Read the attached case, the textbook chapters, and watch the videos to be able to analyze the case. Will health ?????care systems ever find the need to eliminate all their inpa

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Essentials of Health Care Marketing, Fifth Edition Eric N. Berkowitz

The annual fall hospital board retreat was being held in a resort hotel in what has long been known for the beauty of its mountain loca- tion and fall scenery as the leaves changed in the Western Carolina region, as well as the golf and tennis facilities. In recent years, the hospital board had discussed whether it was appropriate to hold their annual fall meetings at such an expensive facility given the rising attention to health care costs. Cost was an overarching concern within the health system, but given that the board composition of com- munity members, executives, and physicians had contributed long hours throughout the years on countless committees, this one yearly event was considered somewhat a reward. The schedule included an intensive all-day Saturday session that was an important portion of the weekend. Friday evening also included a major speaker who typically addressed a topical area of interest in terms of the health care environment. Spouses or significant others of the board members in addition to the leadership team of the organization were also invited. However, the working session was open only to the members of the board and the leadership team.

The weekend schedule for the board meeting was distributed to the Board and Leadership participants as they arrived at the hotel at noon on Friday:

Board Retreat Schedule: Friday Friday arrival: Check in noon to 1 p.m. Open Activity: 1 p.m. (tennis, golf, hiking, touring local artists [signup for shuttles]) Reception: 5:45 – 6:45 Dinner: 7:00 – 8:15 Speaker: 8:15 – 9:00 Dr. Paul Bittenton, Dartmouth College, School of Public Policy

“The Changing Role of Health Care Systems in the 21st Century: The New Mission to Meet the Commmunity Needs”

Saturday Sign-up sheet in lobby from 9:30 to 10:30 for spouses and significant others accompanying board members for activities. Early tee times can be arranged with pro shop as well as tennis court time.

Board and Leadership Meeting will be in Pavillion room on Second Floor at 8:00 a.m. Breakfast and lunch will be served Meeting schedule is from 8:00 a.m. until 4:45 p.m. Saturday Evening: Reception at 6:45 p.m. Dinnner at 7:45—both will be on Veranda outside of main lobby

Sunday Board and Leadership will meet 8:30 – 10:00: Final Wrap-up Check-out is 11 a.m.

The Saturday full-day board meeting began with an overview from the vice president of finance. A brief overview of the finances was presented. There were a few questions, but since finances were reviewed in depth at each monthly board meeting, there was relatively little discussion in this area. The greatest concern remained some protracted negotiations that continued with one major insurer over the reimbursement rates being negotiated. The insurer was always difficult in terms of the payment time in which claims were received and was being increasingly challenging in terms of negotiating rates. In the same regard, the market share of the insurer was too large to not try to negotiate with this third-party carrier.

The follow-up presentation by the vice president of strategic planning along with the CMO (Chief Medical Officer) presented the plans to begin to roll-out the medical home model to the Medicare and seniors who were in the hospital’s Medicaid population. As explained by the VP of strategic planning, the Medical Home Model has achieved growing acceptance across the country as a viable approach to effectively keep this population healthy. These individuals were part of the organization’s accountable care plan. This type of plan was now being offered in their state, the vice president said, and it was important that the health system be out in front of the competition with offering such an alternative. “We are going to be paid increasingly for value, not for how much we in essence produce

The Contentious Hospital Board Retreat: Is the Medical Home Mission Cannibalization?

CASE STUDY

Essentials of Health Care Marketing, Fifth Edition Eric N. Berkowitz

Copyright © 2022 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

in terms of units of surgery. The health environment has changed. Although, as we all recognize, we will always be doing some surgery. We need to change now. The medical home model is the way to go.”

The AV person showed a slide with the overall structure that the medical home model would now have coordinated care approach that would have as their central objective to “keep the person healthy.” In this medical home, a primary care coordinator would be the focal point of the individual’s care to ensure that the correct individual, be it a physician, specialist, social worker, or mental health specialist, be brought to bear as needed to ensure the individual’s health is maintained, their diet is appropriate, and even to ensure that the person is getting the appropriate exercise to keep them out of the hospital. Future plans would involve remote home-based monitoring to allow cost efficiencies as these solutions are integrated into the health system.

As the CMO was about to continue, one of the longer-serving board members interrupted and said, “ Dr. Mattawa, excuse me. I think this really does sound great. My concern, however, is between these four walls, we have just completed a major physical campus expansion and invested more in capital expenditures than I want to think about. Additionally, all of us in this room, with great credit to the finance people, worked tirelessly to maintain our bond rating to get it where it is, all for the purpose of having an organization with state- of-the-art inpatient care. I do not believe the system that you propose to restructure will replace the existing revenue stream sufficiently to service that debt load. Moving down this track is like eating our own young.”

Several heads around the table nodded. The VP of strategic planning started to speak, saying, “Your concerns are understandable, but this externality is one that we must—”

“All well and good,” interrupted another board member, “but we are here for the community to provide the serious work when it is needed, not to worry if everyone is exercising. This is pretty far from what I thought our mission was. I am pretty confused and wonder if instead of a DaVinci robotic surgery machine we are talking of opening a chain of exercise centers.”

The CEO decided the conversation was starting to get away with little focus, and she stood up at the table. “These are all really good points that are being raised,” she said. “I think what our VP of strategic planning has put out for us to consider here and Dr. Mattawa began to describe is a direction that many in health care are beginning to formulate in response to the ACA regulations and the direction the health care ecosystem is moving not only in our region, or state, but nationally. That said, as some of you appropriately suggest, our past direction and investments have been in an asset-based model for invasive based surgical and specialty care when needed. Let’s take a twenty-minute refreshment break,” the CEO continued. “ When we reconvene, I think, I would like to put us into some groups to consider how we might move forward in a more structured model to identify the issues around this medical home model and whether we are in fact ‘eating our young,’ so to speak, if we go down this path to any degree whatsoever.”

After the refreshment break, the CEO had the hotel put six round tables in the room. At each table, she placed six individuals with a flip chart and a sheet of paper indicating which position they were to take in the discussion.

Position 1: Implementing the Medical Home Model is “counter to the mission” and is in effect “eating ourselves” Position 2: In responding to the changing market, the Medical Home Model responds to the change Your role: You were the National speaker from Dartmouth College on Friday evening. You have been asked to present both sides

after members of the board present their views at each table and to moderate the discussion. At the end of your PowerPoint slides with the alternative view, give your final recommendations and the rationale as to why it is the most appropriate course of action from your perspective.