By KEVIN CHIRI
Slidell news bureau
SLIDELL — The changes on the horizon in 2014 from the Affordable Care Act (ACA) can be summed up pretty simply, says Ochsner Health Systems North Shore CEO Polly Davenport.
“The system needs to truly be ‘health care,’ not ‘sick care.’ For too long in the past, our system has been in the sick care mode and that has to change,” she said.
Davenport is among the St. Tammany hospital CEOs who are ready for “Obamacare” to kick in as 2014 begins, but she said Ochsner has been aiming at this kind of transformation in the system for nearly four years.
“We truly began working on this three to four years ago and I believe we are well prepared for it,” she said. “This change in the way we provide health care has to begin with preventative care, and doing the things necessary to keep people out of the hospital and encourage them to live healthier.”
Davenport is the CEO for the Ochsner Health System on the North Shore that is part of the regional Ochsner operation consisting of 40 clinics and eight hospitals. She said the company is setting the example for preventative care right with their own employees, after starting several programs in recent years that encourage their workers to live healthier lives.
“One of the first things we did was offer incentives for our employees to be healthier, particularly losing weight,” she said. “It’s called Pathway to Wellness and provides regular testing, along with support services to lower their blood pressure and cholesterol, and lose weight if needed. When they meet certain goals, it reduces the amount they pay for their health insurance premium, so it really is a financial motivation to be healthy.”
Since beginning the Pathway to Wellness program in 2010, Ochsner employees have lost 48,989 pounds, losing an average of 16.8 pounds per person. In 2012, 66 percent of the participants maintained their blood pressure and 55 percent improved it; 70 percent maintained their body mass index and 24 percent improved it; and 65 percent maintained their body fat with 35 percent improving it.
Davenport said that out of the 8,000 Ochsner employees who could participate in the plan in 2013, 90 percent are taking part.
Ochsner also provides smoking cessation classes for those who want to quit smoking, along with counseling for other health-related issurs.
As the Affordable Care Act was on its way to take over the national health care system in 2014, Ochsner began a unique online system called “My Ochsner,” which allows individuals access to any of their doctors or medical records through the touch of an app on their phone.
The My Ochsner app allows patients to text their doctors for any problems, make appointments, or prescription refills. Davenport said they provide same-day doctor appointments for any of their patients—all which is intended to keep people healthier by catching a problem before it gets worse.
“The first thing we encourage everyone to do is connect with a primary care physician. Everyone needs a primary care doctor who you have a personal relationship with,” she said. “The problem in the past is we haven’t seen that enough, so when someone had a problem, they tended to put it off until it got much more serious.
“That may lead to an ER visit or a hospital visit, and that’s where health care costs are much higher. Most people think health care companies make a lot of money when you end up in the hospital, but the truth is we don’t,” she said. “The reimbursement amounts of companies when people go in hospitals has gone down so much that we frequently lose money when you end up in the hospital. So our goal is to keep people out of hospitals.”
Davenport said the reason health care providers don’t fare well financially from hospital visits is because approximately 50 percent of their revenue comes from Medicare and Medicaid, but reimbursement percentages to providers has been reduced so much in the past 10 years that the payment is often not enough to cover expenses.
To prove that point, Davenport said Ochsner-North Shore has approximately $18 million in uncompensated care from 2013.
“There are several factors that make that happen,” she said. “The Medicare and Medicaid reimbursements are lower, but now that deductibles are so much higher, the hospitals are faced with collecting that from the patient and many times we never get paid.”
Davenport said the future of the system will be for “only the sickest people to be in hospitals. The entire system is working in that direction, and we are already seeing that decline in discharges in St. Tammany Parish.”
The good news for the changes expected in health care is that the push by the entire industry to connect individuals with a primary care physician is already working.
“We’ve seen a 10 percent growth each year in primary care physicians handling patients,” she said. “That says people are realizing that wellness works.”
The Ochsner North Shore CEO said the move towards utilizing technology more—such as the My Ochsner app and electronic medical records—is taking hold even among the elderly population.
“We’re seeing kids get their parents and grandparents to use technology, and I know one lady in her 70s who has the My Ochsner app, and pulls it up all the time,” she said.
The My Ochsner app only applies to the Ochsner doctors and system, but allows patients to have complete access to any testing results, medical records and any doctors they see.
“All you have to do is text any doctor of yours and they will get back to you in a short period of time since we are tracking same-day response and appointments,” she said.
One other area the ACA implementation will affect health care providers is in readmissions to hospitals. If a patient has to go back to a hospital within 30 days of being released, the provider will receive a lower percentage of reimbursement for the care.
“The challenge about that is for us to get patients to have their followup appointments, take their medicine and do what the doctors told them so they don’t end up back in the hospital,” she said. “We don’t have complete control over that, but we still have to try and get that done since providers will be penalized if a readmission occurs within 30 days.”
Davenport said most health care providers are expecting finances to be tighter in the future with the new plan since reimbursements are being lowered. To prepare for that, she said Ochsner has a goal of finding $50 million in expense reductions from their bottom line in 2014. She said they are trying to accomplish it with lower supply costs, decreased re-admissions, preventative care, reducing duplication of tests and generic prescriptions.
“The most expensive place for us to care for patients is in emergency department visits, so we are counting on preventative care and regular checkups with your primary care physician as a way to reduce that,” she explained. “The new health care initiative is about the system becoming more efficient and that’s what our philosophy is here.”
Ochsner is offering help to individuals and businesses trying to sort through the maze of options by offering health insurance seminars, free to the public. For a complete list of sessions, visit ochsner.org/marketplace.