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Q&A with Adventist Health White Memorial CEO John Raffoul

by Sean Ruck, Contributing Editor | March 12, 2019
From the March 2019 issue of HealthCare Business News magazine

JR: In my view, those relationships have directly helped us level the playing field in terms of access and health equity. I’ll give you an example. About four or five years ago, we found out that we have about 50,000 people in our service area who can’t access care. So we went on a mission to expand access. We opened a “federally qualified health center” on campus. We included not only primary care for adults and children, but also mental health services on an outpatient basis, and a dental clinic, neither of which previously existed. Those efforts extended access to care to 20,000 more people.

In that same period, we also found that the amputation rate in our Hispanic community, where there’s a high prevalence of diabetes, is highly elevated compared to the amputation rate in other communities. It was 10 times the average state rate, in fact. So we embarked on creating a state-of-the-art center to address this problem. Our Center for Limb Preservation and Advanced Wound Care brings seven specialties. including vascular, orthopedics, surgical, wound care, and podiatry, all under the same roof to provide the holistic, multidisciplinary care our patients need.

HCB News: Organizational progress in shifting from fee-for-service to outcome-based reimbursement varies greatly across healthcare. Has Adventist Health White Memorial started to make that move? If so, where are you with the shift?
JR: I think we’re ahead of the curve. We’ve already created an accountable care organization where our physicians can join hand-in-hand with us to achieve quality metrics, and we’re participating in the government’s bundled payment initiatives. We’re also focusing heavily on metrics such as readmission rates, infection rates, and other performance-based metrics intended to increase and protect patient safety. That focus has earned us incentive payments while improving the quality of the care we provide.

Another way we’re tackling that shift is by taking on risk: we’re one of the few hospitals that have large capitation agreements with many of our independent physician associations, as well as many of our insurance companies. We also formed a medical foundation to make sure we continue to address quality issues.

HCB News: Are you finding the current political environment challenging as far as anticipating whether reimbursement dollars will continue to be there going forward?
JR: The reality is that healthcare has been changing for over 30 years. In the United States, we have the highest cost for healthcare but we don’t have the best quality outcomes compared to the rest of the world. No one disagrees that we have to address these issues. But as the statistics plainly show, high quality isn’t intrinsically tied to high costs. In fact, delivering quality care saves money – and if you do an excellent job, you could be saving a lot of money in the process.

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