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June 2, 2017

9 ways Dartmouth-Hitchcock's CEO would redesign health care

Daily Briefing

Speaking at a recent symposium at Northwestern University's Kellogg School of Management, James Weinstein, CEO of Dartmouth-Hitchcock and Dartmouth-Hitchcock Health, shared his nine ideas for revamping and reinventing America's health care system.

Building a pay-for-performance compensation model

"I think the country is missing an opportunity," Weinstein, who plans to retire from his position on June 30, said. "The current president talks about rebuilding infrastructure of America—it's an interesting thought. If we had to redesign health care today with a whiteboard, it wouldn't look anything like it looks now."

During his talk, Weinstein urged leaders in government, business, the health care industry, and communities to refocus health care delivery on equity rather than "brick and mortar solutions that don't address the social and economic issues of our times." He outlined nine key steps the health care industry should take going forward::

  1. Make transparency on cost and outcomes mandatory. Patients are currently expected to make health care decisions without knowing the cost of a procedure, the track record of their providers, or a well-defined role in their own health care choices, Weinstein said—and that needs to change. And increased transparency, he argued, will also spur greater efficiency and standardization from clinicians. "These are smart people, they went through medical school," he said. "They will appreciate the data if they believe it, and building data systems they trust is the solution for that.

  2. Focus on the top 5 percent of health care utilizers. According to Weinstein, about 5 percent of the U.S. population accounts for nearly 50 percent of health care spending—while half the overall population accounts for just 3 percent. Citing HHS projections that health care spending will increase faster than the national economy over the coming decade, Weinstein said, "Let's take care of those [with] chronic conditions for the population [who] is aging and responsible for 50 percent of costs. ... Medicare is a national program—if you spend more money in Texas, that's less money to spend somewhere else."

  3. Proceed with value-based payments, but focus on adjusting for social determinants upstream. While Weinstein said the drive to create a health care system that rewards quality rather than quantity exists, "it's kind of a low bar right now. ... It's still about money. It's always about money." He said the industry should continue moving toward value-based payments, but he also called for additional programs that weighed socioeconomic factors when assessing a providers' quality of care and an individual's health. "Social issues account for most of the problems in this country," he said. "And we tend to avoid them."

  4. Revise or eradicate the Social Security max tax. Weinstein cited projections released by the former President Barack Obama's administration that stated the Social Security program would be insolvent by 2034, with tax collections sufficient to cover only 75 percent of promised benefits through 2090. He said the max taxable earnings for Social Security—set at $118,500 in 2016 and $127,200 in 2017—should be modified so that those with high incomes could contribute more, stating, "I can pay more."  

  5. Mandate that people earning more than $100,000 per year contribute more to coverage costs. Weinstein expressed support for a growing but still uncommon payment model that links premium costs to an individual's salary.

  6. Provide routine and preventive care remotely. Weinstein said providers should aim to provide more preventive and routine care remotely, citing the 50 percent of the U.S. population who account for just 3 percent of overall health care costs as  prime candidates for such services. In particular, Weinstein highlighted D-H's ImagineCare program, a 24/7 remote management service that patients can access via tools delivered to their houses, text message, or other online interactions.

  7. Collaborate with industry and consumer groups for AI, predictive modeling, and data analytics. Noting that hospitals alone cannot take advantage of advances in technology, Weinstein urged providers to team up with outside industries to maximize the benefit of such advances. For instance, Weinstein cited D-H's collaboration with Microsoft on ImagineCare, as well as the new opportunities artificial intelligence has opened up for personalized medicine. "No human can do that," he said. "You need technology tools."

  8. Tie pharmaceutical repatriation with endowments aimed at providing drugs for those who cannot afford them. Weinstein said if President Trump's plan to encourage companies to return corporate profits they've stored in other countries back to the United States via tax breaks ever takes effect, pharmaceutical companies should use the savings they incur under the plan to establish endowments to fund medication for people who cannot afford them.

  9. Keep social determinants of health in mind when restructuring the U.S. infrastructure. Lastly, Weinstein said an updated infrastructure that accounts for social determinants of health will "pay big dividends." According to Weinstein, such determinants include public transportation; internet access and other technology; safe, accessible exercise areas; and access to healthy food. "If we do rebuild the infrastructure of America, this is an opportunity" (Gamble, Becker's Hospital Review, 5/23).

Building a pay-for-performance compensation model

Many hospitals find themselves between a rock and a hard place—caught between the reality of extremely limited compensation dollars and the need to implement pay-for-performance incentives.

Find out how one hospital made it work, transforming its compensation and merit pay practices to truly reward exceptional staff performance against organizational goals while still maintaining market competitiveness.


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