Monroe discusses the changing service system of the health-care industry

SYRACUSE — The service system is changing in the health-care industry.

That was part of the message from Ann Monroe, president of the Health Foundation of Western and Central New York, during her remarks at the HealtheConnections event entitled “Connecting for Better Health” held April 30 at the Holiday Inn Syracuse in Salina.

Attendees included professionals in medicine, behavioral health, insurance, long-term care, social services, human resources, and public health, according to HealtheConnections.

Higher costs and poor outcomes are both the result of several factors, such as inappropriate-reimbursement models, Monroe said.

“We’re currently getting what we pay for and if we want to get different things we have to pay differently,” Monroe said during her remarks.

The industry has a “siloed” approach to the delivery of services, Monroe said, using a  power-point presentation during her remarks.

Many in the health field focus within the walls of their organization and don’t think about or get involved in things that happen in the rest of people’s lives, she said.

People see their provider, which Monroe described as “a moment in time,” and the rest of their time is lived in their own life in their own way.

“If our goal is to improve the health of that population, we cannot expect, number one, focusing only on that moment is going to do that but we also can’t expect that that system is going to be able to carry the burden for the rest of us,” Monroe said.

The higher costs and poor outcomes are also the result of inadequate performance and quality measurement, according to Monroe.

The whole area of quality measurement is still in its infancy, she said.

Monroe chairs the consensus-standard committee at the National Quality Forum (NQF), a committee that examines all the performance measures that get endorsed by the NQF.

The committee sees all of the measures that are being developed, and, as a committee, Monroe says the members are continually frustrated that the kinds of measures they’re reviewing are not outcome measures.

That committee is reviewing more process measures.

“Did this happen, check, did this happen, check,” Monroe said, noting the measures are very “distal” (located far from a point of origin) from the actual outcome of a person getting better.

But that science is very slow in developing and the application of good, strong performance measurement is even slower in happening in our communities, she added.

Monroe worries when she reads a headline indicating that hospitals are doing well on infection control, and then the article says they’re only average.

“Now, I don’t know about you, but if my kids came home from school with average grades and tried to tell me they’re doing well, I would have a concern,” Monroe said.

Monroe has a concern that just doing average is considered to be doing well in many communities.

The whole issue, not just in clinical care, but across the community, such as in the management of diabetes, is really in its “infancy” in terms of development, Monroe said.

Another factor leading to higher costs and poor outcomes is the inconsistent accountability for outcomes, she said.

Who is accountable for diabetics to be able to live their life in a healthy, positive way, Monroe asked.

When the response is that the community is accountable, Monroe said that may be true on a global scale, but doesn’t assign accountability to any one person or organization.

And if that’s not happening, Monroe wonders, for example, if diabetics in our communities are having amputations higher than they should be? Who is accountable for that?

When families or patients ask that question, they want three things, Monroe said, “and the system has been unable to provide that for them.”

They want an apology. “Because we’ve become such a litigious society, it’s very difficult for the people in the system to give them a clear, honest – we are really sorry about this,” Monroe said.

They want to know that outcomes will be different moving forward, and that the same outcome won’t happen to the next patient that needs help.

“And when they get these things … the idea of suing the hospital drops dramatically. An apology goes a very long way in making sure there’s not litigation,” Monroe said. 

But, Monroe also said that it’s hard for people to take that step, so they instead just say, “The system didn’t work. Something broke down.”

Monroe also noted other dimensions of change, including “serious challenges” to not-for-profit status of hospitals and community agencies by their local governments that are claiming the organizations aren’t delivering the care necessary to be tax-free.

For example, Monroe mentioned a lawsuit brought by Pittsburgh mayor Luke Ravenstahl against the University of Pittsburgh Medical Center “because they’re [the hospital] not doing sufficient charity care, charity work.”

About the organizations

The Health Foundation for Western & Central New York focuses on “two of the most vulnerable and underserved populations … frail elders and young children living in communities of poverty,” according to its website. The Health Foundation collaborates with organizations in 16 counties to strengthen the health-care system, promote education and advocacy, and encourage positive individual-behavior changes, the website says. 

The organization is headquartered in Buffalo, but operates an office at 431 E. Fayette St. in Syracuse.

HealtheConnections (pronounced “healthy connections), which organized the event, has two primary lines of business, including a regional health-information organization (RHIO) and health-planning services for 11 counties of Central New York.

They include Onondaga, Cayuga, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Oswego, St Lawrence, and Tompkins.

The HealtheConnections RHIO is responsible for overseeing the secure, electronic health-information exchange that provides authorized participating medical providers access to complete patient-medical histories and information in real time.

Contact Reinhardt at ereinhardt@cnybj.com