The most radical efforts to reform the nation's healthcare system are coming not from Washington but from the local communities where a wholesale restructuring of the industry is well under way. Tomorrow's hospital will be radically different, and here are some fresh examples:
In Philadelphia, Independence Blue Cross and Graduate Health Systems have agreed to merge their for-profit operations into a new subsidiary that will link their managed-care operations.
In Toledo, Ohio, Riverside Hospital moved to develop an integrated delivery system by affiliating with Blue Cross and Blue Shield of Ohio and committing $7 million to establishing a network of primary-care centers.
The Lahey Clinic, a multispecialty group practice, and a network of rehabilitation facilities have entered into a joint venture to purchase 112-bed Symmes Hospital in Arlington, Mass., and convert it to provide outpatient primary and rehabilitative care, emergency services, ambulatory surgery and inpatient subacute rehabilitation.
As the industry rapidly reconfigures itself, President Clinton's healthcare reform proposal is reeling from the Congressional Budget Office's decision to recommend that the healthcare plan be counted as part of the federal budget and a triple blast from major business organizations.
These skirmishes should not delude providers into thinking that change won't come, however. The president has signaled his willingness to be flexible on the question of spending limits and on voluntary rather than mandatory health insurance purchasing groups. Large employers, who bear the brunt of cost-shifting to cover the uninsured, in the end may decide they have few reasonable options to an employer mandate. Furthermore, it will be difficult to rein in Medicare and Medicaid spending without reforming the entire healthcare system.
Whatever the final shape of reform, tomorrow's hospital will no longer be the hub of the healthcare delivery system, but rather an important component of a full-service network designed to attract managed-care contracts.
Above all, providers must invest wisely in information technology that allows the development of reliable financial data and outcomes measurements that can provide the basis for changing physician practice patterns. With such tools, administrators will be miles ahead in the struggle to cut costs and to successfully develop a patient-centered focus that will be essential in the healthcare arena of the future.