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When healthcare lines become blurred

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Lennox Hill Hospital, in Manhattan’s Upper East Side.

This  HealthAffairs blog post by Michael Dowling, president and CEO of   Northwell Health, which serves metropolitan New York,  stems from  “The New Health Care Industry: Integration, Consolidation, Competition in the Wake of the Affordable Care Act,” a conference held recently at Yale Law School’s Solomon Center for Health Law and Policy.

Among his remarks:

“Today, the lines delineating the many different stakeholders in the health business are increasingly blurred. Providers are becoming insurers and insurers are becoming providers. To achieve success in this new paradigm, all of us need to work more collaboratively, with the overarching goal of keeping people well and delivering care more appropriately to those who do get sick or injured. We need to provide people access to better, more-affordable care — outside of the hospital. To offer and manage care across the full continuum, you have to innovate and bring resources and pieces together to address the holistic nature of the person’s condition, not just the episodic nature of illness.”

“As president of the largest health system in New York, I am in the ‘health’ business. By default, that means I am also in the ‘hospital’ and ‘ambulatory services’ business, the ‘insurance’ business, the ‘education’ business, and the ‘research’ business, among others. That’s because all of these pieces contribute to the continuum of providing better health to the communities we serve.”

“We are also partners in an insurance company. People ask, ‘Why did you want to get into insurance?’ Like, somehow, we let the fox into the hen house. The answer goes back to being in the ‘health’ business. We want to have as much control as possible over the premium dollar so that we can manage people’s health and not just manage people’s illnesses. That way, when we reduce the utilization in a hospital, we get to keep some of the savings.”

“The old model was a terrible misalignment of incentives. We could do wonderful things to reduce hospital utilization, but if the insurance companies got the savings and left hospitals with the cost, where did that leave providers or their patients? By effectively being in the ‘insurance business’ and partnering in an insurance company, we can more appropriately align the incentives.”

“When I am asked what Northwell Health wants to be in the long term, my answer is: ‘I want to be in the health business, the health-promotion business, and the wellness business, as well as the illness care business. I want to be able to do all those things well.”’



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