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The one-word answer to health reform

March 27, 2011
By Bill Leaver and Sue Thompson


A single word that unlocks a great mystery: What is the ideal way to deliver health care?

All right. Technically, BOFEPET is not a word. Nevertheless, it drives us. Our doctors. Our nurses. Our pharmacists. Our social workers.

It's what Iowa's clinics and hospitals are striving to achieve: Best Outcome for Every Patient Every Time.

At the one-year anniversary of health care reform, we are frequently asked what we think of it.

We see it as an opportunity to create a new way to deliver on the promise of best outcomes. During the past year, we've developed innovations that bring down the cost of care while improving quality. For the first time, BOFEPET isn't a concept that we are pursuing in spite of bureaucratic barriers - it is a value we can express freely, because those barriers are falling.

We have advanced in many areas in light of health care reform:

Empowering the patient-physician relationship. Iowa Health System cares for nearly one of every three patients in Iowa. We rely on a core team of professionals to ensure the greatest care for these patients. This means that our physicians must lead in the mission to strengthen patient trust. Last year, we launched the Physician Leadership Academy, an intensive program for our most qualified physicians to learn leadership and administration-level skills that will help us move from being hospital-driven to physician-led.

Building technological bridges to the patient. We are placing wireless towers across the state to reach out to every Iowan, no matter how remotely from our services they may live.

Lowering bureaucratic barriers. Something has always challenged the ability of physicians, clinics and hospitals to achieve the best care for patients: the structure of Medicare reimbursements. Historically, Medicare has reimbursed hospitals based on patient volume, not quality of care, penalizing high-quality care states like Iowa. This created a system where the patient can become an afterthought. That now can change under health care reform.

Providing greater wellness for the local community. With reform, com- pensation for care is much more likely to reward providers for "best" care, rather than "most" care. Health care reform allows for and encourages coordinated care.

In Fort Dodge and Des Moines, Iowa Health System is piloting coordinated care payment reform models involving a variety of allied organizations that will improve the health of the local populations, enhance quality of health care services and reduce local health care costs. These models involve organizations that previously were not encouraged to collaborate. If successful, the programs will be repeated throughout Iowa Health System, wherever it makes sense for our communities.

One year into health care reform, we see dramatic opportunity in areas that have been stuck in neutral - and even sliding into reverse - for decades.

What do we hope to see in the next five years?

A simple-to-understand, wellness-centered experience for the patient, led by physicians with a renewed personal approach to the practice of medicine in a system that invigorates our work force to foster vibrant communities of people living at their healthiest.

The better parts of health care reform provide our system of hospitals and clinics with better opportunities than we faced one year ago. The new regulations are less likely to hinder us in fulfilling our core duty: to provide the Best Outcome for Every Patient Every Time. Where health care reform goes from here, we can't say.

We do know this: as long as the system affords health care providers the ability to deliver BOFEPET, it will become the one-word answer to health care reform.

Bill Leaver is president and chief executive officer of Iowa Health System, the state's first and largest integrated health system, with 25 hospitals, more than 140 physician clinics and nearly 20,000 employees. It is the parent organization of Trinity Regional Medical Center in Fort Dodge.

Leaver can be reached at

Sue Thompson is president and chief executive officer of Trinity Regional Medical Center, which serves an eight-county region. Trinity employs more than 1,000 area residents and has a medical staff of 65 physicians.

Thompson can be reached at



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