Health care reform and unit-based teams

Value Compass

The health care reform law has a name: the Patient Protection and Affordable Care Act (HR 3590). What’s in a name? In this case, a great deal. 

Our Value Compass and health care reform; it’s a great fit. 

Simply put, health care in the U.S. costs far too much. It has for a long time, and that was true long before Washington finally stepped up and decided to move toward universal health care.

A central feature of the new law is to substantially reduce the cost of care over time. We all know that the current direction of health care costs is literally enough to break the whole economy. That cost breaks the average family budget, too.

Universal coverage does not mean just keep paying out more money. In fact, the new law will mandate cuts in some financing, including payments to Medicare. We also know that as Medicaid coverage is extended, those payments are also substantially less than commercial and Medicare rates.

In short, more care must be provided at a lower cost per person.

As a result, some delivery systems will fail.

An opportunity for Kaiser Permanente’s front lines

For us in the Coalition and KP, we have the opportunity to use our growing skills in improvement work in unit-based teams to leverage more payment based on incentives carefully woven into the new law that reward better, more affordable care.

Over the next several years, regulations will be written to implement a redesigned health care delivery system. We know from our work in unit-based teams that quality, service, affordability and having the best place to work is an integrated and systemic transformation to create the most value. We are advanced practitioners of health care delivery redesign, and the new law will provide many opportunities for the front line of Kaiser Permanente to translate our expertise into the revenue that we must generate to keep KP flourishing. Some features of the law include:

• A comprehensive payment for quality system with bonuses of up to 5% available to Medicare Advantage Plans with high scores on a “star-rating” system based on CAHPS, HEDIS, and HOS data.
• Increased payments to systems that reduce purchasing costs.
• Increased payments to curb and eliminate hospital readmissions.
• Increased payments to hospitals that reduce hospital-acquired conditions.
• Medicaid demonstration projects that will evaluate “bundling of payments” which pays more for better overall outcomes.
• Medicare bundled payment demonstration which rewards coordination, quality, and efficiency of care.
• Shared savings program designed to encourage providers to make investments in infrastructure and redesigned care that promote Accountable Care Organizations (ACO’s).
• Funds to promote workforce development including training programs on medical homes and team management of chronic conditions.

From looking at this opportunity list, we know that we can do these things. We must!

We have said that the National Agreement and our LMP exist to transform Kaiser Permanente so we can transform health care in the nation.

Our aspiration is now our reality. We can lead health care redesign and we can do so as the leading unionized health care workers in the nation. Think of the message we send when we succeed!