Photo courtesy of Westchester Medical Center
As the largest sector in Westchester’s economy, healthcare is big business here. And it’s undergoing big changes — with ramifications for patients, insurers, employers, and providers.
By David Levine
What happens in healthcare matters. It matters to patients and their families, obviously. But it also matters to the economy. Healthcare is an anchor of business in the Westchester region and it is an $18 billion industry supporting more than 52,000 jobs, according to Amy Allen, vice president of the Westchester County Association (WCA) and executive director of the Hudson Valley Workforce Academy. “Healthcare is a leading focus of the WCA’s policy and advocacy initiatives,” she adds, including development of a workforce that has the skills and knowledge to deliver in the ever-changing realms of healthcare tech, patient engagement, payment models, and other emerging trends.
Indeed, these trends occupy much of the time and energy of healthcare leaders in Westchester. Here, some of those leaders describe what’s at the top of their agendas and how they are meeting these new and evolving needs.
Photo courtesy of WestMed Medical Group
The Consolidation/Integration Wave: What Now?
For the past decade at least, consolidation among healthcare players has been the dominant theme. “It’s been massive and fast, hasn’t it?” asks Joel Seligman, Northern Westchester Hospital’s president and CEO. These days, health systems need to be large enough to offer the full range of services patients need and to negotiate better payments from insurers. “Medicine practiced as a mom-and-pop industry is now passé,” Seligman says. “It is a tough environment to go it alone. The regulatory and capital requirements are hard to manage on a small scale.”
But with mergers and acquisitions at or near the saturation point, these newly grown systems are working to integrate and standardize care among their various parts. “As an industry, we should be standardizing care based on the very latest evidence,” Seligman says.
To meet the requirements of today’s demanding patients, Westmed Medical Group has made significant investments in technology and telehealth. Photo courtesy of WestMed Medical Group
In a sense, this amounts to creating a unified brand for the health system. “Patients don’t have to leave Westchester County to get care from NewYork-Presbyterian. The goal is to ensure that all patients are treated the same way regardless of which NYP hospital or medical office they seek care from,” says Michael Fosina, president and CEO of NewYork-Presbyterian/Lawrence Hospital. Standardizing care includes using the same doctors and equipment and following the same protocols. Fosina explains, “For instance, the cardiac-cath lab at Lawrence cares for and treats patients in an identical manner to our cath lab at NYP/Columbia University Irving Medical Center.”
With limited merger opportunities left, the focus now is on strategic relationships within the industry, notes Anthony Viceroy, CEO of Westmed Medical Group. “That could be among medical groups and hospitals, medical groups and technology [providers], any relationship that helps lower the cost of care, creates better access, and allows collaboration around innovation,” he says.
Providers like Northern Westchester Hospital are focused on keeping more patients out of the hospital, in order to control costs and better aid the sickest patients. Photo courtesy of Northern Westchester Hospital
The Changing Role of Community Hospitals
“Hospitals used to be the center of the universe. Now they are often viewed as the high-cost part of the healthcare continuum,” Seligman says. That shift in thinking is a good thing, he feels. There is much more focus on keeping people out of the hospital, because it’s good for both patients and cost control. That means more care is offered in lower-cost settings, like doctor’s offices, outpatient clinics, and urgent-care centers.
Community hospitals, meanwhile, are more focused on advanced care for emergencies and advanced-disease cases. Because they are now associated with larger health systems, these hospitals are being staffed and equipped to perform more complex surgeries and participate in clinical trials, to give local patients access to the latest options without having to travel to bigger cities for it. Northern Westchester Hospital (a member of Northwell Health), for example, was recently designated as a Center of Excellence in robotic surgery.
At the same time, hospitals are working to help reduce problems like hospital-acquired infections and readmittance, because new payment models under the
Affordable Care Act (ACA) reward these lowered instances. “There is a large shift in the hospital perspective, from focusing on what happens in our four walls to the entire continuum of care,” says Dr. Michael Palumbo, executive vice president and chief medical officer at White Plains Hospital. Hospitals need to partner more closely with primary-care providers, post-acute-care centers, and social-services providers, he says. For example, one of the biggest risks for readmission is lack of follow-up care after discharge. Hospitals now work hard to ensure patients have follow-up appointments made before they leave and even find transportation to get them to appointments. “That may not be traditionally what we considered our responsibility, but that is the evolution,” Palumbo says.
Photo courtesy of Northern Westchester Hospital
Embracing Population-Health Management
This shift in hospitals’ approach is also part of the overall move in healthcare toward population health management. The historic model of healthcare, called fee-for-service — in which providers are paid for what they do, whether it’s necessary or not — is shifting to value-based care, in which providers are paid for good outcomes and keeping people healthy. This, in turn, fosters a more preventive, population-based health system.
“We have about 40 members on our population-health team,” says Dr. Richard P. Morel, deputy chief medical officer at CareMount Medical. This team, comprising mainly nurses, focuses on transitions in care — a vulnerable time for many patients — when they move from the hospital to rehab or to home as an outpatient. “We have hired care coordinators to make sure there are ‘warm’ handoffs and communication around reconciling medications and appropriate follow-up care,” Morel says. This approach, he explains, “leads to superior care and better outcomes. In the long term, ideally, it will lead to lower costs.”
With these new responsibilities come new risks, though. There are financial repercusions for providers who don’t meet ACA requirements, which is another reason for increased consolidation in the industry: “You need to be a certain size to accept the downside risk [of this approach to healthcare],” Morel says. “We have about 28,000 Medicare patients, with about $300 million at risk. If we meet our targets, we have shared savings. If we go over cost, we have to reimburse CMS [Centers for Medicare & Medicaid Services].”
Some provider groups have taken on too much of this risk and failed, Morel adds. “We need to proceed cautiously. There is still a need to do fee-for-service, and it’s the classic one-foot-on-the-dock, one-foot-in-the-boat scenario. You need to manage both risks and rewards.”
Cardiac catheterization labs throughout the NewYork-Presbyterian system use the same equipment and protocols to ensure a consistent standard of care. Photo courtesy of NewYork-Presbyterian/Lawrence Hospital
New Frontiers: Tech-Based Health Services
Using the telephone as the main means of communication with patients is a practice that is slowly dying. Younger patients, especially, demand instant online access to their providers. Thus, online communications tools and telehealth are becoming more mainstream — and healthcare providers are embracing this new way of doing business. There is a push, Morel notes, “toward online appointment-making, secure portals for communicating with providers, telemedicine for 24/7 televisits. How care is delivered will change a lot in the next five years.”
For example, in October 2017, Westmed Medical Group launched its new “My Westmed” mobile app, enhanced online patient portal, and redesigned website. These investments in technology and telehealth are helping Westmed meet the requirements of more demanding patients, Viceroy says. “Patients have a lot of choices, so you want to be mindful to have every touchpoint covered,” he explains.
Telehealth leverages the power of integrated institutions to allow patients to receive the care normally associated with big-city medical centers, right in their backyard. “In our ER, if a stroke patient comes in [to NYP/Lawrence], we have the equipment to connect his doctor with a neurologist on-site at Columbia to provide real-time access to second opinion sub-specialty care,” NYP’s Fosina says. “The technology is so good, doctors can diagnose and treat a patient based on the advice from our specialist at Columbia.” Or, a patient with epilepsy can have an EEG at Lawrence Hospital, monitored by a neurologist specializing in epilepsy at Columbia who can read the results in real time. “You have two pair of eyes looking at the patient, to provide higher-quality care,” Fosina explains. “These are pretty exciting opportunities we get by being part of a larger entity.”
The Westchester Medical Center Health Network (WMCHealth) has also developed a robust telehealth infrastructure, covering a wide variety of services at the community, outpatient, and inpatient levels. Its 5,500 sq. ft. telehealth hub in Westchester connects facilities in its 10-hospital health network in such areas as psychiatry, ICU care, trauma and stroke, and even ambulance-based care, says Michael Israel, president/CEO of WMCHealth. Overall, telehealth is not as robust as it could be, in part because of government oversight. “The rapid advancement of this telehealth technology has not been matched by the regulatory environment, which has failed to keep pace,” he says.
Telehealth and other Internet- and tech-based healthcare services are completely transforming the industry, says the WCA’s Allen. Recognizing the economic potential and demand for telehealth, the WCA has been advocating universal gigabit-speed broadband in Westchester. “Having reliable and affordable highspeed broadband will be key to unlocking innovation and growth in the Westchester healthcare industry,” Allen says.
Photos courtesy of CareMount Medical
Powerful computing also allows healthcare organizations to compile a mind-boggling amount of information, and they are employing more artificial intelligence and data analytics to turn that data into action.
Westchester County is part of a health-information exchange, or HIE, called HealthlinkNY, which helps power this data revolution. The HIE connects participating Hudson Valley hospital and major health providers’ electronic-health-record systems, storing that patient information securely, in the cloud. This allows doctors immediate access to a patient’s medical history, promoting more efficient and effective care at the personal level. All that data is being used at a macro level, as well, to identify larger, population-based health challenges so that providers can intervene early. For example, the diabetes epidemic is being fueled by the one out of three Americans who have prediabetes — a constellation of symptoms that, left unchecked, will likely develop into full-blown diabetes. HealthlinkNY uses its data to collaborate with regional health departments and county health providers to find patients who have prediabetes and begin early interventions to prevent the disease.
“We finally have the opportunity to apply more science to medical practice as to what really works, what are the desired outcomes,” adds Seligman. Northwell Health is heavily invested in data analytics, he says. “We are building databases that allow us to answer questions on outcomes that we weren’t able to answer before.” That includes learning what doesn’t work, which allows organizations to divert spending from treatments that don’t have meaningful outcomes. “A decade ago, most of this data was handwritten in medical records, making analysis nearly impossible,” Seligman says. “It is still far more difficult than it should be to bring together all of this data, but we’re turning the corner finally.”
Photo courtesy of Formé Medical Center
Insurance and the Cost of Care
Cost and accessibility are still the top problems in healthcare today, says Heyward Michael Dreher, associate vice president for healthcare innovation and special projects, and professor at the School of Nursing & Healthcare Professions at the College of New Rochelle. “Overall cost of the ACA has gone down, but long-term projections are that we did not do enough to manage cost,” Dreher says. “Access is still variable, and with changes and uncertainty at the federal level, it is unclear if access will get worse or stay the same. I don’t think it will get better.”
The problem, as he sees it, is that the ACA has not been improved upon, unlike other social legislation, like Social Security and Medicaid, which were fine-tuned over the years. “Because of the animosity toward the ACA, the kind of tinkering that makes good legislation has not been done,” he says. “There has not been a single change to improve the ACA. The worst parts still remain. That, in itself, is almost unspeakable.”
Coverage at the state level is also in flux. “With the recent changing of power in the state senate, proposals for single-payer healthcare and mandated nurse-staffing ratios are buzzing around Albany, adding to the flood of uncertainty at the state and federal levels about the future of healthcare policy and regulation,” Allen says. The WCA Healthcare Advisory Board, made up of leaders from healthcare systems and physician practices, is advocating legislative policies “that protect the foundation of our healthcare ecosystem,” and reduce the costs of care, she says.
However, from chaos often comes innovation. Businesses are adapting their services and business models to make better sense for the new healthcare realm. New York City-based Oscar Health, for instance, debuted in 2012 and bills itself as a technology-focused health-insurance company. In 2017, Oscar decided to build its own narrower network, cutting the number of doctors it covered by 50 percent and consolidating its hospital coverage around Montefiore Health System, Mount Sinai Health System, and the Long Island Health Network, according to Crain’s New York Business. Now, the upstart company is moving into Westchester, adding three major local providers to its network — Northwell Health, Memorial Sloan Kettering Cancer Center, and Westmed Medical Group. Oscar’s brand-new small-business-focused Circle Plus program will be among the cheapest at all tiers in 2019, according to data from the Department of Financial Services.
Formé Medical Center in White Plains, which began as an urgent-care/walk-in clinic, has evolved into a healthcare company that offers tiered membership plans — similar to a gym membership. The three membership options are available to anyone seeking care, but are especially attractive for people who don’t have or can’t afford healthcare coverage. Plans start at about $30 a month and include doctor visits, urgent-care visits, and other services.
According to its founder and president, Gina Cappelli, Formé is a licensed diagnostic treatment center. “We can do pretty much everything — primary care, specialty care, physical therapy, diagnostics, even minor surgery.” Formé CEO Maria Trusa adds: “We are here for those who don’t qualify or can’t afford even the contributions [toward health insurance] they have to pay at work.” There are about 183,000 uninsured people in Westchester County, not including undocumented workers, Trusa says. “We are trying to get people who are uninsured to sign up for membership so that Formé can provide primary-care and chronic-care management, so they don’t end up in the emergency room,” she notes. If Formé members do need hospitalization, they can receive emergency Medicaid care.
The program started in March 2018 and now has about 800 members. “If we get 3,000 members, the membership program breaks even. After that, we make money and expand to other locations,” Trusa says. “Our goal is that anyone uninsured has a place to come get guidance about healthcare. We can help patients navigate a very complex system.”
Photos courtesy of WMCHealth
Patient Experience and Empowerment
Patients today are more educated and expect a lot more from their healthcare providers, says Westmed’s Viceroy: “The buzzwords are patient experience. Ten years ago, you never heard a phrase like that. Now it is the end-to-end solution. If patients don’t like the parking or wait times, that’s a problem. It is not just providing high-quality care. It’s also the service. Westmed knows that better patient experiences lead to better healthcare outcomes.”
To appeal to their patients, many healthcare organizations are doing more than just improving parking and adding organic free-trade coffee options. They are including patients in decision-making. “Patient empowerment is a major and wonderful trend,” Seligman says. “We are taking patients out of their gowns and putting them in charge of their care.”
At Northern Westchester Hospital, he notes, patients sit on boards and committees, and their voices are represented in everything from processes and protocols to hiring. For instance, patients or family members of patients who had spent time in the ICU helped create specific education for other caregivers about the use of ventilators during intensive care. Patients have also been involved in redesign processes to improve the prenatal, labor-and-delivery, and postnatal-care experience. “We are getting feedback from the only people who actually know what the patient wants,” Seligman says.
That may be the overarching theme among all of the trends transforming healthcare. Patients, especially those younger ones who have grown up in the digital age, want healthcare to be no different than every other product and service they consume. Order it online. Get it fast. Get it cheap. But it better be good. If it works for Amazon, it had better work at Mytown Hospital and Neighborhood Physician Group. The good news is, smart healthcare leaders are working hard to meet these demands while surfing the turbulent waves of business requirements, regulatory agencies, and, frankly, political whim. Those who make it safely to shore will deliver high-quality care at lower cost — which is good for patients and for the nation.
Freelance writer David Levine is a frequent contributor to 914INC.