Health care and the amount of money and numbers involved tend to make for a complicated and expensive system that makes it hard to follow. So, it’s nice to see people being passionately involved in trying to simplify things and present better efficiencies while being “tactful.”
One of those involved locally is Dr. Bob Rauner, and he is “involved” personified. He is the chief medical officer for One Health Nebraska, an accountable care organization (ACO) for Medicare in Nebraska. He is also president of Partnership for a Healthy Lincoln and is on the Lincoln Public Schools Board of Directors, representing District 6, and a member of the Nebraska Association of School Boards.
Rauner spoke Monday to Executive Club members at their weekly luncheon in downtown Lincoln at the Hilton Garden Inn. On that same Monday, LPS announced the requirement of face coverings through January; and later that night, Omaha Public Schools board members announced the reelection of their board president and vice president.
“We spend $2 billion a year on Medicaid in Nebraska. What do we get for it? How would we know what we’re getting for it?” Rauner asked at the luncheon meeting. “I would say the problem for Nebraskans right now is that they don’t know what they’re getting for their money. And to me, that drives me crazy.”
Rauner compared the lack of knowledge on the Medicaid numbers to a person looking to purchase a house and not knowing the intricate details of the structure, interior, plumbing, heating and upkeep of that house. He further detailed cleaning up some of Medicaid’s issues with comparisons to what Medicare is able to accomplish with ACO work in Nebraska.
“As chief medical officer of One Health Nebraska, we contract with insurance companies. If we make everybody healthy and that saves money, then we split the money with them, and that’s a good thing,” Rauner explained about his ACO, one of eight in Lincoln that he illustrated with graphs.
He also pointed out that it’s better for patients, because they will save money on co-pays, and the insurance companies will save more money as well.
“What drives me crazy is the public doesn’t know about this, and we’ve been doing this for the past eight years with clinics which contract with Medicare,” Rauner said. “Medicare does some cool things and a lot of dumb things; it’s kind of a mixed bag. But what they actually do is publish the results of what these clinics do every year, and if you know where to go find it, you can find this data.”
The ACOs are groups of doctors, hospitals and other health care providers who come together voluntarily to give coordinated, high-quality care to their Medicare patients, according to their website. One Health Nebraska is part of seven other ACOs serving Lincoln including Alegent Health Partners, Bryan Health Connect, Midwest Health Coalition ACO, Nebraska Health Network, NPG Health Collaborative, Think ACO and TPN Health Partners.
Rauner said he likes the idea of seeking out the specifics in the raw data and simplifying the information for easier consumption.
“Ted Frazier and I pull up this information every year and decipher it to help direct people to the numbers and illustrate how the clinics did with their patients,” Rauner explained before cutting to the chase.
“In the past year, our budget was set by Medicare at $114 million. We actually cost $109 million. We saved $5 million. But we didn’t do it by rationing patient care. We did it by keeping people out of hospitals. Out of 1,000 patients, we had only 188 end up in the hospital, which was the best in the state. If I were a business or was buying a house, this is what I would like.”
Rauner continued with describing responsibility toward the patient, which includes integrity from all involved in health care provision.
“You can save a lot of money with health care, but you have to do it right. There’s a wrong way and a right way,” he said before comparing it to some less than scrupulous ways of the 1990s. “How do you make sure? You need to hold people accountable, you need to hold everyone to the same measures.”
He said the insurance providers of Medicare, Blue Cross Blue Shield, United Healthcare and Medicaid needed to commit to the same things being measured.
“And you need to narrow it down to the ones that make the biggest impact.”
When it comes to the coronavirus and its impact with the latest variant, Omicron, Rauner expressed concern for the virus spread due to transmission, evasion of immunity and likelihood of severity. He said as of this past Saturday night, Omaha Children’s Hospital was full.
“We’re already rationing care for adults, so it’s not a good sign when we’re looking at children,” he said. “And, it’s not the amount of beds that are causing the lack of care, it’s the lack of nurses and staff.”
Like any health care provider today, the pandemic and current state of affairs are trying, and it impacts all involved, including Rauner. It’s being reported that he’s losing his filter.
“I have a history of not always being the most tactful person,” he said. “But, my co-worker Mary Jo Gillespie, who has been coaching me about being more tactful for the past decade, said she’s noticed that COVID has completely removed my tact.”
The author, Tim Brusnahan, is program chair at Lincoln Executive Club and employed by Marco.