In all the talk about restructuring the healthcare delivery system, an important point may be lost: Structures do not deliver healthcare. Terms like restructuring, re-engineering, downsizing and continuous quality improvement are just catch phrases for models under which caregivers strive to improve medical care.
The goal of an integrated network of providers and insurers is accountability for improving the health of members of a particular community. In the past, few have stepped up to the plate to take on this challenge. With few incentives to do so, the reluctance is understandable.
But the inducements-both within healthcare organizations and from external forces shaping the industry-are changing. A significant internal incentive is the growing recognition that the Holy Grail for those seeking most efficient, high-quality care is clinical integration-or the coordination of patient-care services across various activities and operating units of a system. Executives are recognizing that cutting patient days and reducing staff may result in one-time expense reductions, but until the delivery of patient care is streamlined, unified and coordinated, managed care will not hit pay dirt on lowering costs.
Just as the mantra of real estate is location, location, location, the mantra of managed-care plans is cost, cost, cost, followed by quality and service. For an example of the importance of being a moderate-cost, high-quality provider, look to Hartford, Conn. Cigna HealthCare announced it will end an affiliation with Hartford Hospital on Sept. 8 and create a new network of physicians affiliated with Saint Francis Hospital and Medical Center and its sister facility, Mount Sinai Hospital. According to Cigna, Saint Francis won by submitting a bid that was about one-third lower in price than Hartford Hospital.
The contract will allow Cigna to save about $1 million in administrative costs by the end of 1995.
Collaboration and cooperation may be watchwords for the industry, but the managed-care era is driving an increasingly competitive healthcare marketplace that rewards value as an essential component of quality.