Gary Stanton and other area healthcare and insurance leaders meet to discuss the present and future of healthcare in the Kansas City area. This healthcare industry outlook was orchestrated by Ingram's Magazine and sponsored by BlueCross BlueShield KC and Lockton Insurance. The event took place in May 2012.

1. Health Professionals Prepare Amidst the Uncertainty
On the unusually cool last day of May, at the Lockton headquarters high
above the Country Club Plaza, a score of local health-care leaders met to sort
out the present and future of health care in the Kansas City area and beyond.
This was the 13th annual Health Care Industry Outlook orchestrated
by Ingram’s Magazine. Sponsoring the event were the Lockton Companies and
Blue Cross Blue Shield of Kansas City, also known as Blue KC. Ably co-chair-
ing the event were Rick Kahle, president of the benefits operation at Lockton,
and Danette Wilson, Blue KC’s group executive for external operations.
In a time of uncertainty—the Supreme Court ruling on health-care
reform is expected by the end of this month—the participants seemed well-
prepared to deal with the future—whatever that future might be.
Healthcare Industry Outlook
(front row, left to right)
Rick Kahle, Lockton Companies
(Co-Chair and Co-Sponsor)
Brian Stewart, Athletic
& Rehabilitation Center
Gary Stanton, Women’s Health Network
Danette Wilson, Blue Cross Blue Shield
of Kansas City (Co-Chair and Co-Sponsor)
Christine Wilson, Mid-America
Coalition on HealthCare
Carolyn Watley, CBIZ Benefits &
Insurance Services
Frank Devocelle, Olathe Health System
(second row, left to right)
Dr. Jeffrey Kramer, Univ. of Kansas Hospital
Lori Mallory, Kansas City Internal Medicine
Jill Watson, Metro Med
Jill Ebbers, Children’s Mercy Hospital
Dr. Stephen Salanski, HCA Midwest
Dr. Nathan Granger, Clay-Platte
Family Medicine Clinic
Dr. Ian Chuang, Lockton Companies
Dr. Mark Laney, Heartland Health
(back row, left to right)
Dayna Hodgden, Encompass Medical Group
Chris Hansen, Univ. of Kansas Hospital
Kevin Sparks, Blue Cross
Blue Shield of Kansas City
Scott Helt, Univ. of Kansas Hospital
Evan Peters, Cigna
12IndustryOutlook
Sponsored by:
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2. IT Readiness
Like many of the participants, Dan-
ette Wilson was not inclined to speculate
on how the Supreme Court might rule.
If nothing else, Wilson believes that
the move to reform has sparked some
new conversations among the people
around the table. One conversation has
been about information technology.
She wondered whether the health com-
munity was to adapt to any changes in
law and to take full advantage of exist-
ing technology.
Chris Hansen, senior vice president
at University of Kansas Hospital, spoke
to the catchphrase of “meaningful use.”
As he explained, the government is
willing to help hospitals and other eli-
gible providers automate medical records
if they do so in a “meaningful” way, one
that accrues obvious benefits.
One of the meaningful variables is
quality. To measure this, however, requires
doctors to do a lot of box-checking on
questions like, “Did you talk to the patient
about not smoking?” This tends to slow
doctors down. Still, Hansen remains
optimistic.
“If you can get past the productiv-
ity issues with the system and some
of the negative aspects of having to
document things that people might
not feel they should have to do,” said
Hansen, “you’re going to have data in
there that actually you can transmit to
somebody, that you can actually use
proactively to manage the care.”
In that his system just went live a
few week ago, Nathan Granger, a family
physician with the Clay-Platte Family
Medicine Clinic, he had some fresh expe-
rience to share. As he noted, a physician
with a chronically ill geriatric practice
has been creating paper charts for 20 or
so years. Trying to transform that into
an electronic health record while run-
ning full blast to take care of a full panel
of patients, said Granger, “is daunting.”
It has taken his practice a few years
to make that transformation.
Hansen observed that hospitals
working with Blue KC can pre-load into
their systems information on patients
with chronic illnesses. Still, he does not
know how small hospitals or doctor
offices manage the transition. He won-
dered whether mandatory automation
would “force consolidation of primary-
care providers because they can’t afford
the IT infrastructure.”
“I’ve talked to hospital executives
who expect there to be more consolida-
tions,” confirmed Jill Watson, executive
director of the Metropolitan Medical
Society. Some physician practices, she
RIGHT AT HOME
Blue Cross Blue Shield of Michigan reported last year that its first foray
into cost reductions through patient-centered medical homes had provided
promising evidence of their ability to reduce the overall costs of health care.
Among them:
• A 2 percent drop in radiology visits for covered patients.
• A 1.4 percent reduction in adult emergency-room visits.
• A 2.2 percent drop in pediatric emergency-room visits.
• A 2.6-percent decline in inpatient admissions.
• Overall patient care costs fell about 1.2 percent.
While no huge swings in any one category, when spread out across an insured
base of 2 million people those numbers represent a significant improvement
in the health-care cost curve, Blue Cross officials say.
1. Rick Kahle saw huge benefits coming from patients’ having ready access to their health
records. | 2. Danette Wilson asked the probing question of whether health-care information
technology was as advanced as it needed to be. | 3. Nathan Granger said IT challenges required
huge investments of time from staff and physicians. | 4. Chris Hansen noted that, once the
productivity issue was resolved, use of data could improve the quality of care.
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3. 1 2
4
1. Mark Laney pointed out that using physicians for routine conversations was an inefficient
use of an expensive health-care resource: A doctor’s time. | 2. Dayna Hodgden said about
25 percent of patients at Encompass Medical Group make good use of their available records.
3. Evan Peters saw the benefits of records access as a patient, and said his own doctor real-
ized those, as well. | 4. Frank Devocelle questioned how the concept of “best practices”
in health care would be defined—and by whom.
3
explained, are choosing to consolidate
with their hospitals “so they don’t have
to make the choices.”
Stephen Salanski, a family physician
with HCA Midwest and program direc-
tor at the Research Family Medicine
Residency program, has observed the
challenge from a number of angles.
HCA, a large national enterprise, was
one of the first systems in the coun-
try to move to electronic records.
And yet, as Salanski noted, HCA is
“still having troubles with processing
and moving our old records into the
system.”
Paperwork, or the digital equivalent,
is taking more time now, not less, and
“meaningful use” is still not what it
should be. “I’ve talked to colleagues in
other systems,” said Salanski, “and every
system seems to be lagging.”
Gary Stanton, executive director of
the Women’s Healthcare Network, be-
lieves that the Internet-savvy consumer
is helping drive the move to automation.
One of the problems his organization
has encountered in responding is the
cost in time and money of training.
“There’s only so much time,” he said.
Getting physicians trained is “cum-
bersome at best,” especially for those
providers lack-ing the proper resources.
From the consumer perspective, Rick
Kahle sees “huge benefits” in getting
access to relevant health information.
He asked his colleagues how pushback
from patients had changed relationships
in the world of electronic records.
HCA is going to go on a live-line
patient portal this summer, said Salanski.
Patients will have access to some of their
records and lab results after these have
been signed off by a physician. “We’re a
little nervous about what that all means,”
said Salanski, “and how that changes
our interactions with patients.”
Encompass Medical Group, observed
CEO Dayna Hodgden, has 32 physicians
who have met “meaningful use” criteria.
Encompass has been using electronic
medical records since 2008. “We had
to commit a lot of resources and hire
quite a few people to make that system
work for them,” said Hodgden. To
date, though, only about 25 percent of
the patients have taken advantage of
the patient portal to access their data.
When they do use it, Hodgden added,
“it has been a good thing for the patients.”
Chris Hansen sees the value in pat-
ient access, but cautioned that doctors
have to be very careful about the lang-
uage they use, lest patients fail to under-
stand it. A secondary issue, of course, is
reimbursement. Technically, there is none
for electronic patient-doctor exchanges,
even those that are time consuming.
“From the patient’s side of things,”
said Evan Peters, the vice-president of
network management for Cigna Health
Care Plan of Mid-America, “I love this
system.” An early adapter, he regularly
communicates with his own physician
electronically. “I love the ability to do
that, but I understand there’s a cost
associated with this system and some-
thing has to support that.”
Collaboration
Rick Kahle asked his colleagues
whether “health-care silos” were giv-
ing way to new collaborations among
health-care entities.
Mark Laney, the president and CEO
of Heartland Health and a pediatric neu-
rologist by training, explained that phys-
icians were effectively “siloed” in their
private practices and lacked electronic
medical records with which to communi-
cate. This made it hard to coordinate care.
Now, Laney believes, “We face a dif-
ferent kind of silo.” He attributes this to
a growing “shift mentality.” Not want-
ing to work the hours older physicians
once did, younger physicians practice
in such a way that there may be two or
three “handoffs” of patients over a period
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4. of several days. This may lead to some
confusion, added Laney, about “who’s
my doctor?” Given this development,
electronic medical records become more
important as “the source of truth.” Said
Laney, “I think it’s critically important that
we practice evidence-based medicine.”
“I think we’re going to see more
standardization,” said Frank Devocelle,
president and CEO of Olathe Medical
Center. He sees the industry “headed to-
ward best practices.” Although Devocelle
thinks this will be good for the patient,
he sees a need for a definition of what
“best practice” means. “I don’t know if
that lies with the insurance companies
or government,” he added, “but I think
there needs to be some direction given.”
According to Evan Peters, one of
the services Cigna has been rolling out
across the country is known as a “collab-
orative accountable-care organization.”
With these integrated arrangements,
said Peters, “It can’t just be the unit cost
you’re looking at. It has to be the out-
comes. It has to be the quality. It has to
be the patient satisfaction.”
Danette Wilson addressed the evolu-
tion of patient-centered medical homes,
now in their fourth year of operation in
Kansas City. Basically, those are health-
care settings that create partnerships
between patients and their personal
physicians and, at times, the patient’s
family. The concept depends on infor-
mation technology, health-information
exchange, registries, and other aids to
ensure that patients get appropriate
care when and where they need it.
“One of the things we are doing
through that model,” said Wilson, “is
paying for care coordination, paying for
things that carriers have not paid for
in the past.” Wilson contended that
most carriers recognize that the tradi-
tional fee-for-service arrangement will
not be sustainable in the future.
Consumer Expectations
Danette Wilson worries about those
patients who think the Web is the “source
of truth.” She wondered how access to
medical information had changed the way
doctors approach bringing care to patients.
“Our job,” said Mark Laney, “is to
provide the sites that we think are evi-
dence-based and are excellent sources of
information.” He added that the health-
care industry could not achieve what
it hoped to unless it had engaged patients.
Danette Wilson believes, in fact, that
patients have been getting more and
more engaged. She told of hearing a good
deal from consumers about issues like
transparency and access to information.
She asked her colleagues what providers
were doing to prepare for increased cus-
tomer demands for access to information.
The University of Kansas Hospital,
said Scott Helt, vice president of contract-
ing, has already set up patient resource
centers with plentiful literature and easy
Internet click access to good, trusted
information. “This makes it easier for
the patients to get information that is
validated and is evidence-based,” said
Helt, “as opposed to ‘Uncle Harry had
the same thing 50 years ago.’”
Evidence-Based Medicine
Christine Wilson, president and CEO
of the Mid-America Coalition on Health-
Care, sees a constant improvement in
the development of evidence-based care.
One reason why is that employers in
Kansas City are watching its progress very
closely. That much said, Wilson acknowl-
edged a substantial lag time between
a given innovation and its widespread
adaptation. Still, she has been encouraged
by the collaborative effort of Kansas City-
area providers in sharing information.
Brian Stewart, chief marketing
and clinicians officer for the Athletic
and Rehabilitation Center in Overland
Park, spoke to the issue of collecting
information from employers to improve
overall service delivery. He cited three
reasons for this effort.
One is to create a model of an “ac-
countable consumer” and an “account-
able provider.” Two is to review the data
internally to see which clinicians are
doing the best job and to partner them
with clinicians who could use their assis-
tance. Third is to be able to make plan-
ning decisions that are truly “objective.”
Rick Kahle asked his colleagues how
they could leverage information to get
the best outcomes. Ian Chuang, medical
director and senior vice president at Lock-
ton, expressed some caution about the use
of data at this stage. Given the inevitable
inconsistencies, Chuang suggested that
providers define a standard, practice it,
analyze it, and figure out if there is
a way to do it better by looking at the
1. Scott Helt noted the emergence of patient resource centers that help people learn more about their own health. | 2. Brian Stewart said
that accountable health care had to include accountability for both the insured worker and his company. | 3. Gary Stanton cited the high costs
of training as an issue for medical offices incorporting new technologies.
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5. data. The challenge now, he said, is to
tie the clinical data with group data from
some of the higher-level employers and
assess the impact.
“The next step,” added Christine Wil-
son, “is to make sure that the inform-
ation is in a format that it can be given
to a patient or to a caregiver, so that
they can make an informed decision
with their physician.”
Chuang worried openly about the buzz-
words of cost transparency. “In our pur-
chasing patterns,” he said, “we don’t us-
ually want to buy the cheapest, because
we know there’s something you give up.”
“I think we would like to be physi-
cian-driven,” said Kevin Sparks, group
executive for internal operations at
Blue KC. For his organization, innova-
tion means keeping the provider at the
heart of the patient care. He conceded,
though, that the industry is in something
of a market shift, with the consumer now
in the middle and the provider circling
the periphery of the universe.
After Fee-for-Service
“What opportunity exists,” asked Rick
Kahle provocatively, “for moving away
from fee-for-service to something else?”
Stephen Salanski sees some move-
ment away from this traditional fee
arrangement, given the emergence of the
patient-centered medical home concept
and other innovative arrangements.
Physicians who are doing more work
by e-mail or by phone and proactively
caring for patients when they transition
from the hospital back to the office are
performing services that defy traditional
fee arrangements. If providers and payers
begin to acknowledge and provide incen-
tives for these kinds of practices, Salanski
believes, higher-value care should follow.
“We’d like to see more insurance
companies focus on shared savings
models and care-coordination fees,”
affirmed Lori Mallory, CEO of Kansas
City Internal Medicine, “because we
believe that if [all parties] are in the room
together that we can, in fact, reduce the
cost and improve the quality.” Added
Mallory to general approval, “Obviously,
I prefer a market orientation to govern-
ment authority on this issue.”
Chris Hansen expressed provider
frustration with the fact that each in-
surer has a distinct reimbursement
model. “We can’t have eight different
care models reimbursement-wise or
PCMH-wise,” said Hansen. “We’re just
going to kill ourselves.”
“It’s not just the different insurance
companies,” said Mark Laney. “Physicians
don’t want to have two classes of patients.
They don’t want to be in a fee-for-service
mindset with Mrs. Smith and in value-
based mindset for Mr. Jones.”
As Rick Kahle observed, there is talk
now within the IRS that the affordability
test would be based upon family cover-
age. This means that an individual could
pay no more than 9.5 percent of his or
her household income towards family
coverage. If more, it would not be deemed
qualified affordable family coverage,
in which case the individual could go
to a health-insurance exchange. Of
course, this whole concept could be un-
done soon by the Supreme Court.
Wellness
“One of the things that we know
is that employers don’t like increased
regulation and complexity,” said Carolyn
Watley, president of CBIZ Benefits
and Insurance services. The role of
CBIZ and other consultants, Watley
explained, is not just to get the infor-
mation out to clients, but to get it out
correctly, so that clients can plan with
at least some confidence. One area that
has enthused CBIZ is the employer’s
embrace of wellness as a way to improve
worker health and productivity.
When asked whether wellness really
pays dividends to the employer, Wat-
ley answered confidently, “We know
that wellness pays.” Rick Kahle agreed.
1. Lori Mallory said it was important that insurance companies focus on shared-savings models.
2. Kevin Sparks said innovation in health care means keeping the provider at the center of
delivery efforts. | 3. Stephen Salanski suggested that higher reimbursements should follow
higher levels of health-care delivery. | 4. Carolyn Watley noted the need to get better infor-
mation out to workers, who could then make better decisions about their own wellness.
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6. 5%
The accumulation of risk factors makes
measurement difficult, but not impos-
sible. Measurement, he acknowledged,
accomplishes little unless employers
also provide incentives and leadership to
make sure goals are accomplished.
“There are so many things that you
can do to help impact the productivity of
the worker,” affirmed Carolyn Watley, “and
help positively impact the business as well.”
Ian Chuang expressed his satisfac-
tion in seeing even small companies
get creative in designing and sustaining
wellness movements. “Employers are
also starting to expand that definition
of health and well-being,” said Christine
Wilson. This expanded definition might
include financial well-being, social con-
nections, career satisfaction, mentoring
and any number of other variables.
A nearly universal problem, several
participants noted, was obesity in the work
force, even in the health-care work force.
“If I was going to give [employers] solu-
tions on how to fix their worker’s comp,”
said Brian Stewart, “I would tell them
they need to address their obesity with
everyone, not just their injured workers.”
As Danette Wilson noted, health-
related observations have a particular
obligation to promote wellness, and many
are doing just that. Kevin Sparks affir-
med that Blue KC has come to recognize
that voluntary participation in a well-
ness program is not always sufficient.
Reinforcement and guidance are critical.
Children’s Mercy has its fair share
of overweight employees as well, said
Jill Ebbers, director of the hospital’s
managed-care program. One response
has been the creation of a successful
program called “New Year, New You.”
This involves teams of four competing
over a 16-week period. The hospital,
said Ebbers, has hired fitness coaches
and has done much to encourage its
employee base to participate.
Rick Kahle asked how employers
sustain these programs and keep employees
engaged. The employer has to value health,
and the employees have to know it. Then,
said Carolyn Watley, there is an understand-
ing by the employee that “I better get on
board or I might want to find a home else-
where because I’m not going to fit in here.”
“We as an organization have to inter-
rupt behavioral patterns that disrupt the
organization,” agreed Rick Kahle, and
senior leaders have to drive that under-
standing. Lori Mallory added the caution
that management not be too heavy-
handed in pushing participation. “I don’t
want to take the fun out of it,” she said.
“I would think that your primary
care physician is your best teacher of
wellness,” said Chris Hansen, adding a
new wrinkle. “Most people listen to
their doctor. If your doctor tells you
not to do something, it’s going to be
a lot more powerful than your peers
or group.” One challenge, of course,
is to get the doctors involved.
A second challenge, Mark Laney add-
ed, is that, “you’re asking the most expen-
sive person on the health-care team to
do education.” Heartland, which is self-
insured, has kept its premiums stable
the last three years, in part by doing
health assessments for every employee,
spouse and child that it covers and by
providing only healthy food to its
employees. “We got to the point where
we thought if we’re really going to
talk about this with the community,”
said Laney, “we have to live our values.”
“As an employer and a provider of
the community,” said Rick Kahle, “you
have the unique opportunity to make
those cultural decisions. You’re provid-
ing so much of the care for your own
people and you can make an ‘account-
able patient.’ The integrated health-care
systems are in a unique position to
solve this problem.”
Going forward, Danette Wilson also
saw real opportunity in working collab-
oratively. “There have been a lot of good
conversations,” she added optimistically,
“and we think things can get better.”
1. Ian Chuang noted that even smaller companies are getting on the wellness wagon to design
plans for improving the health of their work forces. | 2. Jill Ebbers cited the success of an in-
house employee wellness program at Children’s Mercy Hospitals and Clinics. | 3. Financial,
social and career well-being are all part of a broader definition of employee wellness
emerging in many workplaces, said Christine Wilson.
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