At Women Leaders event, Tavenner stresses importance of insurance, preventive care

With the complicated state health insurance exchanges going live in October, CMS Administrator Marilyn Tavenner has a lot to think about at the end of the day.

“What keeps me up at night is, how do we get the message across to this country about the importance of health insurance and the importance of preventive care,” she told attendees today at Modern Healthcare's Women Leaders in Healthcare Conference in Nashville. “For many people, that's not something they understand until they have personal experience. And that's where women leaders make the difference.”

In a keynote address to 250 healthcare executives, Tavenner explained that the public education process to enroll people in exchange plans will focus initially on individuals and small businesses. It will involve navigators, who will guide people through the enrollment process and will start training at the end of this month. It also will involve agents and brokers, who started training last week.

She urged attendees to help educate their friends, family, patients and colleagues about the insurance exchanges, where people with incomes under 400% of the poverty level can buy subsidized coverage and others will be able to sign up for expanded Medicaid coverage. With women making 80% of healthcare decisions, “I think this is an easy mission for all of us,” she said.

She added that while half the focus of the Patient Protection and Affordable Care Act is on expanding coverage, the other half is on controlling costs. “One of the criticisms of Massachusetts (which established an Obamacare-style system in 2006) is that they did a great job with access, but they didn't deal with the cost,” she said. She noted that the U.S. currently has had the lowest healthcare cost trends in the past 50 years, but added, “We will have to stay focused on costs.”

Reducing costs in healthcare delivery was also one of themes of a panel on blending cultures after a merger or acquisition.

Judy Persichilli, interim president and CEO of CHE Trinity Health, whose merger went live in May, said that operational efficiencies were not where the systems saw the most potential for savings. “The real savings are in clinical transformation,” she said, citing for instance the focus on behavioral health in the Pittsburgh market.

Keith Pitts, vice chairman of Vanguard Health Systems, which recently announced a merger with Tenet Healthcare Corp., said that providers need to take out 20% of the total cost of care. He focused on one of the system's most recent takeovers, Detroit Medical Center. “Everyone wants to know: Why would you buy Detroit Medical Center,” he said. “Detroit wasn't a broken health system from an operating standpoint. But they didn't have any capital. They were scrappy, but they didn't have any cash.”

Its 2010 takeover allowed Vanguard to inject funding for deferred projects. “If you drive around Detroit, you'll see cranes up,” he said. “Most of those cranes have our name on them.”

Detroit Medical Center, a safety net hospital for southeast Michigan, also applied for and was selected to be a Medicare Pioneer accountable care organization. “We did save 4.5% the first year so we stayed in a second year,” he said. “The health status of Detroit is one of the toughest in the country. I see a very bright future in Detroit in being able to accomplish that.”

Follow Beth Kutscher on Twitter: @MHbkutscher