The large healthcare systems of today could become giants in a decade.
That vision was summoned up by healthcare leaders yesterday at an event focused on the state of health in New Jersey.
Robert Wood Johnson University Hospital Hamilton President and CEO Anthony “Skip” Cimino said he envisions “five or six” systems dominating healthcare in New Jersey by 2023.
“The model that we see today will be dramatically different,” with much greater coordination of care and focus on patient outcomes, Cimino predicted toward the end of an annual conference hosted by the nonprofit Council on State Public Affairs at the RWJ Hamilton Center for Health & Wellness in Hamilton.
Cimino also expects the merger of Rutgers University and the University of Medicine and Dentistry of New Jersey to strengthen the state’s status as a center for healthcare research.
Not only will there be fewer hospital systems, but more healthcare will be delivered outside of hospitals, said Dr. Kenneth N. Sable, executive vice president and chief operating officer of Saint Peter’s Healthcare System.
Sable added that as hospitals build up strength in specialized areas, different hospitals in the same region will offer different services.
“It’s not that every hospital will do everything for all people,” he said in response to questions from healthcare attorney James A. Robertson, a partner with McElroy, Deutsch, Mulvaney & Carpenter LLP in Morristown, who led the discussion.
Sable also predicted that the overall health of the state’s population will improve. He pointed to improvements in pediatric care, including a reduction in dangerous sepsis infections, as a sign of good things to come for the overall population. He added that he expects less need for hospital stays for patients with a wide range of conditions.
“I think this recipe changes the need for these huge, many-building hospitals all over the place, and that consolidation will be part of that,” Sable said.
Dr. Mary Campagnolo, president of the Medical Society of New Jersey, said consolidations will occur across traditional boundaries, creating “conglomerates” that are no longer recognizable as hospital-centered systems.
“We’re seeing pharmacies joining in with accountable care organizations and physician groups,” said Campagnolo, referring to arrangements in which an insurer attempts to compensate providers for how well they perform and keep costs down, rather than for each service they provide.
The new conglomerates “may not be the traditional health systems as we think of them,” said Campagnolo, chief of the family medicine department at Virtua-Memorial Hospital in Mount Holly.
Campagnolo added that doctors will increasingly become “leaders of teams,” which include other providers.
She added that while she hopes doctors continue to do in-person diagnoses of patients, they will also be basing more decisions on data that’s been collected on patients.
Campagnolo said having hospitals that are more specialized could also reduce the patchwork of healthcare services in the state.
“It should drive down costs, if it’s not doing that, then we’re probably not doing the right things so that New Jersey can become a much more efficient state for healthcare,” she said.
Campagnolo said after yesterday’s event that it’s essential for healthcare providers to continue to make decisions based on the needs of patients, regardless of how large healthcare conglomerates become.
The discussion on the future of long-term future of healthcare followed panel discussions on the implementation of the health benefit exchange and Medicaid eligibility expansion, key features of the 2010 Affordable Care Act that are both scheduled to beginning covering more New Jersey residents on January 1, 2014.
Seton Hall health law professor John V. Jacobi noted the challenge involved in informing uninsured residents about the new options. The exchange will be an online marketplace in which uninsured people can buy coverage and learn whether they are eligible for federal subsidies.
The panelists said the ACA is primarily focused on expanding access to care, but further work is needed to control healthcare costs.
Former Gov. James Florio said the biggest issue with implementing the ACA will be “impatience – people wanting to have all these things resolved sooner rather than later and that’s somewhat unreasonable, in the sense that we’re talking about one-fifth, roughly, of the gross domestic product, represented in healthcare costs. So we have to have a little bit of patience as we try to reconcile costs, quality and access.”