The State of the Healthcare System:

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The State of the Healthcare System The Mandate
for Change Lessons from Extraordinary Change
and our Evolution to Health Homes James W.
Connolly, FACHE President and CEO, Ellis Medicine
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• Change Comes To Ellis
• Shared Evolution in Human Services
• The Mandate for Change
• Whats Driving It?
• How Do You Do It?
• Why Should I Do It?
• Walking My Talk The Next Evolution to Health
  Homes

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SCHENECTADY HOSPITALS BEFORE THE BERGER COMMISSION

Ellis Hospital Bellevue Womans
Hospital St. Clares Hospital
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Schenectady B.B.C.(Before Berger Commission)

• Ellis Hospital 368 bed general hospital, 1,550
  FTEs, excellent stroke heart attack care
• St. Clares Hospital 200 bed general hospital,
  920 FTEs, safety net provider
• Bellevue Hospital 55 bed specialty womens care
  hospital, 275 FTEs, largest maternity provider

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What Ellis Assumed
1133 Employees 118 million Of operating
expense 10,600 Additional patients 43,000
Additional days of care 8,400
Surgeries 39,000 ER visits
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Summary of the Results

• 455 Total Beds 100,500 patient days
• 2,500 Babies Delivered
• 79,000 Emergency Room Visits
• 600 Cardiac and Thoracic Surgeries
• 3,400 employees - virtually no one lost their
  job, compensation or benefits
• 7 million combined loss in 2007 became 8
  million gain in 2008 and 2009
• Bellevue Takeover Seamless Times Union 11/2/07
• Hospital Merger Nearly Painless Times Union
  6/17/08
• And we did this in ten months calendar time
  three months for one and four months for the
  second

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Help from the State But not enough
Status of Dept. of Health HEAL-NY Phase 4
Funding Total Bellevue St. Clares
Ellis Bellevue Transaction 28.0 22.2
----- 5.8 Ellis/St. Clares 50.0
----- 41.3 8.7 Transaction _______
______________________________ Total 78.0
22.2 41.3
14.5 100 28 53
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WHAT ELLIS LOOKS LIKE TODAY
Central location for outpatient services,
primary and wellness care, and rehabilitation
and long term care.
Central location for inpatient and emergency
care.
Location for inpatient OB/GYN services.
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Preparing for the Future
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Observations
Does extraordinary and dramatic change always
take a long time? Is rapid extraordinary change
always cataclysmic?
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Our shared evolution in Human Services over 30
years

• From large and centralized institutions
• Inpatient hospitals (no ambulatory care)
• Institutionalization
• To enlightenment
• Outpatient focus
• Community-based care
• Humanistic/holistic

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Enlightenment breeds consumption

• Coincides with increase in government funding
• Proliferation of providers
• Patients and families find helpful new services
  which insurance pays for
• Consumption goes up

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Consumption goes upSpending Goes
upGovernment payors get nervous...They Look
at high costs and respond with Price Freezes,
consolidations, and Forced Economies of Scale
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Costs stabilize temporarilyBut then
consumption continues to Growand budgets start
to go bust all over the place
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What do Medicaid and Medicare do then? Well,
they look at care differently than we do

• We see delivering a service
• They see purchasing a service

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And when your purchasing costs are Too high, what
do you do?You renegotiate prices.And when you
are the government and
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Government Owns Healthcare
Ellis payor mix 60 Medicare and Medicaid (YTD
Oct. 2011)
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its not so much a negotiation . as it is an
arbitrary cut in payment
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• Consumption keeps increasing
• Despite government efforts to control costs,
  total spending keeps escalating
• Panic Sets In . And that pretty much brings us
  up to date!!

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• Why does panic set in?
• People predicted that costs will overwhelm the
  government
• And they were right!
• Debt is degraded, programs are affected, caps are
  put on Medicaid spending, states are suing the
  federal government in supreme court .

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Whats Driving this change?

• Hint 1 Remember Government thinks
  differently
• Hint 2 Its not the delivery of services

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Mandates not just efficiency but a Change in
our model
A Car Analogy First we maximized efficiency
tire inflation, engine tune-up, tweak the
computer But you can only get so efficient with
a V-8 So we changed the chassis to a 4, or a
hybrid, or an electric And then maximized the
efficiency of that vehicle
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What do we need to do? (To change our model)
Focus on the goal keep people well, meet core
not all - care needs Design all systems for cost
efficiency root out all costs that dont add
value Plan to put yourself out of
business Reduce services but still meet
patient/consumer needs
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How do you do it?

• Meet patient/consumer needs while
• Consolidating
• Redesigning
• Breaking down silos
• Patient-centered care
• Leverage community resources
• Get out of the trenches and hope for a stable
  environment on the other side!

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WHY Do I have to do this?
To control your own destiny and the destiny of
the people you care for Embrace change, seize
opportunity or get rolled over Things are
going to burn down. We can control the burn.
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Weve talked about

• Extraordinary, unprecedented change and how we
  met the challenge at Ellis
• The common evolution of human services
• As we face change
• What we need to do to change
• How to change (and still survive )
• Why we need to change (embracing change)

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BACK to Schenectady
Walking the talk Evolving to the Health Home
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How we got to be a Health Home a history
Caring for the indigent and poor in the Emergency
Department Primary Care / One-stop Shopping /
Navigators at the Medical Home Community
linkages Evolving to a Health Home broad
partnership integrating primary care, acute care,
mental health, developmental disabilities,
housing, etc., etc., etc.
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HOSPITAL
Neighborhood Home - Home Team creating
long term integrated adult housing alternative to
nursing homes/shelters congregate housing (PACE
model) - Chronic care management

100 Clinical
ED
PATIENT
TRANSITION TEAM/DISCHARGE PLANNERS
Transition neighbor-hood home
Chronic 60
Chronic 40
Clinical Care - Medical Home (PP, HTH, Mental
Health)
100 Social
Discharge Phone Calls
Non-Chronic
Loop of Readmissions
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Patients
Hospital
Primary Care AND Medical Homes
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Patients
Hospital
Primary Care AND Medical Homes
Health Home
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Patients
Social and Commty Services
Hospital
Primary Care AND Medical Homes
Health Home
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Patients
Social and Commty Services
Hospital
Chronic Care Interventional Team
Primary Care AND Medical Homes
Health Home
Care Coordinator/Navigator Acute Care
Interventional Team Community Health
Workers Case Management
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Is This Enough? Probably Not
IT infrastructure Jettison the old
ways Shrink as expeditiously as we can (All as
we cautiously watch the Baby Boomers get older)
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But It will help us get to where we need to be

• The Triple Aim
• Better health for the community
• Better care for the individual
• Lower cost for the community and the individual

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Where We Are Going Short Run

• Aggressive wellness programs keep people
  healthy
• Emphasis on primary healthcare catch illness
  early
• Community-based care holistic approach
  coordinating medical, behavioral, disabilities,
  and community-service providers
• Chronic care management target known
  interventions
• Hospitals as part of the community still
  necessary for the right care at the right time

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Where We are going Long Run
From Managing Peoples Healthcare To Managing
the Populations Health
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But when confused or in doubt, just Remember
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