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Moving from volume-based to value-based health care

The problems of the U.S. health care system are well documented soaring costs, low customer satisfaction, increasing problems with quality and restricted access to care. These issues are gripping the psyche of most Americans who worry about what their health care will cost and what level of quality they can expect.

There is no single system that can take care of the demands of an entire region. As a formal ministry of the Catholic Church, Catholic Health must remain independent to fulfill its mission. It's also widely proven that competition reduces costs, while monopolies drive them up. The delivery of health care services is elevated and costs are reduced when there is both healthy competition and collaboration, and when patients have a choice.

The School of Medicine and Biomedical Sciences at the University at Buffalo focuses on research, teaching and patient care to support its first two disciplines. The academic medical setting is important to the health care delivery equation, advancing research and educating new doctors.

Catholic Health, on the other hand, has developed a unique organization, a high-performing health care system, that is positioned to deal with the reductions the health care industry is facing, while maintaining high-quality, nationally ranked care for the patient -- providing the right care, in the right place, at the right time and at the right cost.

After decades of operating in an industry full of redundancies and unnecessary expenses, our efforts to control rising health care costs are impacting patients in a positive way. Today, Catholic Health cares for 40 percent to 50 percent of the marketplace, depending on the service line.

The system's transformation hasn't happened overnight, but over a period of several years that began long before the Berger Commission was created to respond to community needs for high-quality, affordable and accessible care. At a time when Medicare is the nation's largest insurance program, reducing health care cost isn't just an option, it's a matter of survival.

Today, in this new paradigm, we are being recognized as a model for other state and national systems to follow. We have set the bar on quality and safety, controlling costs through delivery efficiencies, setting new performance standards and incentivizing providers to reward better quality care, not more care.

By rebalancing our focus -- from a traditional hospital-based medicine model to a more accessible, lower-cost, outpatient and sub-acute delivery model, we are adding value to every patient experience and gaining the highest state, federal and industry ratings for care in the region.

Catholic Health is ranked the top integrated health care system in New York State, the third in the Northeast and 30th in the nation. It has again received the most five-star and quality Excellence Awards of any Western New York health provider from HealthGrades, the nation's leading objective rating source studying patient outcome information based on federal Medicare data. The Society of Thoracic Surgeons continues to recognize Catholic Health in the top 15 percent nationally for cardiac surgery performance with a "three star" award for quality, its highest rating. And according to the New York State Department of Health, the Mercy Heart Center has achieved the highest scores in cardiac care in the region, proving that you don't need to be the biggest to be the best.

Catholic Health's goal is to have our standard of care integrated at every stage and location of the patient experience, and that includes our physician partnership with Catholic Medical Partners (CMP). This network of 900 Western New York physicians shares our vision of a new and improved patient experience, one that saves time and money while adhering to nationally recognized practice standards.

A key component of this partnership is strong disease management programs through the creation of Patient Centered Medical Homes at CMP. Administered by more than 120 nursing care coordinators placed in primary care practices, our attention is focused on patients with chronic medical conditions, representing 75 percent of the nation's health care spending. By helping patients take a more active role in their own care, we are reducing hospital admissions and the need for more expensive intervention.

Care coordination between Catholic Health hospitals and CMP member physicians is facilitated by the area's most advanced electronic medical records system. With more than 75 percent usage compared to 25 percent nationally, this unprecedented level of communication allows physicians to speak in real time, reducing repetitive testing and properly managing treatments and medications, and ultimately bending the health care cost curve. Only 69 hospitals in the country have achieved this standard.

And by expanding our geographic footprint and creating partnerships with Mount St. Mary's to the north and Bertrand-Chaffee and Cuba Memorial to the south, patients now have access to specialty services that didn't exist or were geographically out of reach up until two years ago. It's our goal to work with community hospitals to help strengthen their ability to care for patients rather than bring them to Buffalo unnecessarily, ultimately weakening their care systems.

By working together and changing the way we operate -- to thrive in an era of health care reform -- Catholic Health is empowered to give patients the kind of care they trust, and the kind of experience they value. As a result, we are prepared for the industry shift from a "pay for services" to a "pay for outcomes" model; leading the region in health care reform.


Joe McDonald is president and CEO of Catholic Health and chairman of the Healthcare Association of New York State.