Solutions for the Health Industry

The Medicare Pioneer accountable care program has closed out its first year with the departure of nearly one-third of its participants. Health care providers face huge challenges in their quest to reduce spending and improve quality of care. The goal of the Pioneer program to get the industry there by more tightly integrating providers and establishing joint financial incentives for them to provide better, more seamless care and improve the overall health of their patient populations is laudable. But, as evidenced by the departure of so many participants, perhaps involves too much risk to providers to be the best solution. Perhaps the best solutions may come not from Washington, but from the providers themselves.

At Scripps, we’re continuing what we’ve been doing for more than two years to cut costs and improve quality throughout our system. We believe that our approach is not only in alignment with the intent of health care reform, but also is in the best interest of our patients.

We are eliminating unnecessary variation and building more physician alignment and integration by implementing a physician co-management model in cooperation with our Physician Leadership Cabinet and ScrippsCare, formerly our Physicians Business Leaders Cabinet which we re-formed as an Integrated Delivery Network board that includes representatives from our affiliated medical groups.

In partnership with our physicians, Scripps has already begun transforming the way we deliver care to our patients. Together, we are creating comprehensive models of care delivery that allow us to meet the needs of patients across the San Diego region.

This even closer working relationship with our doctors is built on more than a decade of developing trust through transparency with them through the forum of the Physician Leadership Cabinet, whose membership includes the chiefs of staff and vice chiefs of staff of the system’s hospitals. In the history of the PLC, every one of their recommendations to management has been adopted.

It was the strong culture of trust and transparency that made it possible to turn Scripps on its side in late 2010 in a restructuring that added a horizontal and matrixed management to the existing vertical management, all aimed at looking across the system to eliminate variation that wasn’t improving patient care. That huge organizational change would not have been possible without the buy-in of the doctors, who have gone beyond that to taking a leadership role in the effort. In an unprecedented approach to health care change, our employees and physicians have come together across locations and disciplines to identify unnecessary variation and develop new solutions that work better for us and our patients. Together, we are identifying and adopting the best clinical and operational practices, renegotiating contracts, standardizing supply usage, implementing new information technology and so much more.

The result is a better patient care experience and health care value, with reduced costs and increasing revenue that resulted in performance improvements of $77 million in fiscal 2011, $64 million in fiscal 2012 and a projected $66 million in fiscal 2013.

This wasn’t done through an ACO program out of Washington. We did it ourselves. Providers can and should take the initiative and make the changes that will make the difference for patients. To me, that’s real health care reform.

Chris Van Gorder

About the author

Chris Van Gorder is president and CEO of , an integrated health delivery system based in San Diego. The $2.6 billion system treats nearly 500,000 patients annually through care provided by more than 2,600 affiliated physicians and nearly 13,000 employees across five hospital campuses. In 2010, Van Gorder served as chairman of the .


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