Compass Point – Healthcare: Finding healthcare examples to follow

Health officials listened to a variety of options and approaches on how to reform Cayman’s healthcare during a three-day conference exploring how the quality of health services can be improved while reducing costs at the same time. 

At the second national Healthcare 20/20 Conference held at the Ritz-Carlton, Grand Cayman from 17-19 November, speakers delivered examples of how healthcare and insurance systems are run in America, the United Kingdom, Australia and Bermuda, as well as how one major healthcare industry company improved the health of its employees and reduced their insurance premium payments. 

At the conference’s end, health minister Mark Scotland said the information related at the conference gave him and other delegates a lot of food for thought, as Cayman looks to make changes to how healthcare is delivered. 

Dale Sanders, chief information manager in Cayman’s Health Services Authority, who has previously worked for Intermountain, a company renowned in the United States from improving services and cutting costs in its many hospitals, and Seth Avery, chief executive officer of US-based Applied Revenue Analytics, delivered presentations on how to start healthcare pricing and payment models “from scratch”. 

Mr. Sanders’ advice was Cayman had to move away from the US system of billing and price coding for procedures, which he said were overly complex. 

“The US health insurance and claims processing environment is the single greatest flaw in US healthcare system, it’s not physicians, it’s not nurses … It’s the insurance system and payment system in the United States that is causing so much trouble,” said Mr. Sanders, adding the US-centric systems of third party administrators and IT systems greatly influenced how healthcare systems operated in Cayman. 

He said Cayman had an opportunity to reduce the influence of the US system and ultimately become a role model for the United States, citing the recent introduction of the CarePay system with CINICO and the Health Services Authority, which streamlines verification and payment of bills for CINICO members. 

Mr. Sanders said the Health Services Authority sees 35,000 patient financial encounters a year in its hospitals, clinics and pharmacies. About 20 per cent of claims, or 70,000, related to those transactions are denied and resubmitted due to errors and disputes.  

“It can take anywhere from five hours to five days to fix those errors,” said Mr. Sanders, adding the HSA has 750 employees with 103 of them involved in billing and reimbursement. 

Mr. Avery used examples of what he had seen while working with the Bermuda hospital board for six years to “create a more accountable healthcare system for the patients, the payers and the providers”. 

The need for a new hospital, to replace the aging King Edward VII Memorial Hospital, was the impetus for revamping Bermuda’s public healthcare system. 

Studies into, for example, how long patients spent in the hospital for pneumonia were examined to give researchers data from which they could build and create a new hospital with a better, more streamlined system offering better results, Mr. Avery said. 

The old hospital had a “per diem” system, where the patient or the insurance company paid per day during the patient’s stay.  

“The problem with that model is it provides little or no incentive to the hospital to get patients out. It tends to stymie access, it tends to stymie innovation,” he said. 

When the new hospital is completed, the hospital will charge a fixed dollar amount for each kind of case, he said, with the payers, the insurers, the doctors, the IT and administration giving input on creating that new payment and billing system. 

The delegates also heard from Jennifer Attride-Stirling, CEO of the Bermuda Health Council, who expanded on the reforms in the country’s health system and its national health plan. 

Bermuda launched a consultation phase to get feedback from all the players in the healthcare system, as well as from the public. 

One of the approaches Bermuda took to tackling health issues such as diabetes, obesity and infant mortality, was to closely examine its figures and compare them with those of other countries, based on an OECD model of collating and comparing statistics.  

She said she did not expect the statistics gathered to be so wide ranging, but with the cooperation of all of the healthcare sector, data on 98 indicators was collected.  

The information enabled the medical community to address infant mortalities, that were higher than they had previously thought, due to the collation of the data. 

Tami Hutchison, general manager of employer services at Cerner, a healthcare information technology corporation, explained how her company used incentives and preventative measures to create a healthier work force. 

The company has its own inhouse health centre in Kansas with four full-time doctors, where care is fully covered to its staff and their dependents. 

“Most people respond to financial incentives … We provide financial incentives to our associates to be healthier,” Ms Hutchison said, adding competition and social networking also helped drive health improvements at Cerner. 

The company has a high deductible health plan and its staff receive 100 per cent coverage.  

“We said ‘you are going to have a high deductible plan, so if you get sick you’ll have some out of pocket expenses. In order to stay well and encourage early detection and diagnosis, we’ll pay for all of it’,” she said. 

The company increased contributions to staff health plans by $1,000 a year, which members could “buy back to zero doing the right thing” by creating a points system, with each point worth $1. Staff and associates could earn 400 points, or have their contributions reduced by $400 simply by filling out a questionnaire and finding out their health risks. Staff who were tobacco-free were given 200 points, those with BMI in the healthy range received 50 points, those who got flu shots earned 50 points and so on. 

As a result, smoking has nearly been wiped out at the company and the company has seen staff drop a total of 20,909 pounds since it launched a weightloss programme last year. 

Cayman is in the process of examining its own healthcare system and how it is funded. Minister Scotland said the challenge now would be to process all the information and expertise delivered at the conference, as well as input from other sources, and implement changes in the Cayman Islands. 

Dale-Sanders,-Seth-Avery-and-Paul-Nisselle

Speakers at this year’s national Healthcare 20/20 Conference included, from left, Dale Sanders of the Cayman Islands Health Services Authority, Seth Avery of Applied Revenue Analytics and Dr. Paul Nisselle of the Medical Protection Society. – PHOTO: NORMA CONNOLLY
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