James Skogsbergh, CEO of Advocate Health Care in Downers Grove, Ill., began his one-year term this month as chairman of the American Hospital Association's board of trustees. In an interview with Modern Healthcare editor Merrill Goozner, Skogsbergh, a former college baseball player, didn't duck the high hard ones on the challenges facing the AHA and Advocate's proposed merger with NorthShore University HealthSystem in Evanston, Ill. The following is an edited transcript.
Modern Healthcare: What are your goals, and what do you see as the most pressing issues for the AHA this year?
James Skogsbergh: This is an unusual year for the AHA because it's a year of transition—Rick Pollack's first full year as president and CEO of the AHA. So a big part of this year is really making sure that transition is smooth and seamless.
We on the board really appreciate Rick's willingness to pause and re-examine the way the organization is structured. He has our full support to do that. Beyond that, the goals continue to be the same—to advance the field in terms of what we oftentimes refer to as the triple aim, making sure that the field is moving toward better health outcomes, better service and lower cost.
MH: Your year is going to bridge a transition in the White House and a possible change in control of the Senate. What do you see as the greatest threats to the healthcare sector from a political transition?
Skogsbergh: Unfortunately, despite all the rhetoric, we all believe that healthcare has a bull's-eye on its back. There is so much spent in this country on healthcare that we do fear significant cuts in reimbursement, which would create tremendous stress and strain on all of our nation's hospitals' ability to care for their communities.
MH: The political emphasis is on repealing and replacing Obamacare, which could affect the exchanges and Medicaid expansion. How do you view those issues?
Skogsbergh: The rhetoric is sort of strident about repeal, replace. I might be naive (but) that's much easier said than done. I can't imagine that there are too many Republicans, let alone Democrats, that really want to turn 40 million Americans out on the street and take away their coverage. There may be some modifications. But the notion of replacing and fully repealing is highly unlikely.
MH: If the Republicans take the White House and maintain control of Congress, we could see a shift to tax credits for people who don't have healthcare insurance.
Skogsbergh: I view that negatively, largely because of the increased amount of out-of-pocket (expense), whether that be the premium itself or the deductible or the copay. It is becoming such a burden that it often ends up in bad debt for our nation's hospitals. We consider that to be of great concern.
But at the same time, there is some value in that notion of personal responsibility, both in how we care for ourselves—my choices that I make—and some financial responsibility as well. Where that fine line is, I'm not quite sure.
MH: A few years ago, Advocate Health Care instituted a clinical integration program. How is that working out?
Skogsbergh: We have stepped off of fee-for-service and moved into fee-for-value. That doesn't mean that all of our contracts are fee-for-value, but now a majority of them are. We've reached that tipping point at Advocate.
We saw a situation five years ago where we had the same scene playing out time after time, in which the contract with insurance companies would be up and they'd be saying, “You're too expensive,” and we would approach it by saying, “We're not being paid enough.” There's this brinkmanship, and it really wasn't working for us, and it wasn't really working for the insurance company. So, credit to Blue Cross of Illinois, we suggested, “Let's just step off of that path and go down a new one,” and they were willing to do that.
So, we created at the time a fairly innovative approach in which we would get paid for better health outcomes at a lower cost. Now there are a lot of contracts that have that mechanism in them. We're proud to say that at Advocate Health Care, our cost per discharge today is less expensive than it was five years ago. I'm not sure there are a lot of healthcare organizations that could say that.