Are women's centers doomed in the face of merger mania?

Integrated delivery systems can benefit those that create opportunities

What three words can send shivers of fear through even the most steadfast leaders of the nation's women's health centers? Integrated delivery system, or IDS for short.

The purpose of an IDS is to create a comprehensive network of care that appeals to managed care organizations. As an IDS develops, hospitals, outpatient clinics, physicians, and other entities may join forces to provide simplified contracting for payers and guaranteed patient bases for providers.

While assets may or may not merge, eliminating duplication of services among facilities and maintaining cost efficiency are paramount to success. For this reason, many components of the developing system, including women's centers, feel threatened.

There is reason for fear.

"The whole intent of mergers and IDSs is to reduce waste, streamline operations, and economize on service delivery," says James G. Easter Jr., MArch, president of Nashville, TN-based Easter and Mason Healthcare Consulting, which specializes in facility and capital asset development. "To do that, once you become part of an IDS, you become a part of a change that requires some service realignment, redefinition, or adjustment."

An effective IDS must have an impact on the operation of a women's center that has been running as an independent facility or as part of a solitary hospital. The good news is that if change is approached strategically, opportunities to enhance the impact of women's services exist.

Gather data

Research and a local market assessment are essential to convince the governing board about the need to focus on women's health care needs. The Internet and the National Association of Professionals in Women's Health in Chicago are excellent sources for general information about women's health trends. A marketing and planning department or a consultant can assist with a local market assessment. (See story on how one IDS examined the health care costs for its female employees and presented this information to administrators, p. 99.)

As a start, proponents can note that women make more than 75% of consumer health care decisions (Megatrends for Women by Patricia Aberdeen and John Naisbitt) and constitute 52% of the workforce. "The woman consumer is a critical driver in terms of panel selection," says Genie James, MMSc, a Nashville, TN-based health care consultant and author specializing in managed care business development, program development, and product launch. James has written Winning in the Women's Healthcare Market Place, which will be published this fall by Jossey Bass Publishers in San Francisco.

When considering health plans, the first thing a woman looks for is whether her OB/GYN is on the panel and whether her child's pediatrician is there, James says.

A local market assessment should focus on gathering information about the financial impact women may have on the developing IDS. Because the IDS is interested in building market share and increasing profit margins, information related to these measures should be emphasized. Where do they find this information?

"The background music IDSs are dancing to usually is driven by lower reimbursements from managed care," says health care consultant Rita Menitoff, MT, MS, president of Women's Health Management Solutions in New York City. "Revenue is going down. The only way to increase revenue is to increase volume and lower cost. Hence, increased market share and improved economies of scale are going to yield higher profit margins."

While profit margins for OB/GYN services are not necessarily large, explains James, excellent service in this area allows the system to increase market share and build allegiance. Emphasize this point in your presentation to the board.

"Then you'll get the upstream referrals for high-margin procedures," James says. "Appealing to women is critical to the success of an IDS in terms of long-term viability."

True success in an IDS, however, goes far beyond maternity services.

"How can we put together a fuller product line across a continuum of settings and top diseases and conditions to be able to provide seamless service to the consumer - the women? This is the question women's center leaders should ask as the IDS develops," says Menitoff. "Hospitals that call me tend to focus on the threat of duplication and overlook opportunities that present themselves in service gaps."

James adds, "As the marketplace changes, you have to broaden the definition of women's health care and infiltrate a women's health care strategy across the health system." (See tips for working with others within the system, p. 100.)

Show me the money

Menitoff's company has developed a process that not only redefines women's health care across the life spectrum, but allows an IDS to predict the revenue potential it can expect to generate from females under this new approach to gender-based medicine.

For BJC Health System, based in St. Louis, that amount was $500 million annually. Menitoff's "grouper," as her company refers to the model, segments women into four life cohorts as defined by the National Institutes of Health:

· adolescence;

· childbearing years;

· midlife;

· senior years.

The grouper indicates the revenue-producing conditions experienced by women in each segment, including specialty areas such as cardiology and oncology.

"When you start to redefine women's health across these cohorts, it demonstrates how important women are to the system," says Kathy Hanold, RN, MS, vice president of women and infant services at BJC Health System.

The grouper also takes changing demographics into account. In the BJC market area, a system that spans two states, 14 hospitals, 100 ambulatory centers, and 25,000 employees, the midlife population is growing at an annual rate of 10%, the number of women OF childbearing age is decreasing by 9% every year, and the adolescent population is expanding. The model enables better planning as the IDS matures.

A set of core competencies accompanies the program as well. Users can measure whether all providers directly and indirectly involved in women's health care understand the differences in treating women from an evidence-based perspective. Cardiologists, for example, must ascribe to gender differences in diagnosis, screening, detection, therapy, and recovery.

Women are the ultimate beneficiary

Women's centers that adapt to these changes are best positioned for success in an IDS. Researching, expanding the definition of women's health, and demonstrating the financial impact women have on a health system are essential elements not only for survival, but the ability to thrive.

Ultimately, women benefit. One of the biggest concerns women have about health care is fragmented service, says Menitoff.

"Within an IDS, a women's center may actually be a virtual facility connected by a common information system, common protocols, and a common referral system," she says. "The goal is to achieve comprehensive, seamless care from the consumer point of view and do it in an efficient way from the perspective of the new IDS. The new enterprise - the IDS - brings value in that a woman should be able to get all of her care within the enterprise, and it should be coordinated without duplication."