Last week I attended the 3rd annual National Healthcare Coalition Preparedness Conference in Denver. This has grown to be one of the premier healthcare preparedness meetings with well over 700 attendees from all over the country. There were a number of interesting presentations on a wide variety of preparedness topics, including my own presentation on allocation of scarce resources in a disaster that I will address in a future post. In this post I will focus on the tremendous growth that has been seen in preparedness coalitions and their possible future.
In a really informative presentation by Melissa Harvey Deputy Director of the Hospital Preparedness Program (HPP) in the Office of the Assistant Secretary for Preparedness and Response (ASPR) in the Department of Health and Human Services (HHS), I learned that there are now approximately 500 coalitions. These coalitions have almost 24,000 members, which represents a 47% increase since last year. Most of the coalitions include the “big 4” as members: hospitals, public health, emergency management and emergency medical services (EMS). As we and many others have said in the past, all coalitions are different and that “if you have seen one coalition you have seen one coalition”. But many speakers at the conference endorsed the notion that many different coalition structures can be effective.
Going forward, HPP’s goal is to broaden coalition membership to the “next 3” namely: home health, dialysis centers and nursing homes. They also want to increase coalition membership by another 100% to 48,000 in the coming year. This seems like an ambitious goal but they think that the coming emergency preparedness rule from the Centers for Medicare and Medicaid (CMS), which is due out in about a year, will provide a strong incentive for healthcare facilities to join in coalitions. While the CMS draft rule does not mandate coalition membership, it does require CMS providers to collaborate with local partners and encourages coalition membership.
While on the one hand this growth in coalition is very encouraging, I see potential financial problems down the road. The CMS rule is a stick without a financial carrot. Healthcare facilities will be penalized for not meeting the requirements but are not provided additional funds to do so. Currently most hospitals get this funding from the HPP; however, the HPP has seen an almost 50% decrease in budget over the last 10 years and its future after 2017 is not guaranteed. So the question of financial sustainability of coalitions looms large in the minds of many coalition leaders as expressed at the conference.
One intriguing potential solution to this dilemma, articulated by Brendan Carr from ASPR, is to expand the scope of coalitions beyond emergency preparedness and response. Coalitions largely overlap with regional referral networks (such as trauma, cardiac and stroke referral systems). As we as a nation move gradually to a healthcare system organized around regionally determined outcome measures, existing coalitions could be a vehicle through which healthcare facilities collaborate to improve population based outcomes and constrain costs. This should be food for thought for coalition leaders and healthcare planners alike.