It's one of the most complex and controversial issues in America today. It's also the fastest growing sector of the economy. But Delta County Memorial Hospital CEO Jason Cleckler managed to cover a lot of ground about health care at his July 10 presentation at the Paradise Theatre in Paonia. Speaking to an audience of about 50 mostly senior citizens, he addressed health care issues on both local and national levels, and explained how DCMH is responding to challenges in today's political climate.
One thing for certain: health care in America is changing. In introducing Cleckler, DCMH board member Jean Ceriani said he and his team "have managed to stay afloat even in this health care landscape that's like walking on shifting sand."
With some 600 employees and a payroll of $32 million, DCMH is now the largest employer in the county said Cleckler. Since 2012 it has increased local access to health care, and in 2016 and 2017, it was named a top-100 hospital in the nation. They have recruited some 20 providers in the last two years and are bringing in more. They operate nine primary care clinics and will soon open two acute care clinics in the North Fork Valley.
Cleckler is optimistic about the future of health care, both locally and nationally. "But we have a long way to go."
Cleckler joined DCMH in 2009 and became CEO 2012, just as the Affordable Health Care Act was kicking in. Hospitals and clinics across the country faced new mandates and rising costs. Revenues were declining as providers cut back on reimbursements. Multiple hospitals either closed or were bought out by bigger hospitals. He called it "the most tumultuous time in health care."
The ACA's roughly 460 measures addressed three important areas that Cleckler referred to as the "triple aim": better access, better quality, and lower costs. But under the ACA health care costs have risen, fewer insurance plans are available, and deductibles and other out-of-pocket costs continue to rise. An interesting fact, said Cleckler, is that in the past, the No. 1 payer for services was Medicaid. Due to what's available in today's insurance market, increasing premiums and deductibles, the individual is now the No. 1 payer.
In addressing problems, DCMH has made many changes in recent years. Prior to the ACA, it operated under an "illness model," said Cleckler. Provider reimbursement was determined by patient care volume rather than quality, and care was fragmented due to a lack of communication between caregivers. "The more patients we had in the hospital, the more money we made," which isn't sustainable, he said.
In 2014, they looked ahead two or three years and created a strategic plan, said Cleckler. "Because the health care landscape is changing so rapidly, that's about as far as they could look." In the last two years DCMH has invested millions of dollars in technology, equipment upgrades, and infrastructure.
The hospital also began shifting from an "illness model to a health and wellness model," focusing on getting patients out of the hospital. By improving outpatient services and preventative care, and transitioning to a fee-for-service model and shifting "from volume to value," occupancy rates went from an average of 23-24 beds per night to 12-13 today. One example of its success is the surgical infection rate, now at a "remarkable" 0.19 percent.
It's about bringing the right care to right place at right time, said Cleckler. "If we can keep you out of the emergency room we're going to save you money."
Today, mental health care is one of the biggest issues emergency rooms across the country face, said Cleckler. In 2016, DCMH mental health-related emergency room visits outpaced all trauma visits. "I've been in health care for 27 years and I never thought that I'd see such a thing," he said.
At the end of 2016 DCMH conducted a community health needs assessments in Delta, and a separate assessment in collaboration with Montrose and Gunnison hospitals. They identified mental health, affordability, and access to quality, affordable health care, that "triple aim," as their priorities. "We believe that part of the future of health care is partnering with your neighbors, not duplicating efforts," he said. Through sharing of services, health care can improve and costs can be lowered.
The hospital is also using a more personal approach to health care. They now provide diabetic care and cooking classes, weight management and tai chi classes, and have plans to expand their alternative health care options in the future.
People are also taking health care into their own hands and creating personalized wellness plans and other means of addressing their needs, said Cleckler. By the time they see their caregiver, patients often have Googled their symptoms, diagnosed them, and know what medication and dosage to prescribe.
He used A Little Help North Fork Valley, a nonprofit helping seniors thrive in their own homes for as long as possible, as an example of how to provide better health to the individual and the community.
Where health care goes from here remains to be seen, said Cleckler. "The ACA has made health care a hot political topic that's in the news every day." Cleckler said he does not support the Better Care Reconciliation Act (BCRA), nor do the American and Colorado hospital associations, AARP, and many legislators. It doesn't address that "triple aim" of affordability, access, or quality of care, he said. It would limit access to preventative care, resulting in more ER visits, lost jobs, and would leave millions more uninsured.
There's also nothing in the BCRA about tort reform (medical malpractice), which drives up costs, the pharmaceutical industry, insurance providers, or the medical suppliers, all of which affect the triple aim.
Proposed cuts to Medicaid are also concerning, said Cleckler. That would adversely affect the disabled, those without financial means to pay for care, and children, which makes up the largest segment of the population on Medicaid. "It will unravel the progress that the country has made."
In asking if the country should move to a single-payer system, Cleckler said it could solve a lot of problems, but how the country would get there in this political climate, and how it would look, are complex questions that need to be addressed.
Cleckler said he hopes over the next few months that people, regardless of political leaning, will agree: "We all need health care. We should all be sitting in the same room talking about what we can do to come up with a plan that covers us all," and one that doesn't veer from the triple aim.