A PUBLICATION FROM THE PROVIDENCE TARZANA MEDICAL STAFF OFFICE
Winter 2o12
FROM THE CHIEF OF STAFF
Zahi Nassoura, M.D.
The New Face of Health Care INTEGRATION Where is it that health care is trying to go? The answer would not be clear without a reminder of where it has been. The face of health care in the 1990s was the Health Maintenance Organizations. HMOs were seen as the savior and future of health care, controlling cost and improving quality. Physicians were scared, and many were told that unless you join you will be left behind. Ironically, twenty years later, the percentage of patients belonging to an HMO has dropped from 27% in the 1990s to almost 18% in 2008. Today’s efforts at integration, the new face of health care, are “déjà vu all over again,” says Paul M. Wiles, Chief Executive of Novant Health, a 13-hospital system based in Winston, Salem N.C. Many of these attempts
have been tried before and did not improve quality and did not reduce cost. Certain hospitals lost money on their doctor-practice acquisitions because of overly high prices and doctors’ tendency to ease up work after selling out. Furthermore, HMOs triggered a backlash from consumers who feared they were being denied access to needed care. The success or failure of efforts to change health care will largely hinge on doctors. Doctors in general often react sharply to efforts to control their practices. A recent survey of medical administrators found doctors’ cooperation to be the most frequently cited “serious obstacle” to creating accountable-care organizations. Doctors are not the problem, and they have not been consulted for the
solution. It is being imposed upon them. Of course, some integrated models have been successful: Kaiser Permanente in California, Pennsylvania’s Geisinger Health System, and Inter-Mountain Health Care in Utah. Proponents of integration point out to such systems, today’s new technology (EMR), and again, preach on quality to cut costs. They believe things are different this time around. Only time will tell. Nobody disputes that there is tremendous waste in health care and ample room for improvement, but there is no one model or system that fits all. Change is needed; however, what kind of a change remains to be seen.