For indie Holy Name, value-based care critical to survival

The New Jersey health care system must include price transparency and a total commitment to fee-for-value care in order to survive, says Michael Maron, CEO of the 361-bed Holy Name Medical Center in Teaneck.The New Jersey health care system must include price transparency and a total commitment to fee-for-value care in order to survive, says Michael Maron, CEO of the 361-bed Holy Name Medical Center in Teaneck.

One of the few remaining independent hospital systems in the state, Holy Name has been expanding. It recently added a wound healing institute and expanded its cancer care center. It has secured new state grants for its Villa Marie Clare nursing home, and last year added specialty practices in Oradell and Paramus to expand its physician network.

The system also recently settled a dispute with Horizon Blue Cross Blue Shield of New Jersey. Holy Name, along with CentraState Healthcare System and Valley Health System, were suing Horizon for breach of contract and breach of good faith over not being included in the Tier 1 portion of Horizon’s OMNIA plan.

Maron said continuing the legal battle became too costly after Bergen County Superior Court Judge Robert Contillo dismissed the breach of contract charge in April.

“So after two and a half years of litigation and fighting with Horizon, we had always kept the door open for a settlement,” Maron said. “We never really wanted to be in court. Based on the pace and complexity of the court proceedings it was becoming clear to us that while we may win the legal arguments the remedy would be to negotiate a settlement.

“So we laid all that out and said, ‘Look, the best time to get the best deal was now. Not down the road. The more time passes, the more leverage we lose.’ So we sat down with Horizon and reached an agreement.”

Maron added that part of the settlement included a deal to allow Holy Name to participate in future, value-based-care insurance products.

“We are pleased with the outcome of our discussions with Horizon and look forward to partnering with their health professionals to ensure the best outcomes for our patients.Maron’s greatest concern about the state’s health care industry is the lack of pricing transparency. With that, he said, independent hospitals will be forced to join the larger hospitals over the next several years.

“Pricing today is hidden it’s all private and it’s a mess,” said Maron. “When it comes to pricing, the inconsistencies across the board are off the charts. Pricing needs to be transparent and more consistent so consumers can know the price of care and weigh price to the quality that’s being offered and make educated decisions.”

So how does an independent hospital such as Holy Name stay independent in an era in which hospitals are joining health care conglomerates such as Hackensack Meridian Health, RWJBarnabas Health and Virtua Health?

“It’s definitely a challenge, no doubt about it,” said Maron. “Holy Name has been fortunate in its financial viability. What I believe is that if, down the road, value-based delivery becomes reality and if pricing becomes transparent, organizations like Holy Name are going to flourish. I would also predict that if we truly move to a fee-for-value system, you’re going to see a break-up of the large systems. There is no evidence across the country that consolidation lowers cost at all, and that anybody has achieved better pricing or efficiencies of scale by joining large systems.

“So what hospitals are going to realize is that we’re better off being independent and being small and nimble and agile and having relationships, which you can’t really do in a large system. They’re going to say that ‘we’re better off being independent and dealing with our own community in our own way.’ If pricing transparency does not come to fruition, and if the powers that be keep pricing hidden, then at some point, we can go for a long time but we’ll be forced to join one of the large systems.”

On the business side, Maron said that Holy Name is currently in the midst of writing its own software to universally manage electronic health systems, an effort that is one of the keys to providing high quality, cost-efficient care.

“From a service line perspective, we want to expand across the entire continuum. Our goal is to provide care from cradle to grave,” he said. “For us, value-based care means building a relationship with patients and with the community. That means caring for patients in terms of lifestyle and normal screening, emergencies, acute episodes, postoperative care and end-of-life care. To be able to touch patients at each one of those points is critical. Right now, that is where the current health care system fails. There’s a lot of miscommunications and a lot of inefficiencies and repetition in the system.

“So we want to be dominant in all those spaces, and we are in the midst of a very aggressive rewrite of our own software and technology to facilitate those transitions and help the flow of information between all those points,” he said.

In addition to creating their own EHR platform, the hospital is also expanding its ethnic-based care programs, particularly for the Hispanic and Korean populations.

“We have found that it is within our ability to really personalize the delivery of medicine among ethnic communities,” Maron said. “And there are nuances within communities, so you want to tailor the care to the community. Those programs for us are very big for us.” Copyright 2018 BridgeTower Media. All Rights Reserved.

CREDIT: Vince Calio