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Kaiser Is Moving Ahead to Improve Care and Comply with Reforms

Stalled fiscal cliff negotiations have kept area hospitals, insurance companies and employers puzzling over the next steps to take regarding health care reform in 2013, said Mary Ann Barnes, senior vice president and executive director of Kaiser Foundation and Health Plans in San Diego.

“But we’ve known health care reform was coming and from a public policy standpoint, we are implementing the act — we have no choice,” said Barnes, an expert panelist at the recent San Diego Business Journal’s 2013 Economic Trends event. “We’re still learning what the laws and taxes are — and I think the health of the economy will determine what kinds of tax revenues will go toward funding government health plans in this year and beyond.”

Barnes said that government funding dictates the level of safety net services given, including MediCal coverage, to those who will either lose employer-sponsored coverage or never had it in the first place.

Since it was signed into law in 2010, Barnes said that the Affordable Care Act has driven stakeholders —hospitals, physicians, insurance companies, the local government and employers — to work together to create continued, cost-effective care.

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“From a standpoint of local access to care and efficiency, everyone’s working to find ways to reduce cost, get waste out of system, and really comply with the new national health care laws,” she said.

More Wellness Initiatives

Rather than following the standard fee-for-service model that rewards volume versus value and coordinated care, Barnes said that health care systems are looking to build greater care integration through Accountable Care Organizations. These promote more wellness initiatives from employers, more patient-doctor contact with the help of streamlined electronic medical records, and home monitoring through telemedicine. Kaiser, for instance, has begun dermatology consultations via webcam, and has teamed up with Qualcomm Life to let doctors gauge patient’s blood glucose levels remotely.

Area hospitals have been working on the San Diego Beacon Community Project, an electronic medical record system that allows providers to securely share patient information across health systems. The project was launched in 2010 with a $15.3 million government grant.

“We have been working with local hospitals through the Beacon project to improve the coordination of care and patient management by bridging the communication gaps that currently exist between health care delivery sites,” Barnes said. “We believe connectivity in an integrated system is the game changer for care improvement for chronic disease patients.”

Through the Beacon system, Barnes said patients will get up to the minute, secure information on their health care when they want it and how they want it — allowing patients to take an active role in their health. Barnes called this an important step that will also help reduce redundancy in medical testing and reduce re-hospitalization rates, ultimately driving health care costs lower.

Employers can do their part by inculcating a sense of personal responsibility in the workplace, Barnes said. More “presenteeism,” as she puts it, has a dual-edged benefit — healthy employees are more productive, and avoiding illness ultimately keeps hospital costs and insurance premiums lower.

Plans to Hire Physicians

“People are often at work longer than they are at home, so exercise programs, flu shots and other preventative measures will keep the whole community healthier,” she said. “Larger businesses may have more people on staff to promote wellness, but any business owner can cultivate a healthful work environment — the size of the organization doesn’t matter.”

Barnes said that Kaiser plans on hiring more physicians to accommodate the influx of newly insured patients in 2014. While the number is unknown in San Diego, more than 30 million people are expected to enter the insurance market next year.

There has been a recent spate of local hospital construction projects — in August, Palomar Health opened an expansive, $1 billion hospital in Escondido. Scripps Memorial Hospital is doubling the size of its emergency department in a $93 million expansion project on an Encinitas critical care building. And Kaiser is continuing to expand with a new, 350-bed hospital in Clairemont that is slated to open in 2017.

“We’re all working to make health care more affordable, and allow greater access for all the newly found people who have not had health insurance,” she said. “There’s going to be significant expansion in San Diego to be ready for health care reforms to take effect.”

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