Engaging the Private-Sector Health Care System in Building Capacity to Respond to Threats to the Public's Health and National Security Proceedings of a Workshop (2018) / Chapter Skim
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6 Exploring Opportunities to Improve Private-Sector Investment in Capacity Building
6 Exploring Opportunities to Improve Private-Sector Investment in Capacity Building
Pages 81-94
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From page 81... ...
For several years, PAHO has been working on its Safe Hospitals Initiative and has created a hospital safety index that helps facilities assess their safety and avoid being a casualty of a disaster.1 This index is based on structural, nonstructural, and functional factors, he explained, and the idea is for the index to provide a probability that the hospital would continue operating during 1 See http://www.paho.org/disasters/index.php? option=com_content&view=article&id=964: safety-index&Itemid=912&lang=en (accessed April 27, 2018)
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From page 82... ...
According to Camacho-Vásconez, a 2015 assessment of the Safe Hospital Initiative found that 71 percent of the 35 PAHO member nations had a national safe hospital program and 97 percent had created a database of evaluated hospitals using the safe hospital index. In addition, 63 percent of PAHO member countries had established formal, independent mechanisms for supervising hospital construction, and 80 percent had included safe hospital concepts in new health investment projects.
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From page 83... ...
NERC operates three committees -- the Critical Infrastructure Protection Committee, the Operating Committee, and the Planning Committee -- that develop the standards and guidelines meant to ensure a secure, reliable, and resilient bulk power system, said Griffin. The Critical Infrastructure Protection Committee, for example, develops cybersecurity standards, physical security standards, and emergency procedures for natural disasters, acts of terrorism, and pandemics.
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From page 84... ...
He noted that a recent amendment to the Federal Power Act allows utilities to recoup the costs of responding to any national emergency declarations made by the Secretary of Energy. Daniel Hanfling commented that a third model to consider is the one the VA used from 2007 to 2010 to engage in a comprehensive evaluation of its emergency management programs.
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From page 85... ...
All told, more than 1,000 case managers from his company alone can be mobilized online during an emergency to help patients receive the care they need or bring them to a place where they can receive needed care. Frankford commented that the health care finance world has been well aware of the silos, lack of coordination, and the need for more community capacity for more than 40 years, dating back to the time when the Health Maintenance Organizations Act of 1973 was seen as a way to replicate health systems such as Kaiser Permanente and Geisinger Health System.
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From page 86... ...
When Hurricane Katrina hit, those maps came in handy because the disaster management team had no idea where the nursing homes in the affected region were located. Savitz has overlaid maps showing locations of nursing homes, public health departments, major road networks, and funding regions for all 50 states and the District of Columbia.
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From page 87... ...
In doing so, they are creating databases, and she suggested looking at ways to repurpose those resources for disaster preparedness by adding incentives, either through accreditation or other kinds of programming. Platt explained that the issue "is not always about the money, but in this case the money is not at the table because we do not have the casualty insurers, the risk managers, or the investment community here." In particular, he said the investment community is "the big elephant that should be invited to the party." Based on 40 years of experience of working in various aspects of private capital, he believes there is a way to get the investment community involved to help fund a sustainable health system capable of responding to disasters.
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From page 88... ...
Baskin replied that the cost of emergency preparedness, response, and resiliency is more than just a medical cost issue. Today, health plans are already financing the medical costs that occur, and in that respect, he has some concerns going forward as the health care financing system starts moving more risk onto providers than it has in the past.
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From page 89... ...
Although the Patient Protection and Affordable Care Act ameliorated that to some extent, shifting costs and risks are still basic incentives in the system. "This raises the classic free rider problem, where everybody looks to everybody else to make the necessary investment, and no single entity alone has the incentive to make that investment because they thereby confer benefit on their competitors," said Frankford.
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From page 90... ...
Frankford seconded this idea of using network adequacy as a stick, particularly with regard to coordinating the components of a network, which he believes is the missing piece regarding preparedness and response. Kaplan, returning to Brice-Smith's remark about the scale of the private sector's voluntary participation in the response to Hurricane Harvey, said the American spirit of volunteerism is something the health care system has not tapped or leveraged yet.
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From page 91... ...
For example, insurance companies have expanded their concept of networks to include pharmacies and community health centers as places that could provide flu vaccines and developed new mechanisms that made it simple for these non-network providers to bill and be reimbursed. In the same vein, he wondered if it would be possible for health plans to cooperate and collaborate on their networks so that the network can be as big as it needs to be to fit one of these large-scale disasters.
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From page 92... ...
An unidentified participant noted that the insurance industry was a terrific partner during the H1N1 influenza pandemic, but the health system does not really understand how to engage the insurance sector on a more sustained basis to work collaboratively on these situations. Bergero noted there is a huge lever with regard to increasing surge capacity and resilience that has not been pulled at the national level, and that is the potential role of home health care.
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From page 93... ...
He asked Baskin if there was some mechanism that could be used to reimburse pharmacies if they were given the authority to dispense Tamiflu during an influenza outbreak without first requiring individuals to go to the hospital or to see their physician. Baskin replied that health plans reimburse for services allowed under the scope of practice associated with their license.
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