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Healthcare Q&A

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Healthcare continues to move beyond the four walls—and multiple floors—of a hospital. Reasons for the “outpatient migration” to ambulatory care sites, other nontraditional locales and even into the home flow from personalization in care, cost savings, socioeconomic factors and lifestyle changes, all keyed to the goal of determining optimum treatment.

The Business Journal’s Sherry Hsieh asked OC healthcare executives to weigh in on the hospital of tomorrow, how such facilities will connect with their communities, and what their organizations are doing to move toward that future.

Here are their edited responses.

Barry Arbuckle

Chief Executive

MemorialCare Health System

Fountain Valley

We embrace the transition from hospital-based care to community-based, ambulatory care. Technology and other advancements in medicine let us provide treatment more cost-effectively and conveniently than ever. We’ve diversified from a hospital system to an integrated network: four hospitals, two of which are in OC; 2,500 physicians; and many freestanding surgery, imaging, urgent care, dialysis and breast health centers, in Orange and Los Angeles counties.

The freestanding centers are convenient, provide exceptional quality and are not licensed as part of our hospitals—meaning they’re less expensive to run. Procedures can be priced up to 300% less than at a hospital, producing lower costs for patients and insurers. Networks also let us participate in more value-based health plans including an HMO with Anthem and six other health systems and a “direct-to-employer” PPO with Boeing. 270,000 patients participate in our value-based offerings, delivering cost-of-care reductions and high patient satisfaction. We’ll keep expanding our network, developing our own sites and via partnerships.

Hospitals will continue to be vital; some procedures and more complex care must be delivered there. We’ll invest in our centers of excellence there, including in maternal and pediatric care, and institutes for heart and vascular work, orthopedics, neuroscience and cancer.

Peter Baronoff

Chief Executive

KPC Healthcare Inc.

Santa Ana

Our mission is to ensure patients and families can enjoy life in great health. That means offering services, programs, and a philosophy that focuses on delivering excellent and fast care.

People don’t want to be at the hospital; they want to be at home with their family and friends enjoying a healthy life.

Consider the emergency room: for many that means waiting in an uncomfortable chair, not knowing how long it will be before they see a doctor and get treated. One of our main objectives is to create a better experience that offers ease and comfort for patients and their families.

So the future of emergency care in Orange County at our four hospitals here will include a concierge service with dedicated personnel to ensure our patients experience the best service, have access to fast care, and receive excellent treatment by our physicians, nurses and staff.

Other areas include implementing new technology and our patient satisfaction program, a system of surveying our customers and their families and continuing refining our services based on their responses.

Robert Braithwaite

Chief Executive

Hoag Memorial Hospital Presbyterian

Newport Beach

A hospital is no longer a physical building but a system of care providing quality services in various environments.

We continue to find new ways to bring high-quality care directly to communities we serve. This includes our health centers and urgent care facilities, as well as specialized services for cancer, heart and vascular, neurosciences, orthopedics and women’s health, to offer outpatient care where communities can easily access it.

Hospitals will continue to be important for those needing acute care. In Irvine last year, we expanded the emergency department from 3,600 square feet to 13,500; the original space is now being renovated and when complete in mid-2019, the facility will have 70 treatment spaces or rooms, up from 22 prior.

Technology advances and increased knowledge are big parts of future care that will move to ambulatory care and the home. We use patient-generated health data to personalize cancer treatment, for instance; in precision medicine we can study a patient’s genetic sequencing report to help guide care.

Wearable devices continue to arm individuals for proactive involvement with their care; what was once solely the duty of a primary care physician or cardiologist can now be monitored in real time by the patient. The smarter the devices get, the more patients will get involved in their care and the more doctors will know about diagnoses and wellness planning.

Innovations that lead to more effective and efficient treatment—robotic surgery, virtual reality—will help us offer customized, personalized care where our patients need it.

Mark Costa

Executive Director, Orange County

Kaiser Permanente

Anaheim and Irvine

The future is timely and convenient care helps patients get what they need at the best facilities for those services. It would be fair to say the hospital is no longer the center of that: healthcare is moving to integrated health systems that include all components: from wellness and prevention to caring for those already ill.

Physicians, therapists and pharmacists in ambulatory settings have more touchpoints with patients than hospitals; to get the greatest value, we should ensure those touchpoints are accessible, coordinated and provide quality.

Hospitals will be smaller, offering acute care and complex procedures, highly focused on services only available in such settings, rather than a general-care location that does everything. Outpatient and ambulatory settings will aim at other treatments and wellness counseling.

We look at what we do best and where to best do it. Not every site has pediatrics, neurosurgery or cardiovascular care, and we don’t plan to add acute care hospitals locally. With the two we have and 25 medical office buildings we’re covered geographically.

In fact, the fastest-growing site for medical care is in the home: patients prefer to be there and it speeds recovery. We’re working on “acute care at home” which will use technology, monitoring and staffing to offer home care for complex patients, too, and services like senior day care, home safety visits and meal delivery.

Providing data and information to patients and their families so they can better manage their care will be exciting as well. We should see dramatic decreases in chronic disease through these efforts.

Kimberly Cripe

Chief Executive

CHOC Children’s

Orange

We and our colleagues across the country are experiencing increased patient acuity—caring for sicker children who require more intensive care and longer stays.

Our neonatologists travel to birthing centers in Southern California; our helicopter transport is always ready to bring the most critically ill and injured children to our hospitals. Working with St. Joseph Hoag Health and UCI Health, for example, we’re collaborating to enhance maternal fetal medicine, to help ease the anxiety of expectant parents with high-risk pregnancies as we prepare for optimal care after delivery and, in certain situations, perform fetal surgery to save a baby’s life.

Given survival rates of so many conditions that previously claimed lives, we’re developing programs and services for adolescents and young adults. We’re evolving the clinical and psychosocial expertise of a children’s hospital with chronically ill patients so their care can remain consistent as they age from childhood into their 20s.

Our cancer institute is one of the few U.S. programs with treatments and services dedicated to children, teens and young adults. A medical intelligence and innovation center is fostering robust developments in artificial intelligence methodologies and advances in genomic medicine, regenerative medicine, robotics, nanotechnology and other areas.

Our goal is to transform pediatric medicine and the patient and family experience. One concept, the iClinic, works with emerging technologies, such as wearables, to improve patient care in the home.

We’ve strengthened relationships to deliver care at the right time and place, including a recent affiliation with PIH Health, a healthcare network in Southern California.

Richard Gannotta

Chief Executive

UCI Health

Irvine

The landscape is evolving.

First, healthcare quality has improved: medical techniques are safer, healing is quicker and many procedures can be performed in one day, so hospital stays are shorter. Second, the way we pay for healthcare has an impact on where care is delivered. Finally, the use of technology has advanced significantly, opening doors for outpatient care.

Still, hospitals are here to stay. We need homes for all levels of care, from primary to the most advanced specialties such as neurosurgery, cardiovascular and cancer. In addition, UCI Health’s role as Orange County’s only academic medical center is unique. We provide the full spectrum of care along with teaching and research, pursuing a mission that moves beyond boundaries of community hospitals.

Our role defies outpatient trends—we are part of the community’s trust and this long-term commitment goes beyond the hospital. We’re advancing in the outpatient arena to be closer to people we serve: a new multispecialty center in Yorba Linda, including imaging services related to women’s health; a Newport Beach site for men’s, behavioral and executive health services; a cancer center, also in Newport Beach, with infusion therapy, diagnostics, and imaging and testing. We plan to have more sites over the next five years as our population grows with more acute, complex needs.

Hospitals will never go away, but our care delivery will change and adapt as we look at an optimal model of care to provide for illness, chronic disease, and the healthy. In the health kitchen at our center in Anaheim, people learn to cook meals that maintain healthy blood sugar levels and lower blood pressure.

We can rethink our models of how care is delivered, integrative principles that keep people healthy, and innovative approaches based on science and technology to help people become more engaged and live healthier lives while, in our case, remaining a hospital and research center working on complex problems.

Annette Walker

President

City of Hope, Orange County

Irvine

Hospitals get a bad rap for being expensive but we have to consider what makes them so: these are highly regulated, open 24/7, acute care sites with expensive equipment. There’s absolutely a need for this.

I was recently on a panel talking about healthcare disruptors and there’s disagreement on if the need for hospitals is diminishing and if we’ll have a lot of healthcare real estate available. There will be a need here in Orange County because the community is aging and we’ll require more acute care. Last year, when many people had the flu, our hospitals exceeded capacity.

Yet we now also understand that hospitals are part of health systems that must be involved in disease prevention and wellness, along with caring for the sick. Additionally, procedures that 10 years ago we wouldn’t have imagined doing outside of hospitals can now be done at lower-cost outpatient locations. It’s more economical and means more access—we should be excited about what can be done there. The push comes from cost-containment, as well as generational differences on how people want care and services.

I’m optimistic about hospitals finding how we can provide the best care, which I think is high-acuity, high-expertise; a place that will be narrower and more refined. City of Hope has it a bit better because we’re focused on cancer and diabetes and have tremendous intellectual capacity: more than 500 researchers working on those two areas.

In Orange County, we are really focused on outpatient services right now and trying to interact with patients and the community. Our Newport Beach location alleviates the burden for some of driving to Duarte. It’s our first step towards fulfilling a bigger vision here.

Erik Wexler

Chief Executive

Providence St. Joseph Health

Southern California

Irvine

Healthcare and hospitals in particular, are experiencing significant transformation. Disruptors like the CVS-Aetna merger, Amazon, and other ventures and new entrants to the field are helping us recognize there are other ways to deliver care and meet patient need. Part of that is bringing care closer to home and the digital revolution increasing connectivity to patients.

Payment is shifting: we’re beginning to be paid on a model where everything is bundled into one payment. We need alignment among physicians, hospitals and outpatient centers to ensure we’re doing everything in unison to reduce costs and improve quality. There are also higher prices for supplies, pharmaceuticals, and wages, and how cost relates to reimbursement.

Going forward there will be fewer large, community hospitals; some areas will see micro-hospitals and facilities that specialize in certain types of care, like orthopedics, and variations in ambulatory locations, including our urgent care program that treats more high acute needs than traditional urgent care facilities; we have 10 in L.A. County and hope to bring it here.

With several other healthcare organizations we started a generic drug company, an important initiative to keep costs down. We have an app for parents about to have or who’ve recently had babies, providing care and education for the family and child. We have a special responsibility to define the very best in care and compassion because of our size and our faith-based mission, which differentiates us and creates connection between our caregivers and our mission.

I can’t think of anything we’re not exploring to help deliver care more efficiently or differently—we’re on a never-ending journey to care for the whole person.

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