Stanley Feld M.D., FACP, MACE Menu


Thought You Could Win?

Stanley Feld M.D.,FACP,MACE

There are lots of healthcare systems that think they can win by supporting Obamacare.

It has always been clear to me that hospital systems cannot win by participating in the present rules of the Affordable Care Act.

Major hospital systems are finding that fact out slowly but surely.

“HealthSpan is the insurance arm of Catholic hospital system (Mercy Health).”

The Catholic Healthcare System is one of the top ten rapidly growing hospital systems with a network of 387 acute care hospitals.

The governance of the Catholic Healthcare System thought it could profit from Obamacare, its federal Health Insurance Exchanges and the formation of an Accountable Care Organization.

Mercy Health believed it could profit by setting up an insurance arm for its network and selling insurance in the Obamacare Health Insurance Exchanges.

In order to form an ACO it bought an existing integrated physicians group.

Mercy Health, a 23-hospital system, formerly known as Catholic Health Partners, bought Kaiser’s Ohio business in 2013.

Mercy Health tried hard to make the strategy work for its financially.

I have stated previously that it is very difficult to set up ACOs. The business model is destined to fail because of faulty premises and inadequate cultural and financial incentives.

Patients should be responsible for their healthcare dollars. Healthcare insurance companies should be responsible for financial risk and financial reward by providing the insurance coverage.

“HealthSpan, the insurance arm of Catholic Healthcare System Mercy Health, is getting rid of its medical group (Kaiser) and halting sales of Affordable Care Act policies just two years after acquiring Kaiser Permanente’s Ohio subsidiary.”

The move represents a failure of one health system trying to replicate the much-heralded Kaiser model of healthcare which integrates the payment and delivery sides.

HealthSpan has been a failure financially. Mercy Health’s managers realized that the two new programs became a financial disaster for the entire healthcare system.

The reality is in contrast to the optimistic statement made by CEO Michael Connelly two years ago. His announcement was not dissimilar for the many other statements by hospital systems that are on the road to failure. It almost sounds like they had the same consultant.

In announcing its agreement with Kaiser Permanente, Catholic Health Partners president and CEO Michael D. Connelly said in the joint release, “This opportunity interests us because it preserves a values-based, patient-centered care model that we can expand throughout the region. Additionally, it enables us to focus on enhancing quality, improving access to health care, and effectively managing costs.”

No one ever asks practicing physicians what system will work to Repairing the Healthcare System.

No one every talks about the patients’ responsibility in preventing chronic diseases or once a chronic disease occurs, what is their responsibility in managing the disease.

Until a healthcare system is built around patients’ responsibility along with ways to prevent insurance company, hospital system and physician abuse, a healthcare system will not be built that is cost efficient with increased quality of care.


The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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