USF Health hosted a panel of leaders discussing the impact of the Affordable Care Act on communities and their health care organizations.

Question: How do you build an integrated health system to stem the unsustainable rise in health care costs that provides access to affordable, high-quality care at all stages of life, while optimizing preventive care to help avoid disease and promote well being in individuals and communities?

Answer(s): It’s complicated

The complexities inherent in fixing a fragmented health system were discussed when USF Health hosted a panel discussion April 20 at its Center for Advanced Medical Simulation and Learning (CAMLS).

Representing academia, government and business and industry, the panel was moderated by Jay Wolfson, DrPH, JD, associate vice president for health law, policy and safety at USF Health.  The panelists were Charles Lockwood, MD, senior vice president of USF Health and dean, Morsani College of Medicine; Mayor Bob Buckhorn, City of Tampa; Meredith Rosenthal, PhD, associate dean for diversity and professor of health economics at the Harvard T.H. Chan School of Public Health; Mark Anderson, DSc, senior vice president of ambulatory services, Tampa General Hospital; and Jessica Cooper, executive vice president and director of sustainability for Delos Solutions, a real estate firm that has pioneered designing buildings to promote the health of occupants.

Topics touched on ranged from the Affordable Care Act, the evolution of health care payments from fee-for-service to capitated payments, and clinically integrated networks to telehealth and community wellness districts.

While they brought different perspectives to the table, all the panelists could agree on one thing. Transitioning to a system that balances optimal health outcomes while keeping costs affordable requires strong leadership, new and meaningful collaborations and evidence-based policies.

Dr. Rosenthal, who has advised federal and state policy makers in health payment policy and implementation, was in Tampa as the 2016 Alpha Omega Alpha Visiting Professor, hosted by the Morsani College of Medicine’s chapter of AOA, a premier national medical honor society.

“The United States spends more per capita on health care than any other nation, and it’s at the expense of other public and personal spending,” Dr. Rosenthal said. “Yet, research shows that things we can put in place to help solve the affordability problem, like reallocating some funds from acute care to various types of prevention, can also improve health outcomes. If the goal is to improve health within a budget constraint, we need to think more holistically and employ other tools of care within the community, not just the medical system.”

The following is an edited sampling of the just some of the panelists’ comments:

“The bottomline is that by 2020, 20 percent of the gross national domestic product will be involved in health care and that (growth in healthcare spending) is unsustainable. More importantly, 50 to 60 percent of the health care costs are borne by our companies, which puts them at a competitive disadvantage with other industrialized nations… And that’s driving the move to consumer-based health care, high deductibles, private exchanges and so forth, all of which will impact the medical school’s clinical revenue…”

 “So, we have to teach our medical students to live in a world that will drive down the cost of health care… They have to be efficient in every way in providing care. They have to focus on value. They have to improve outcomes – and that means evidence-based care, patient satisfaction, patient safety and reduced costs.”

“Five percent of patients account for 50 percent of health care costs. Some of (the cost) is end-of-life care, some of it is ICU care. A lot is that, on average, this 5 percent of high-cost patients has five disease states, including diabetes, hypertension and heart disease. We have to be able to provide care for this group in a much more rationale, comprehensive way than we currently do…. to help guide them among all the specialists.”

– Dr. Charles Lockwood, MD, USF Health senior vice president and dean, Morsani College of Medicine

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“You have to be able to make the economic case to employers as to why this makes sense. Taxpayers and those who have insurance are the ones paying for the uninsured…. I think it’s an easy argument to make, notwithstanding the complexities of execution. People understand that for folks who don’t have access to health care, who walk into Tampa General’s emergency room, we pay that burden as a community and as someone who pays for insurance.”

– Mayor Bob Buckhorn, City of Tampa

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“Complex systems require systemic solutions. That’s where health reform is moving –thinking more about the entire continuum of care and how all the pieces fit together to get to the higher value solution. It’s going to be challenging… I imagine we’ll see strategic initiatives about consolidation, including partnerships with industry where that’s feasible, although conflicts of interest may arise… But, I understand that in order to fund underfunded activities that are an important part of your mission, academic medicine will have to leverage that in some way.”

“I hope what we’re talking about in health reform is taking money out of low-value health care services and investing it in health…. There is not a roadmap for a lot of this. There are some successful initiatives that can be adopted, but it’s hard work and requires up front investment for long-run payoffs. That’s a real political challenge.“

-Meredith Rosenthal, PhD, health economist, Harvard T.H. Chan School of Public Health

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“We know that we need to do prevention and wellness programs. We know that we need to align with partners in the primary care arena… We’re having a huge shift into the outpatient arena, and it’s driving us more and more toward trying to identify the ambulatory programs that will serve the needs of our patients and their families out in the community.”

– Mark Anderson, DSc, senior vice president of ambulatory services, Tampa General Hospital

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 “There is public health and design research showing that building and spaces can teach. Our architecture and building infrastructure, the real estate, is more than just four walls and a roof, more than the streets you walk around on. They provide environmental cues that enable and encourage us to make healthier decisions… and potentially also impact our ultimate habits and behavior. So, that’s an exciting prospect when we consider a more systemic change, a sea change really, in the way we think about preventative health.”

– Jessica Cooper,  executive vice president, Delos Solutions

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“An important component that will shape the future of our health care system in the home, in the hospital, in the community and in the training environment has to do with health care technologies, ranging from the health information we want to collect from patients at the point of care to virtual technologies associated with patient care like robotics from a distance and other virtual patient encounters.”

– Jay Wolfson, DrPH, JD, USF Health associate vice president for health law, policy and safety

During the audience question-and-answer session, hospitalist Deborah DeWaay, associate dean for undergraduate medical education at the USF Health Morsani College of Medicine, raised the issue of physician end-of-life care conversations with families of patients.

Catherine Lynch, MD, associate vice president of women’s health and faculty development at USF Health and professor of obstetrics and gynecology at the Morsani College of Medicine, hosted and helped convene the panel.

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Photos by Eric Younghans, USF Health Communications