Edward D. Miller, M.D., chief executive officer of Johns Hopkins Medicine, visited Christiana Care Feb. 15 to discuss how JHM is preparing for health care reform.
Headquartered in Baltimore, Md., Johns Hopkins Medicine is a $6.5 billion integrated global health enterprise and one of the leading health care systems in the United States.
Johns Hopkins Medicine’s preparation for health care reform includes developing a model for achieving “population health” while observing government and gauging the pace at which reform is likely to occur.
Dr. Miller described population health as a model in which a health system supplies all medical care to a population of people for a premium, per member, per month. For Johns Hopkins Medicine, the model currently includes 205,000 prioritized members, 60,000 Medicare members, 33,000 retired military members, and 52,000 JHM Employee Health Plan members.
Dr. Miller asked “What is needed to achieve population health?” His five-point answer included:
- A network of primary care physicians (PCPs).
- Access to hospitals and outpatient facilities.
- Access to specialists.
- Home care.
With respect to the first point, data, he said Johns Hopkins Medicine has invested $600,000 to install new computerization technology to ensure that the electronic medical record for any patient at any point of care within the organization is the same.
Asked by Department of Surgery Chairman Michael Rhodes, M.D., about the current and anticipated future shortage of primary care providers, Dr. Miller said help from the health system in simplifying the delivery of care should lead more medical school graduates to choose careers in primary care.
Regarding access to hospitals, outpatient facilities and specialists, Dr. Miller referred to Johns Hopkins Medicine’s massive rebuilding and renovation projects at the East Baltimore medical campus, including research buildings and clinical and patient care facilities. He also discussed Johns Hopkins Medicine’s acquisition of several area hospitals, such as the 267-bed Howard County General Hospital in the suburban market between Baltimore and Washington, D.C.; the 328-bed Sibley Memorial Hospital, inside the District of Columbia; the 233-bed Suburban Hospital; and the 259-bed All Children’s Hospital. As a point of reference, the Johns Hopkins Home Care Group annually treats more than 100,000 adults and children in Central Maryland.
Turning to the pace at which health care reform will occur, Dr. Miller suggested a number of influential factors are involved, from debt markets and U.S. elections outcomes, to Medicare incentives for integrated care, states’ solvency, a Supreme Court mandate decision expected in June 2012, critical mass and the success or failure of health exchanges, and the state of accountable care organizations, or how well providers learn to partner with insurance companies.
One of the most important factors that will influence the pace of health care reform will be value measurement, Dr. Miller said. “Currently, all [value measurement] is based on process, not outcomes,” he said. Johns Hopkins is working on delivering outcome measurements in the near future, he said.
Regarding the impact of possible outcomes of 2012 elections and beyond, Dr. Miller opined that there are some things that Republicans and Democrats do agree on, such as the idea that integrated care drives value, and provider risk drives down cost.