given extensive media coverage. However, he indicated that science and the data should drive vaccination decisions, rather than emotions.

Some final thoughts revolved around insurance premiums. When asked what the impact of COVID-19 would be on insurance costs, Eyles indicated that things are uncertain. “On the one hand, there is pent-up demand for care, which would push premiums up. However, telehealth services may help the plans manage affordability. It is a tough time being a health care actuary right now.”

Last year, Florida Blue spent more than $200 million covering claims for members who were unable to pay their premiums, said Geraghty. “We extended a lot of credit rather than leaving the medical community without funds. It was the right thing for us to do.”

The University of Miami’s Business of Health Care conference is an annual event. As we see what develops over the upcoming year, we will be quite interested as to what these industry leaders have to say one year from now. The theme for the next conference on April 1, 2022 is “Business of Health Care: Technology, Access, and the New Normal.” We look forward to their future insights.

Health Care Access, People, and Policy in a COVID World: A Discussion with Healthcare Industry Leaders

Steven G. Ullmann and Richard Westlund, University of Miami Herbert Business School

Contact: sullmann@bus.miami.edu

Abstract

What is the message? The annual conference of the University of Miami Center for Health Management and Policy identified key issues concerning healthcare access during the COVID era, many of which will continue post pandemic.

What is the evidence? The insights draw on the knowledge of executives, policy makers, and scholars with a deep base of experience in U.S. healthcare.

Timeline: Submitted January 12, 2021; accepted after revision: January 13, 2021.

Cite as: Steven G. Ullmann and Richard Westlund. 2021. Health Care Access, People, and Policy in a COVID World: A Discussion with Health Care Industry Leaders. Health Management, Policy and Innovation (HMPI.org), Volume 6, Issue 1, Winter 2021.

Download PDF

Insights from the Ninth Annual Business of Health Care Conference at the University of Miami

The University of Miami Center for Health Management and Policy recently held its ninth annual Business of Health Care Conference. This year’s theme was “Health Care Access, People and Policy, COVID-19 and Beyond.”  Participants focused on some of the most pressing issues of the year, including the financial impact of the pandemic on providers and patients, as well as the social determinants of health, disparities in access to care and the importance of public sector support.

One of the sessions at this year’s conference included a panel made up of Matt Eyles, president and CEO of America’s Health Insurance Plans; Joseph Fifer, president and CEO of the Health Care Financial Management Association; Hallee Fischer-Wright, M.D., president and CEO of the Medical Group Management Association; Ernest Grant, president of the American Nurses Association; Barbara L. McAneny, M.D., former president of the American Medical Association; and Richard Pollack, president and CEO of the American Hospital Association. As such, nearly all the major sectors of the healthcare industry were represented in the discussions. Given the diversity of industry representatives, it is noteworthy that there was significant agreement on the numerous areas of policy discussion.

Access and the social determinants of health

Among the areas focused on by the panel and its moderator, Pat Geraghty, president and CEO of Florida Blue and its parent company, Guidewell, was on the theme of access, and in turn, the interrelationship with the social determinants of health. Access reflected both geographic access and financial access. As Dr. Grant of the American Nurses Association indicated, “Nurses can help address the social determinants of health and alleviate the burdens of doctors and hospitals.” Dr. Grant went on to indicate that underserved communities have been particularly vulnerable to death and serious illness during the COVID-19 pandemic. In addition, many are essential workers living paycheck to paycheck who cannot afford insurance and might not see a doctor.

A number of other aspects of access were discussed, many associated with COVID. As per Pollack, hospitals are having significant funding issues, limiting their ability to provide safety net services. Further, their costs have increased significantly. Non-COVID revenue is down and there are significantly more uninsured patients due to job loss. From an insurance perspective, Geraghty noted there is a need for comprehensive planning at the national level – not just with respect to COVID, but with other aspects of healthcare provision as well.

Challenges to physician practices

The physician sector has also been impacted significantly by the pandemic. Dr. McAneny and Dr. Fischer-Wright noted that physician practices have been facing higher costs with fewer specialty patients seeking care due to COVID-19 fears. Smaller medical practices continue to have problems accessing personal protection equipment. Further, with their lower census, smaller practices are also experiencing difficulty in accessing capital resources, an issue not experienced to as great an extent by larger medical practices. Those difficulties are of particular concern to inner city and rural areas where communities are reliant on their local physicians. Add to this is the long-term impact of having more than 20 million Americans infected by COVID. Although hospitals provide the acute care associated with the coronavirus, it will be physician practices that will be providing longer term care for a growing number of patients exhibiting chronic conditions associated with COVID such as lung disease, heart disease, and blood clotting issues.

Looking forward

Transparency in prices and quality

As we go forward, what can we expect? There was again relative consensus. Fifer spoke about the continued movement toward consumer-focused healthcare with an eye toward value, and hospitals will have to be a part of this process. But for this to work, Eyles said that there must be transparency regarding prices and quality. Pollack noted that the relevant cost figure for consumers is the out-of-pocket price, not the rate negotiated between the hospital and the insurance company. The value proposition, i.e., value equal to quality divided by cost, also reflects the need to look at alternatives to in-hospital care, including home care. As Eyles said, “There is always a need for acute facilities and personal care, but a shift to in-home services would help meet the social needs that drive so much of our healthcare costs.”

Changing roles for hospitals

And so, what is the role of the hospital going forward? As Pollack indicated, the hospital will always be needed for emergencies and surgical procedures, but it may be much more important to access other types of healthcare from more convenient locations. As Dr. Fischer-Wright said, there must be a focus on prevention, keeping people healthy. The aspect of social determinants of health again becomes quite important and the panel shared reflections on multiple aspects of it.

As the panelists indicated, hospitals continue to have significant financial issues in small towns and rural areas. Dr. McAneny reflected on the implications of the loss of such facilities, including the loss of basic and emergency services in the community, as well as the economic impact as healthcare facilities are oftentimes the most significant local employer. It was suggested that perhaps these facilities should have tax-supported emergency rooms, much like fire-rescue and police departments are tax-supported. This could become even more important, as per Eyles, as millions have lost their employer-based health insurance coverage. The Emergency Medical Treatment & Labor Act (EMTALA) requires emergency departments to provide emergency care regardless of the patient’s ability to pay. But with the unemployed uninsured population growing by the millions given the COVID-induced economic plight, the financial impact on already stressed facilities is enormous as a result of bad debt and the provision of charity care.

Continued need for the Patient Protection and Affordable Care Act

As the session and discussion came to a close, other timely issues were discussed. Regarding the Patient Protection and Affordable Care Act, the panelists agreed unanimously that the law be retained and built upon. Further, given the sheer enormity of the task and the logistics, they agreed that it will be well into the latter part of 2021 before vaccine distribution will be widespread and be able to demonstrate its effectiveness from a public health perspective.

Next Conversation: April 16

We will reconvene this panel, a featured aspect of our yearly conference, on April 16. It will be interesting to see where we are at that point in time as the theme will be, “The Business of Health Care: Post Elections.”