Alternative agendas. System priorities for the 1990s will differ from those of the last decade

The Sisters of Charity Health Care Systems (SCHCS) was established in 1979 in response to changes in the U.S. healthcare system and to new needs of sponsors and Catholic healthcare facilities. However, the agenda that SCHCS leaders (and leaders of other systems) set at that time must now give way to an agenda that will address the new challenges and responsibilities facing the Catholic healthcare ministry in the 1990s. In its first decade of existence, SCHCS established and fulfilled a number of goals: It strengthened governance relationships, helped systems and sponsors better identify with local communities, enabled facilities to steward resources more effectively, and facilitated members' understanding of mission and sponsorship values. In the 1990s, however, systems will have to create more opportunities for regional, collaborative, and networking relationships among member facilities and between members and non-members. To achieve this, they will have to reevaluate their structures, find ways to faciliatate collaboration, make resources available to institutions outside the system, and develop an overall philosophy that enhances both the fiscal and spiritual well-being of member facilities.     

Meeting mission challenges in IDNs. Through integrated delivery networks, organizations can continue their ministry and extend its reach

Whatever the final shape of healthcare reform, providers and sponsors are already collaborating with each other in various network arrangements. As they pursue these arrangements, they are asking questions about their role in a reformed system and whether the networks they participate in will strengthen their mission and ministry. Documents published about five years ago by the Catholic Health Association (CHA) and the Commission on Catholic Health Care Ministry provided the rationale for CHA's proposal to form integrated delivery networks (IDNs) as part of a national healthcare reform plan. The documents called for a continuum of care with comprehensive community- and institution-based services and challenged Catholic healthcare leaders to work for a healthcare system that guarantees access to the needy and most vulnerable in society. The central task for administrators today is to determine whether participating in an IDN enables Catholic healthcare providers to fulfill their original mission and purpose. To determine this, organizations must clarify their mission and evaluate their beliefs. They must also develop a shared vision of motives and goals among everyone with whom they collaborate. IDNs' success in furthering the healthcare ministry will depend on leaders' ability to ensure that new corporate cultures which arise in cooperative ventures and arrangements support Catholic values and mission. In making the transition to a new environment, leaders should remember that aspects of IDNs support many of the goals of the Catholic healthcare ministry.     

Seizing opportunities under the Affordable Care Act for transforming the mental and behavioral health system

The Affordable Care Act, along with Medicaid expansions, offers the opportunity to redesign the nation's highly flawed mental health system. It promotes new programs and tools, such as health homes, interdisciplinary care teams, the broadening of the Medicaid Home and Community-Based Services option, co-location of physical health and behavioral services, and collaborative care. Provisions of the act offer extraordinary opportunities, for instance, to insure many more people, reimburse previously unreimbursed services, integrate care using new information technology tools and treatment teams, confront complex chronic comorbidities, and adopt underused evidence-based interventions. The Centers for Medicare and Medicaid Services and its Center for Medicare and Medicaid Innovation should work intensively with the states to implement these new programs and other arrangements and begin to fulfill the many unmet promises of community mental health care.     

Collaboration as a source of strength. Specific criteria guide potential collaborative relationships

Leaders at SSM Health Care System (SSMHCS), St. Louis, believe collaboration can ensure that existing Catholic healthcare ministries continue to serve and to provide a full continuum of care. They see collaboration as both a source of strength and an expression of their Catholicism. To facilitate collaboration, SSMHCS leaders have developed six relationship models in which two types of collaborative arrangements are possible--informal and formal. Informal cooperative relationships may include consultation and participation by non-SSMHCS entities in established SSMHCS activities. Formal collaborative relationships include joint ventures at the operating entity level and in contract management, joint ventures at the governance-management level, and total affiliation (merger-acquisition). To ensure that SSMHCS leaders adequately evaluate healthcare providers with whom they may collaborate, in 1987 the system established criteria for collaboration. The criteria are based on specific mission, planning, financial, and operations principles. SSMHCS weights the mission criteria more heavily than other criteria because of the emphasis on mission in all its ministries.     

On the path to healthcare reform. The 78th Annual Catholic Health Assembly

A healthcare revolution is at hand, and not just in Washington, DC. The 78th Annual Catholic Health Assembly, held June 6 to 9 in New Orleans, drew 1,300 Catholic health providers from across the nation to explore the progress of healthcare reform--at the federal level, in state initiatives, and in cities across the nation where providers are collaborating to provide more comprehensive, cost-effective care. Culminating in an affirming address by First Lady Hillary Rodham Clinton, the assembly afforded attendees opportunities to discuss the operational opportunities ahead, innovative care approaches, and strategies to maintain their Catholic identity and values under a reformed system.     

Covenant model of corporate compliance. "Corporate integrity" program meets mission, not just legal, requirements

Catholic healthcare should establish comprehensive compliance strategies, beyond following Medicare reimbursement laws, that reflect mission and ethics. A covenant model of business ethics--rather than a self-interest emphasis on contracts--can help organizations develop a creed to focus on obligations and trust in their relationships. The corporate integrity program (CIP) of Mercy Health System Oklahoma promotes its mission and interests, educates and motivates its employees, provides assurance of systemwide commitment, and enforces CIP policies and procedures. Mercy's creed, based on its mission statement and core values, articulates responsibilities regarding patients and providers, business partners, society and the environment, and internal relationships. The CIP is carried out through an integrated network of committees, advocacy teams, and an expanded institutional review board. Two documents set standards for how Mercy conducts external affairs and clarify employee codes of conduct.     

Regionalization of human resources. SCHCS healthcare facilities collaborate to head off labor shortages

Shortages of healthcare personnel become more pronounced each year. Effective human resource strategies are therefore important to facilities' success. The Sisters of Charity Health Care Systems (SCHCS), Cincinnati, is meeting the labor shortage head-on through collaborative regionalization among its facilities. Regionalization develops an integrated continuum of care on local and regional bases, helps SCHCS members avoid duplication of services, and ensures communities' future access to care by spreading financial risk among partners. SCHCS human resource personnel encourage employees to stay within the organization if they must relocate or are looking for career advancement. Members use a systemswide brochure to recruit nurses and allied health professionals. To attract employees from outside SCHCS, human resource personnel join forces at trade association conferences, job fairs, and school career days. SCHCS human resource personnel recruit and select values-oriented employees. Values-based human resource guidelines provide a framework for SCHCS members to assess how effectively the core values and mission are demonstrated in policies, programs, procedures, behaviors, and culture.     

An educational response to assisted suicide. Catholic systems reach out to advance compassionate care of the dying

The future of "The Oregon Death with Dignity Act" is uncertain since a preliminary injunction blocking the law's enactment has been granted. Still, three Catholic healthcare systems in the Pacific Northwest are quite clear about their commitment to providing optimal care to persons at the end of life. Bellevue, WA-based PeaceHealth; Seattle-based Sisters of Providence Health System; and Aston, PA-based Franciscan Health System have formed the Committee on Care of the Dying of the Franciscan, PeaceHealth, and Providence Health Systems. The three organizations have collaborated to develop and offer comprehensive educational outreach on compassionate care of the dying throughout Oregon. Twenty system representatives met in Portland, OR, in January 1995 and developed a vision statement, "Care at the End of Life." In addition, a steering committee of 12 representatives has identified the goals of the Committee on Care of the Dying. The steering committee has also identified seven "Organizational Commitments and Common Elements" to ensure quality and excellence in compassionate care of the dying. Recently, the Daughters of Charity National Health System, the Carondelet Health System, and the Catholic Health Association-all based in St. Louis-have joined this collaborative effort to educate healthcare providers and the public.     

Reconciling practice and theory: challenges in monitoring Medicaid managed-care quality

The massive shift to managed care in many State Medicaid programs heightens the importance of identifying effective approaches to promote and oversee quality in plans serving Medicaid enrollees. This article reviews operational issues and lessons from the ongoing evaluation of a three-State demonstration of the Health Care Financing Administration's (HCFA) Quality Assurance Reform Initiative (QARI) for Medicaid managed care. The QARI experience to date shows the potential utility of the system while drawing attention to the challenges involved in translating theory to practice. These challenges include data limitations and staffing constraints, diverse levels of sophistication among States and health plans, and the practical limitations of using quality indicators for a population that is often enrolled only on a discontinuous basis. To overcome these challenges, we suggest using realistically long timeframes for system implementation, with intermediate short-term strategies that could treat States and managed-care plans differently depending on their stage of development.     

Status of the Medicaid competition demonstrations.

In 1982, the Health Care Financing Administration approved funding for demonstration programs in six States to test a variety of alternative delivery strategies for Medicaid recipients. A number of innovative health service delivery features have been used in these programs, including competition, capitation, case management, and limitations on provider choice. These strategies have been tried in order to address the key Medicaid problems of cost containment and access to appropriate and high quality care. This article provides an overview of how the demonstration sites have approached the task of designing, developing, and implementing their various programs.     

The modern association. Preserving a Catholic presence in the U. S. healthcare system

A leader in U. S. Catholic healthcare since 1915, CHA has helped Catholic hospitals meet the challenges of the standardization movement, the Depression, and two world wars. The fifth Health Progress article on CHA's history (June 1990) described the association's postwar emergence as a service organization under the leadership of Rev. John J. Flanagan, SJ. This article, the last in the series, charts CHA's response to the revolutionary changes within Catholic healthcare brought about by the Second Vatican Council and the passage of Medicare. It recounts the struggles within the U.S. Catholic healthcare community to sustain its Catholic identity, as well as the community's increased presence as an advocate for a just healthcare system. In the spirit of the institutes of women religious who established the Catholic healthcare ministry in the United States, CHA enters the 1990s committed to advocating for universal access to healthcare and enhancing its members' ability to serve the poor and vulnerable.     

An opportunity for positive change. We have the history, experience, and will to preserve a Catholic presence in healthcare

The charitable acts of women religious in response to the needs of the communities in which they settled is one of the great chapters in the history of the Church in America. But in the past two decades providers have had to contend with extraordinary changes in the healthcare environment. The Catholic healthcare mission was rooted in concern for the poor. Should Catholic healthcare providers withdraw from this field in which they have had such a significant presence and have contributed so much, or be driven from healthcare by the fiscal consequences of fidelity to mission? Instead, through its reform proposal, the Catholic Health Association has recommended that Catholic providers become advocates of change. However, even if change, such as universal access to healthcare, is achieved, we shall still have a society in which there will be many poor people. The challenge will be to see that healthcare for the poor does not become poor healthcare. Although the changing urban environment presents enormous challenges to providers, the Catholic healthcare ministry is a significant presence in urban areas. Widespread poverty accompanied by behavioral problems and social breakdowns are significant factors affecting healthcare and healthcare costs. Drug addiction; AIDS; teenage pregnancy; homelessness; the deterioration of the family; and generations of unemployment, anomie, abuse, and violence, which are often most acute in concentrated neighborhoods of poverty, challenge the ability of Catholic hospitals to meet their community's needs. Catholic providers today have a real opportunity to bring about positive changes in healthcare. They have the history, experience, and will to preserve a Catholic presence in the provision of healthcare.     

PACE (Program of All-Inclusive Care for the Elderly): innovative care for the frail elderly. Comprehensive services enable most participants to remain at home

PACE--the Program of All Inclusive Care for the Elderly--provides integrated comprehensive healthcare services to the frail elderly on a capitated basis. Begun in the early 1970s in San Francisco's Chinatown, PACE today comprises many individual programs across the nation. PACE's goal is to provide participants with the healthcare services they need for the highest possible level of functioning and autonomy. A typical PACE program is divided into sites, each of which serves 120 to 150 participants. Most participants come several times a week to the site's adult day care center, where they see members of an interdisciplinary team that includes physicians, nurses, social workers, therapists, and others. Home care is provided to participants unable to attend the center. PACE is financed by capitated payments from Medicare and Medicaid, which put providers at full risk for the services used by participants. The flexibility provided by this funding enables PACE to offer a wide variety of services, including supportive housing, which help keep participants out of institutions. Estimates of Medicare savings attributed to PACE are 12 percent and higher.     

Home health care industry braces for OASIS (Outcome and Assessment Information Set)

Use of Health Care Financing Administration's OASIS (Outcome and Assessment information Set) standardized data is now mandatory for all HHAs (home health care agencies) participating in the Medicare and Medicaid programs. While OASIS requires a "learning curve," incorporating it into the daily business of an HHA is not difficult. Use of OASIS offers several benefits to HHAs and their patients.     

An effective, efficient elder care program. Providence ElderPlace focuses on maintaining the continuum of care

Providence ElderPlace, Portland, OR, is an innovative long-term care health maintenance organization. The program is a type of integrated delivery network, offering comprehensive benefits and coordinating the delivery of healthcare services in a specific geographic market. Providence ElderPlace is based on the Program for All-Inclusive Care for the Elderly (PACE), which was developed 20 years ago by On Lok Health Services of San Francisco. PACE helps frail elderly persons remain in their homes as long as possible. PACE is financed through an integrated funding pool of Medicare, Medicaid, and private fees. To be eligible for PACE, an individual must be in need of nursing home care but able to live in the community, with support. Providence ElderPlace provides all healthcare, community-based, and long-term care support services from an adult day healthcare setting. Participants usually attend the day center three times a week. When participants are not at the center, a team of workers visit their homes to observe participants and provide personal and chore support services.     

A new role for the Church. Dioceses should do more in providing care for dependent and dying persons

In 1988, with the publication of Catholic Health Ministry: A New Vision for a New Century, the Commission on Catholic Health Care Ministry called on the Church to redefine its healing mission in society. Unfortunately, despite various efforts, the Church has not yet fully articulated a shared vision of Catholic healthcare, healing, and support. Healing human brokenness has always been the Church's work in the world, whether the brokenness be physical, emotional, intellectual, moral, or spiritual. The Church, having a broader definition of brokenness than that of the larger healthcare system, must sometimes act as a countercultural critic of that system. Two of the great challenges facing healthcare today are providing care for dependent persons (people with chronic illnesses and older people) and for dying persons. In both cases, much more coordination of the various actors is needed. The Church could ensure that this coordination is carried out. In each diocese, the bishop should organize a pastoral health and social service planning group to assess community needs and apply Church resources to them. Local Catholic healthcare providers and social service agencies should develop a corporate culture of healing and support. Parishes should accept the idea that healing and supporting frail people are integral parts of parish life.     

After the shaking stops. Catholic healthcare workers should prepare for seismic changes

In an attempt to cap spiraling costs and remain competitive, both providers and insurers are going through a frenzy of consolidation. Experts are predicting these changes: The integrated delivery system (IDS) will be the prevailing type of healthcare organization. There will be fewer acute care beds and fewer hospitals. Hospitals will be subsidiary to IDSs. Catholic and non-Catholic providers will join together to form IDSs. Regional IDSs will join statewide networks. The Catholic healthcare ministry can survive in such an era of consolidation if its leaders (1) collaborate with others on a basis of shared values, (2) have a well-defined mission, (3) provide holistic care, and (4) ensure that the organization remains true to its mission and demonstrates core values in its decisions and behaviors. Sponsors will need to find ways to share management of IDSs with non-Catholic organizations; to collaborate in the formation of regional and statewide IDSs; to urge other Church leaders to support social justice, human dignity, and community service; to be mindful of the stresses these changes will place on physicians and employees; to encourage dialogue about other changes in religious life; and to prepare laypersons to be their successors in the leadership of Catholic healthcare.     

GAO's role in the evaluation of federal health programs

The General Accounting Office (GAO) is a legislative branch agency whose mission is to support the oversight role of Congress. Health policy issues have constituted a substantial part of GAO's recent workload. Whereas GAO's work on health has ranged broadly, it has often focused on fraud and abuse in federal programs, particularly Medicare and Medicaid; the lack of meaningful indicators and other information, particularly on outcomes in health programs; access to care, increasingly connected to managed care; quality of care; and issues related to cost control.     

An innovative way to continue the ministry. A Catholic multi-institutional healthcare system achieves public juridic person status

Members in a Catholic multi-institutional healthcare system that has been established as a public juridic person know their missions will be carried on even if they must leave the healthcare field. The establishment of a public juridic person was a goal of the Catholic Health Corporation (CHC), Omaha, since it began in 1980. The juridic person was to be named Catholic Health Care Federation (CHCF) in order to distinguish the canonical juridic person from the civil law corporation. It took many years to determine which competent authority was the most appropriate to grant CHCF public juridic status. The Congregation for Institutes of Consecrated Life and Societies of Apostolic Life (CICLSAL) was deemed the appropriate authority. CICLSAL established CHCF as a public juridic person on June 8, 1991. CHCF's member religious institutes are the same as CHC's. But CHCF is the canonical sponsor for two owned facilities and manages a third community-owned facility. The religious institutes remain the sole canonical sponsor for their own facilities; however, they jointly sponsor three facilities through CHCF. Public juridic person status is a way for CHCF to continue Christ's healing mission.