Nancy H. Shanks

University Healthcare System (UHS) has been a major player and been successful for over 100 years in a large west coast metropolitan area. It operates an EMS system, is a Level 1 trauma facility, is affiliated with a major medical school, has associations with feeder hospitals around the state, maintains centers of excellence in many areas of medicine (including cardiac, cancer, and women’s and children’s care), is known for conducting cutting-edge research, and is viewed as one of the preeminent leaders of medical care in the community, as well as the state. That said, the UHS leadership team has begun to recognize that they may be out of sync and that the world of health care is rapidly changing.

Consumerism is becoming one of the waves of the future. After reading several recent articles and reports about disruptive innovation and how other large health systems around the country are beginning to work with retailers to provide services, to connect with consumers, and to potentially channel patients to other services within their health care systems, the UHS leadership team thinks that it may be time to consider moving in this direction. In particular, the team recently noted that Kaiser Permanente, one of its major competitors, had begun partnering with Target, had set up walk-in clinics in several Target stores, and was staffing the clinics with Kaiser employees. Kaiser had also hired a Director of Consumerism who was spear-heading its ventures into consumer directed health care.

UHS has always operated from a volume-oriented mindset, but now knows that this too is changing. The Centers for Medicare and Medicaid Services (CMS) is moving toward a value-based approach in reimbursing for Medicare patients. CMS does not want patients to have surgery, be discharged quickly, sent home, and then readmitted with complications. CMS also doesn’t want to pay for a second admission and wants better quality and outcomes for patients. That is, CMS wants patients to be sent home, have their care coordinated, not experience complications, not have to struggle through multiple hospital stays, and not be exposed to nosocomial infections.

While the leadership always thought UHS was providing the best health care, the institution now realizes that it has focused on providing mainly medical care in an inpatient setting and has done little to keep people out of the hospital and to promote health and wellness. It’s time to start thinking outside the box and to change the organizational mindset. UHS has, however, never done anything like this and really doesn’t have the expertise to do it. This is going to force the leaders to make some significant changes in many different areas and to involve several different departments in brainstorming how to approach partnering with a retail organization to deliver care at different sites.