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CentralIowaBUSINESS [APR / MAY 2010]
[ ON THE COVER ]
Text by Micholyn Fajen • Photos by Brent Isenberger Photography
Delivering the Best Outcome
for Every Patient Every Time
T HE V ISION
OF
I OWA H EALTH S YSTEM
T
he debate surrounding the direction of America’s
health care reform will continue well beyond the
current administration. And while Iowa Health System
President and CEO Bill Leaver knows the reform measures
signed into law won’t be a cure all, he is encouraged about
what it could mean for Iowans: quality medical care, preventive
care for chronic diseases designed to help reduce emergency
admissions and, over time, maybe even lower premiums.
The recent health care reform will result in 31 million more
Americans having health insurance. That translates to an
additional 9 percent of Iowans. With the American Hospital
Association reporting that more than 35 million Americans are
admitted to the hospital annually, hospitals will have to prepare
for more admissions of insured patients beginning in 2014 —
the year all Americans will be required to purchase health
insurance or face a penalty.
Shifts in the System
The path to insuring the vast majority of Americans has been
a bumpy ride, met with conflict and near defeat. Even with
35 years of experience in the industry, Leaver says he could
not have foreseen this path.
“A year ago, I had great optimism that we were going to
finally get something done. Then during the summer of 2009
and last fall, I was discouraged that nothing would happen,”
Leaver says, adding that the current state of health care in
Small Business TAX CREDIT
76%
America is not sustainable. Having no reform would not have
served anyone well.
Even with reform passing Congress and being signed into
law, challenges will follow. Greater volume of patients coupled
with making sure Iowa has a sufficient number physicians to
care for them is one such challenge.
The journey has only just begun, but Leaver foresees positive
changes on the way.
Take for instance the care of patients with chronic diseases such
as asthma, diabetes, chronic obstructive pulmonary disease and
coronary artery disease. While representing a small percentage of
the overall number of patients, the care for these diseases
accounts for half of all health care spending in the nation.
Leaver says in the long term, care for chronic disease will
change. “Providers, physicians and hospitals will be encouraged
to care for the chronically ill differently, in a way that is more
focused over a continuum. We’ll see more robust care that
touches the patient in a way that will result in better outcomes
and a more satisfied patient.”
The model Leaver is talking about will put primary care
physicians in a practice environment that would help “bring
the joy back to practicing medicine and will better serve the
patient.” For example, primary care physicians would focus
on the patient as a whole to help ensure preventive steps are
taken that ultimately could help keep such patients out of the
emergency room and promote living healthier lifestyles.
Leaver calls it “care coordination,” and for Iowa Health
System, it would involve an entire medical team, directed by
physicians, with these health care practitioners involved in
patient care in a more dynamic way.
“From the nurse manager to a nutritionist to the pharmacist,
there would be a care path designed around the patient’s needs.
This takes a much more coordinated team approach led by the
physician,” he says.
Portion of Iowa’s businesses that are small businesses.*
42%
Percentage of small businesses that offered health coverage
benefits in 2008.*
[* Center for Financing, Access and Cost Trends, Agency for
Healthcare Research and Quality, Medical Expenditure Panel
Survey - Insurance Component, 2008.]
Medicare Reimbursement Rates Will Improve
Reform also addresses the rate at which Iowa’s physicians and
hospitals are reimbursed for the care they provide for Medicare
patients. While Iowans receive among the top-rated care in the
nation, the reimbursement rate for those providing care is
among the lowest.
“The disparity in reimbursement for Medicare hurts us. It
puts us at a disadvantage when we try to recruit physicians and
[APR / MAY 2010]
About
IOWA HEALTH SYSTEM
Iowa Health System is the state’s
first and largest integrated health
system, serving nearly one of
every three patients in Iowa.
Through relationships with
26 hospitals in metropolitan
and rural communities and
more than 140 physician clinics,
Iowa Health System provides
care throughout Iowa and
western Illinois.
Iowa Health System entities
employ the state’s largest
nonprofit workforce, with
nearly 20,000 employees working
toward innovative advancements
to deliver the best outcome for
every patient every time. Each
year, through more than
2.5 million patient visits, Iowa
Health System hospitals and
clinics provide a full range of
care to patients and families.
With annual revenues of $2
billion, Iowa Health System is the
sixth largest nondenominational
health system in America and
provides community benefit
programs and services to
improve the health of people
in its communities.
CentralIowaBUSINESS
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CentralIowaBUSINESS [APR / MAY 2010]
[ ON THE COVER ]
Health Care Reform:
IOWA’S NUMBERS
302,000 Iowans do not currently
have insurance.
171,000 Iowans have non-group
insurance and will be able to get
affordable coverage through the health
insurance exchange.
187,000 residents could qualify for
premium tax credits to help them
purchase health coverage.
505,000 seniors would receive free
preventive services.
89,700 seniors would have their
brand-name drug costs in the Medicare
Part D “doughnut hole” halved.
48,600 small businesses could be
helped by a small business tax credit to
make premiums more affordable.
>>continued from previous page
staff,” says Leaver, who cites that under reform, the playing
field is about to even. “There will be a mechanism to address
that economic disparity and how to create an even playing
field. The government will be focused on paying for value.
It’s a great benefit for Iowans because we’ve been underpaid,
but we produce great outcomes.”
The Journey Ahead
Over the long term, Leaver says Iowa Health System leaders are
working toward reducing costs and at the same time improving
patient outcomes. Patients will have a better health care
experience and a deeper interface with their care providers.
One way Iowa Health System is improving care and
efficiency is through HealthNet connect. Last year, the a
3,200-mile fiber optic network was launched and allows for
electronic-prescribing, tele-medicine in homes in even the most
remote parts of the state and the transmission of medical
images such as X-rays and CT scans almost instantly to any
hospital or clinic on the network.
Health care reform also calls for patients with preexisting
conditions to have access to health insurance coverage and an
improvement in the portability of policies. It’s unknown,
Leaver says, what will happen to a business’ premiums over the
long haul or whether tax credits or other taxes balance
each other.
According to the Agency for Healthcare Research and
Quality, by 2014, 48,600 small businesses in Iowa could be
helped by a small businesses tax credit proposal that makes
premiums more affordable. And these small businesses would
be exempt from any employer responsibility provisions.
Parts of the reform, no doubt, will have unintended
consequences that, Leaver says, we don’t fully understand
today.
“That will end up having to be fixed. This is not a
perfect bill. It will have to have tweaks to take care of those
unintended consequences,” Leaver says. “The downside of
that is we are going to have to live with the consequences
until they get fixed.”
At the end of the day, Iowans want to know that a
high level of care will be there when they need it. Iowa
Health System is working hard to continue many of the
transformational changes already in motion and is prepared
to respond to the new health care reform laws as it strives
to deliver on its vision of providing the Best Outcome for
Every Patient Every Time. ■