Healthcare in the U.S. has been changing for the past decade with the rise and fall of the Affordable Care Act (ACA), and it continues to evolve and change in Nevada.
“There’s so much change, so much innovation in healthcare around the country right now, it’s really an amazing time,” said Mark Price, president, Healthcare Partners Nevada, a provider with 310 primary care physicians and over 1,700 specialists.
“Nevada continues to be a fragmented, dysfunctional system in Las Vegas and Clark County, and Reno to a much lesser extent,” said Dr. Sherif Abdou, CEO, P3 Health Partners. “Las Vegas is the largest metropolitan city in the country that does not have a single healthcare system. Las Vegas is dominated by for profit, publicly traded companies that deliver the majority of healthcare. There is no influence of a not-for-profit, mission-driven healthcare system in Las Vegas. Companies continue to change hands with consolidation and merger and acquisition from one for-profit, publicly traded company to another.”
One current transaction involves Healthcare Partners, operated in Nevada by DaVita, which is possibly selling to UnitedHealth Group’s OptumCare, but the Nevada clinics are unlikely to be picked up in the transaction. Healthcare Partners Nevada was originally supposed to be part of that transaction, and according to Price, “We continue to work closely with regulators and Optum to finalize this transaction in a timely manner.”
What does the sale of Healthcare Partners mean for Nevada businesses and individuals dealing with medical costs? “It depends on who is going to own DaVita Healthcare Partners. If Optum is going to divest the Nevada assets, who are they going to divest it to?” said Abdou. “Are they choosing a weak competition or a strong system that’s going to bring value to that acquisition? We’ll have to wait and see.”
Whatever happens with the buyout, Healthcare Partners will continue offering complete medical services to more than 350,000 patients in Southern Nevada, including a variety of Medicare Advantage programs.
That’s just a fraction of what’s needed by way of doctors, nurses and other professionals in the state. According to Price, data from University of Nevada, Reno School of Medicine indicates that Nevada ranks 47th in the nation in terms of physicians per capita. The state would need another 2,500 doctors just to reach average, and that’s a 68 percent increase.
“There continues to be a tremendous need in Nevada for medical groups that can deliver care that is high quality, readily accessible and also affordable,” said Price. “We have fewer physicians per capita than any of the states we border, but we have more hospital beds per capita than any of them. So we struggle with preventative care and end up paying for it with acute care costs.”
We want to be on the flip side of the physician per capita equation and, toward that end, the state is making progress. Significant funding has been granted at the state level to help pay for medical residency programs, and healthcare organizations are responding to that. Valley Health System and Valley Health System and HCA Healthcare, among others, are expanding residency programs. Healthcare Partners is training providers at multiple levels, supporting rotations for Touro University Nevada and University of Las Vegas School of Medicine students.
“We’re also opening a fellowship program for advanced practice clinicians, nurse practitioners and physicians assistants,” said Price. The program is on the road to accreditation and will be the first accredited fellowship for advanced practice clinicians in Nevada.
In addition, healthcare organizations are recruiting physicians from other states; Healthcare Partners alone recruited 51 professionals to Nevada in 2018, and there are other medical organizations recruiting doctors. But one of the effects of not having enough doctors in the state is that it makes it harder to actually recruit doctors to the state when they see the challenges they’ll be facing working in Nevada’s system.
“We have great healthcare organizations in the state doing great things, but we absolutely need to continue to provide more access to preventative care and part of that is continuing to add to the number of physicians that we have in the state,” said Price.
At the Intersection of Health and a Healthy Bottom Line
Lack of access to healthcare can have a significant impact on the bottom line of businesses, not just on employees.
One significant change that affects businesses and employees in Nevada is the return of association health plans. In June 2018, the President signed an executive order allowing association health plans, which had been unavailable for eight years under the Affordable Care Act.
Association health plans allow chambers of commerce, small businesses, groups of self-employed individuals and similar associations to join together to purchase health insurance coverage as an association.
“Association health plans existed prior to the Affordable Care Act,” said Mary Beth Sewald, president and CEO, Las Vegas Metro Chamber of Commerce. “Because of [the executive order], chambers and associations of any kind, really, are able to partner with a [health insurance] carrier, which is what the Vegas Chamber did. We partnered with Anthem Blue Cross & Blue Shield and were able to put together an association health plan where any chamber member in good standing can participate in this larger pool of members so they’re able to get more robust healthcare at a more affordable price.”
The Las Vegas Metro Chamber is one of three associations in the country providing statewide insurance. It has partnered with the Carson City Chamber, and Gardnerville and Minden’s Carson Valley Chamber so their members, for a small fee, can become affiliate chamber partners and participate. Though there’s no requirement to be a part of any other chamber – individuals can join the Las Vegas Metro Chamber and participate in the program.
“We wanted to make it open to as many people as possible, including everybody from sole proprietors all the way through large companies,” said Sewald. “It’s critical to be able to provide this to sole proprietors because the main fabric of our Chamber is made up of small and medium sized businesses. We wanted to be able to help everybody. Small businesses and sole proprietors are the ones who need it the most.”
“There’s a lot of different definitions of ‘small business,’ but about 85 percent of our members are companies of 20 employees or less. Access to healthcare impacts the workforce. People can’t get the help they need, or treatment that they need, or diagnosis that they need, so that’s a ripple effect back through the office, especially if it’s a small business. If you remove one or two key people out of that, things can grind to a halt,” said Scott Muelrath, president, Henderson Chamber of Commerce.
One way to reach patients is telemedicine, especially in under-served rural counties. The state is making progress in the area, but there’s need for more education of both individuals and healthcare professionals.
“We need folks to be more educated about what their options are and we need more education in terms of universities educating doctors and nurses,” said Sewald. “Education has been a primary focus of the Chamber, and working to help establish UNLV’s School of Medicine was a major accomplishment for the chamber.”
In Southern Nevada, UNLV School of Medicine, Roseman University of Health Sciences and Touro University Nevada are working to graduate healthcare professionals. “We need to create a pipeline of doctors and nurses, and we need to keep them here,” said Sewald.
The Business of Healthcare
Healthcare doesn’t exist in a vacuum. It’s not only a business but it has an impact on the bottom line of pretty much every other business. What’s the ripple effect of not having enough physicians on the economy or on businesses?
The first effect is a struggle with access for patients. Scheduling appointments takes longer, getting diagnoses and treatments takes longer, and people are at risk of having what could have been avoided become an acute care event. “They end up being hospitalized for something that could have been prevented with better care,” said Price.
“Health is a main ingredient of having a viable, productive workforce, and if people are sick and can’t come to work or are taking leaves of absence to deal with health-related issues, it’s a loss of productivity,” said Ann Silver, CEO, Reno+Sparks Chamber of Commerce.
So what Silver wants for the 75 percent of the chamber’s 1,700 members that are small businesses is what big businesses already have: the ability to offer a health benefit package.
“We think it’s particularly effective when people have a choice between working in a large business and a small business environment,” said Silver. “Maybe they didn’t have the choice before because while they would have loved to work for a local print shop or restaurant or small office, there was no insurance benefit so they had to go work in a factory or some big place because ‘at least I get dental insurance for my kids.’ Now we think we’ve leveled the playing field and actually broadened employment opportunities for people.”
The Reno+Sparks Chamber has had a plan in place since December, offering a comprehensive, affordable insurance benefit plan to their small business members. The chamber chose to partner with local provider Prominence Health Plan. “We’re also offering it to other chambers for a one-time affiliation fee,” said Silver.
Henderson’s Chamber rolled out an association plan September 2018 through a partnership with Clark County Health Plan Association (CCHPA), which in five months has managed to cover nearly 10,000 individuals under its respective plans.
“It really has been a very valuable member service that has brought down premium pricing for those engaged in one of our health plans,” said Muelrath. “Not in every case, but it’s brought down costs for the majority.
The Henderson Chamber was the first in the country to put together its particular type of plan, which created an umbrella group. CCHPA is an association that brings together four other Southern Nevada chambers: Asian, Urban, Latin and Boulder City. The Henderson Chamber is the sponsoring agency, and they’re partnering with UnitedHealth Group, which means the transaction concerning Healthcare Partners Nevada and OptumCare could eventually have an impact on the Chamber’s association plan offerings.
“It doesn’t [currently],” said Muelrath. “There’s a handful of big mergers going on, but we have contracted with UnitedHealthcare, they’re the ones who contract with the doctors and the clinics and the groups, so I think long term it could [affect our members], because all those groups and partners, they all shift as plans renew. It could have an effect long term. But it could work out for the better. Or not. It’s hard to say at this point, but generally more competition is better.”
Being able to offer a healthcare plan to employees affects a company’s bottom line. Depending on the type of plan, Muelrath said, some groups have saved up to 30 percent on their annual premium. “That’s fantastic, because it brings down healthcare costs for the business community.”
Having a health plan in place also impacts a company’s ability to recruit and retain the best employees.
“Employees when looking for a job anymore are interviewing the prospective employers, so when they’re looking at a company and have several options, one of the first things they look at is ‘What are my benefits going to be?’ and healthcare is one of the most important things they look at,” said Sewald. “In our case, the health insurance we’re able to provide is doing two major things: it’s saving money for the employer, and it’s saving money for the employee. The majority of our employees were able to save money by switching to the chamber plan, but the chamber was also able to save money, so it has impacted our bottom line in a very positive way.”
Another benefit to the association and the Las Vegas Metro Chamber’s plan is stability. The size of the group meant the chamber could negotiate with Anthem and obtain a two-year rate lock.
Along with changes in healthcare such as health insurance coverage and telemedicine, patient care is changing too. More patients are being educated in living healthier lives and managing their own diagnoses, and the delivery of care is changing.
In 2018, Healthcare Partners Nevada rolled out a new medical clinic concept. More than 20 myGeneration clinics opened in Southern Nevada, providing care for seniors on Medicare. Some of the differences with these clinics is a cap to the number of patients per physician that’s about one-third of the number of patients most primary care physicians in the US take care of. Doctors can spend more time with patients, appointments are easier to schedule, and there’s an ability to manage care between appointments. Coordinated extended care teams work to educate patients to lead their healthiest lives and connect them with resources that improve quality of life.
“Early returns on these clinics are remarkable in terms of patient outcomes and provider engagement and satisfaction,” said Price. “Improved health outcomes mean better lives and lower costs for all. Improved provider engagement means it’s playing a large part in how we recruit providers from other states into our model, because they see what we’re doing here and say ‘it’s new, it’s different, it’s having great results and a lot of people want to work in it.’”
“Economists always have said the biggest threat to our national security in the long term is going to be the out of control healthcare costs because we will reach a point in time where we have to compromise and decide are we going to spend for healthcare or spend for our national security,” said Abdou. “Right now healthcare is reaching 19.8 percent of our GDP, more than double that in Japan. It is impacting the economy by diverting resources that can go to a lot of other aspects of innovation and growth into spending on healthcare.”
Change may be coming there, too. “There’s a lot of talk about physicians stepping up and taking leadership roles emphasizing patient-centric and clinicians overall leadership and managing costs rather than managing profits, and integrating the healthcare system,” said Abdou.
“Our first order of business is to develop an integrated healthcare system, at least one in Nevada. Reno has the Renown system that is fully integrated with its hospital, physicians, Renown Home Health, and its hospice. There isn’t such a thing in Southern Nevada. So the first order of business is building a patient-centered, physician-led, population health focused, fully integrated health system in Southern Nevada. When that happens you will see the state of Nevada become a whole different place for delivery of care, and we’re hoping the level of academia of the UNLV, Roseman and Touro medical schools will push us toward that,” said Abdou.
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