Want Cliffs Notes on health reform? Look at Wishard

July 10, 2013
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So much is changing in health care, it’s hard to have a sense of where things are going.

So here’s the quickest shortcut I know: Look at Wishard Health Services.

I was reminded of Wishard’s usefulness as a Cliffs Notes-type guide to the future while listening Tuesday to a presentation by Dr. Lisa Harris, who has been CEO of Wishard since 2004.

Soon to change its name to Eskenazi Health, the county-owned hospital system in Indianapolis continues to stand out because it is actually implementing a model that tries to promote patients’ health, rather than merely treat their diseases.

And that model is made possible by significant public support.

The future of health care under Obamacare and the demographic challenges produced by retiring baby boomers is exactly that—and is exactly opposite of how most hospitals operate now.

Wishard is already a big user of comparative-effectiveness data about drugs and medical devices. Harris said its formulary includes all the pharmaceuticals shown to be clearly better than competitors.

“The me-toos are not," Harris added. The result has been that Wishard's annual spending on drugs has been flat at about $30 million for the past decade.

Because the 339 beds at Wishard’s hospital downtown are filled 95 percent of the time—an occupancy rate about 50 percent higher than most of Indianapolis’ private hospitals—Wishard tries to treat patients as much as possible in its 10 clinics spread around Indianapolis.

Wishard is building a $754 million hospital, which will open in December. But unlike most hospitals built around Indianapolis in the past three decades, this one will replace an existing facility.

The new hospital will be 30 percent smaller and yet be designed better, so it can accommodate 20 percent more patients, Harris said.

It even has been reaching into patients’ homes. Wishard purchased apartment buildings to serve as transitional housing for homeless and mentally ill patients, so they make fewer visits to the Wishard ER. For the same reason, Wishard works with local lawyers to get landlords to clean up mold-infested housing units, to prevent asthma attacks and other maladies.

Also, Wishard’s GRACE program sends nurses and social workers to the homes of low-income seniors to check up on their health and habits. The program was shown to reduce hospitalizations 44 percent.

Reducing hospitalizations will be the name of the game for all hospitals as new payment models being adopted by both government health plans and private health insurers make any growth in reimbursement payments hinge on how well hospitals reduce medical spending.

“Everything we do in health care affects pre-mature mortality by only 10 percent,” Harris said in her presentation to the Employers Forum of Indiana. “We’re going to be getting very serious about the other 90 percent.”

Wishard does preventive screenings. For example, Harris said, it screens every patient for depression and substance abuse because those factors have been shown to make it far harder for a patient to control an expensive chronic disease, such as diabetes.

And Wishard uses electronic medical records to manage a specific population of patients. The hospital launched one of the nation’s first digitized record systems back in the 1970s and in conjunction with the Indianapolis-based Regenstrief Institute Inc. has pioneered several uses of such records to improve care and lower costs.

I gave a detailed rundown of the Wishard-Regenstrief accomplishments in this article.

The reason Wishard does all these things is the same reason the rest of health care is moving toward it: It has no other financial option.

Of Wishard’s patients, 40 percent have no insurance—a rate nearly 10 times as high as experienced by Indianapolis’ privately run hospitals.

Nearly half of Wishard’s patients are on either Medicare or Medicaid—patients that privately run hospitals say they lose money on.

Only 12 percent of Wishard’s patients have private insurance—and most of those are its own employees.

In that kind of financial environment, Harris said, “you develop a system that works to put resources to best advantage.”

Indianapolis’ other hospitals are now starting to do the same. Their challenge, however, is to make this model work without the special public support Wishard enjoys/requires.

Wishard relies on special payments ranging from $15 million to $40 million from the Medicaid programs and $25 million a year in taxpayer support, to make its model work. Also, special governmental revenue from the bevy of nursing home licenses it owns brings in $155 million a year, which helps offset Wishard’s losses and helps pay the debt services on Wishard’s new hospital.

All told, these special payments are $200 million, paying for a huge chunk of Wishard's annual expenses of $520 million.

Can other hospitals adopt the Wishard model and still survive financially? That’s the question for the future of health care.

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  • What ???
    "... Wishard tries to treat patients as much as possible in its 10 clinics ..."? As opposed to what - not trying to treat them? Did a reporter actually write this stuff?
    • hardly a model to follow
      Nearly $200 million in subsidies? None of the other private Indpls hospitals enjoy/require such a huge subsidy. Nearly all rural hospitals across the state have at least 50% Medicaid/Medicare.
    • Hopefully...
      Hopefully Wishard/Eskanazi Health will update their communication systems. As a Wishard patient (because I lost my insurance) I have been continually frustrated by the lack of communication both with me and internally that happens. I spent more than 3/4 of last year in pain, but the doctors had no power to push forward tests that ultimately helped my condition. Also, I have never seen so many different doctors in such a short period of time in my life. Every single one of them started over from scratch; a huge waste of time since none of the records were digital. Every time I go, I have to plan on being there for a minimum of three hours which doesn't work so well if you're trying to have employment. I'm thankful things are better for me now and I appreciate the doctors, but the system within which they work is the quintessential example of inefficiency and waste. That should NOT be a part of Obamacare.
    • Perspective
      Thanks JK. I think while the operational and logistical challenges that hospital administrators face are really tough (putting it very lightly...), the point of your article is that Eskenazi Health is trying to lead in the midst of all of this healthcare system change. Eskenazi is trying to lead with a message that has been trying to punch through the traditional model of offering "sick care" instead of comprehensive wellness, and this is hugely bold as any marketing strategist would tell you. I think, or rather I hope, we are seeing the beginning of a long overdue philosophical change in the way we approach healthcare in the U.S. My guess is that it will work, because the market wants it, but IU Health and Ascension will concede by learning from Eskenazi's mistakes and getting in the pool with them.
    • clinics instead of hospital
      @dave -- as opposed to treating them in the hospital facility, where treatment would almost certainly be more expensive.
    • As opposed to the hospital
      I think your answer is in the first part of that sentence.
    • clinics vs hospital
      @Dave, I'm assuming they are choosing to treat patients at clinics as opposed to those patients returning to the emergency department for treatment. Clinics are much cheaper than ERs, thus saving tax dollars. It's a very smart move on Wishard's part.
    • Not Unique
      JKW - To your comment "continues to stand out because it is actually implementing a model that tries to promote patients’ health, rather than merely treat their diseases", Eskenazi-Wishard is not unique in these ventures and you point that out later. So the uniqueness of Eskanazi is that they have so much public support, not that they are striving to manage the health of patients. Reading your article makes other like-minded health care providers cringe at the misguided comments.
    • Be Careful What You Wish For
      JK, as you tout the success of Wishard, look closely at how they are funding their success. $155 million in special Medicaid payments due to a special relationship in place with nursing homes around the state. The Star did an article on it a while back. There are two points: (1) that only works as long as CMS keeps that strange progam in place, and (2) Wishard, being large, was able to implement this program in many rural communities, blocking out the local county hospitals from taking advantage of the program. This program is another example of government intervention gone wrong. Surely the spirit of the program was not for the Wishards of the world to run a nursing home in Logotee to divert funds back to build a new county hospital that has no relationship to those patients. The program should be limited to nursing homes within a reasonable service area of the hospital. If we had access to our fair share of those funds, we could put in such programs in our community as well.
    • Are you really THAT dumb??
      Reading comprehension, how does it work??

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    1. Socialized medicine works great for white people in Scandanavia. It works well in Costa Rica for a population that is partly white and partly mestizo. I don't really see Obamacare as something aimed against whites. I think that is a Republican canard designed to elicit support from white people for republican candidates who don't care about them any more than democrats care about the non-whites they pander to with their phony maneuvers. But what is different between Costa Rica nd the Scandanavian nations on one hand and the US on the other? SIZE. Maybe the US is just too damn big. Maybe it just needs to be divided into smaller self governing pieces like when the old Holy Roman Empire was dismantled. Maybe we are always trying the same set of solutions for different kinds of people as if we were all the same. Oh-- I know-- that is liberal dogma, that we are all the same. Which is the most idiotic American notion going right back to the propaganda of 1776. All men are different and their differences are myriad and that which is different is not equal. The state which pretends men are all the same is going to force men to be the same. That is what America does here, that is what we do in our stupid overseas wars, that is how we destroy true diversity and true difference, and we are all as different groups of folks, feeling the pains of how capitalism is grinding us down into equally insignificant proletarian microconsumers with no other identity whether we like it or not. And the Marxists had this much right about the War of Independence: it was fundamentally a war of capitalist against feudal systems. America has been about big money since day one and whatever gets in the way is crushed. Health care is just another market and Obamacare, to the extent that it Rationalizes and makes more uniform a market which should actually be really different in nature and delivery from place to place-- well that will serve the interests of the biggest capitalist stakeholders in health care which is not Walmart for Gosh Sakes it is the INSURANCE INDUSTRY. CUI BONO Obamacare? The insurance industry. So republicans drop the delusion pro capitalist scales from your eyes this has almost nothing to do with race or "socialism" it has to do mostly with what the INSURANCE INDUSTRY wants to have happen in order to make their lives and profits easier.

    2. Read the article - the reason they can't justify staying is they have too many medicare/medicaid patients and the re-imbursements for transporting these patient is so low.

    3. I would not vote for Bayh if he did run. I also wouldn't vote for Pence. My guess is that Bayh does not have the stomach to oppose persons on the far left or far right. Also, outside of capitalizing on his time as U. S. Senator (and his wife's time as a board member to several companies) I don't know if he is willing to fight for anything. If people who claim to be in the middle walk away from fights with the right and left wing, what are we left with? Extremes. It's probably best for Bayh if he does not have the stomach for the fight but the result is no middle ground.

    4. JK - I meant that the results don't ring true. I also questioned the 10-year-old study because so much in the "health care system" has changed since the study was made. Moreover, it was hard to get to any overall conclusion or observation with the article. But....don't be defensive given my comments; I still think you do the best job of any journalist in the area shedding light and insight on important health care issues.

    5. Probably a good idea he doesn't run. I for one do not want someone who lives in VIRGINIA to be the governor. He gave it some thought, but he likes Virginia too much. What a name I cannot say on this site! The way these people think and operate amuses me.

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