FARMVILLE – The Affordable Care Act, which even the president is now calling ObamaCare, is reshaping the philosophy and delivery of health care, and Centra is determined to be at the forefront of the paradigm shift.

If John Milton was writing an epic poem about Centra's approach, he would not title it Paradigm Lost.

“Centra's going to lead this effort, not be dictated by it,” Centra's CEO, W. Michael Bryant, told the Farmville Area Chamber of Commerce. “You can't put your heads in the sand any longer. It is going to change and health care's going to change dramatically. It has impacts on us as providers, it has impacts on you as individuals, but most importantly, this is a chamber, this has impacts on you as a business community.”

The words we're all going to be in this together composed the recurring theme in Bryant's presentation.

“For us in Central Virginia, we just have to have the courage to get in front of this and make it happen because it's all right there in front of us,” Bryant told chamber members at their monthly luncheon meeting last week. “And the goal of keeping each other healthy ought to be something we get excited about. Our children and grandchildren will certainly grow up in a new era.”

Implementation of the Affordable Health Care Act is underway and there are 1,200 or more lines in the 2,700-page document that say “The Secretary shall,” which means, Bryant pointed out, “That's at least 1,200 new regulations that are about to emerge. They're estimating that when Obamacare is fully implemented it's going to be about 100,000 pages long. So we're just getting started in this new era in health care.”

Accountable Care and Accountable Care Organizations are going to take center stage.

“Either individually, your business and your community are going to be significantly impacted by this movement toward accountable care,” Bryant advised.

ACOs, or Accountable Care Organizations, will be held accountable for providing comprehensive health services to a defined population and it consists of providers, not insurance companies, not the government, but providers that jointly are accountable for achieving measured quality improvement and reducing the rate of spending growth.

“This definition here is important…The only people who can create an ACO are the providers, not insurance companies,” Bryant noted.

“What the government is saying, in essence is, 'Okay providers, hospitals, doctors, nursing homes, for 50 years you've been complaining about the government and business and insurance companies dictating how health care should be done, we're going to give you your chance, we're going to let you create a mechanism to define what health care should look like…and in exchange for this privilege we're also going to hold you financially accountable,'” he explained.

“Today at Centra Southside we're only responsible for you clinically, we're not responsible for you financially but over the next five years we're going to transition to a model that we're going to be both responsible for you clinically and financially. We're going to become a quasi-insurance company over the next five to eight years,” he said.

Togetherness will not be quasi.

“We're all going to be in this together. We're all going to be incented to keep each other healthy. We're all going to be incented to keep you out of Southside, put you into home care, doctor's office, ambulatory sites. Because we're going to be financially invested in you…” Bryant continued. “That may sound easy, but today-does everybody know how we get paid if we're a provider? We only get paid if you come see us if you're sick. We do not get a single dollar to take care of you to keep you healthy. A surgeon only gets paid if they operate. They don't operate, they don't get paid. If you own an MRI you only get paid if they utilize the MRI. We're talking about a truly transformative paradigm shift. To go from a system that is illness-based-we get paid to take care of you when you're sick-to one that says (to ACOs) 'We're going to reimburse you and pay you to keep (your service area population) healthy, and we will penalize you if you don't indeed do everything you can to keep someone healthy.' That is a huge paradigm shift for those of us in health care.”

A reconstruction or reconfiguration is underway.

The nation's health care system “was never built around patients, it was built around an acute care hospital,” Bryant said.

That was then.

This is tomorrow:

“We're going to build a system around a healthy person,” Bryant told chamber members. “Think about that. Health care looks a lot different if you look at it from a hospital perspective

“Who here wants to be in a hospital?…Nobody here wants to be in a hospital, and we're about to enter a golden age of health care…In the next two or three years you're going to be able to carry your gene sequence with you for under $100. It will be on you iPhone. Your iPhone will be a medical device,” he said.

Health care's about to go through the same revolution that banking went through, from having to physically find a bank building to digital access from wherever you happen to be.

“Consumerism and technology are merging with technology to really change…You're going to be more incented to stay healthy. We're going to be incented to keep you healthy, and will have tools that we will connect to you on a regular basis, maybe even daily, to make sure that you're staying healthy. Mobile apps are beginning emerge. For those of you who might have a heart condition there's a mobile app…that you can scan yourself and upload your medical record and your doctor can monitor your heart…

“In long-term care facilities when you get out of bed in the morning you stand on this device that scans you and uploads your body signs, your vital signs to a medical record that some provider will be looking at…Think about that in 20 years, that will be in every home,” Bryant predicted.

“We're going to connect to you wherever you are in the world and our goal is to keep you healthy. It's exciting stuff,” Centra's CEO enthused.

Over the next five years Centra's got a delicate balance to manage.

“We don't get any payment today to keep you healthy, and yet we know we've got to transform care to this new model,” he said. “Our health care system today is unsustainable, it's going to bankrupt this country, it's going to bankrupt business. So we've got to change it. What we are going to be doing…we're going to have sit down with you as employers, with the insurance companies, the federal government and say 'Here's the payment stream we need to go through this process.' And in five years or so, five to seven, we're talking about essentially probably having a global payment…we're going to get a global payment of like $700 million,” Bryant gave as an example, “and we have to, for that $700 million, take care of, literally, all of Central Virginia. And we've got to find a way to provide all the care you need…with that global payment that we can make that happen. So now we have a great incentive to keep you healthy, and we're going to have to engage you in a way that you're going to want to stay healthy.”

And it will take more than a village. It's going to take the entire community and region, in communities and regions across the state and nation.

“We're going to build a system around a healthy person…around healthy people in the next five years,” Bryant continued. “We're going to build a new model and we're going to change the game in Central Virginia, we're going to lead the country in establishing this new model…and we're going to coordinate with communities like this, we're going to have groups, like this, where we can sit down and say in Farmville 'Are we improving the health of this community, not just individually, are we overall?'”

Community health is actually four components. Clinical care is only 20 percent of it. Economic development is the number one issue in community health, according to Bryant. “People who have jobs are more educated and are healthier,” he explained.

“And the second most important thing is education. So if we're serious about community health and building a better community, a healthy community, Centra needs to play a role, it may not be a leading role, but needs to play a role in economic development because that has more impact on health than what we do clinically…Most health care organizations are going to have to do something they weren't set up to do, which is partner and collaborate in communities where they're not going to be leading the effort, they're only going to be part of the effort. They're not the solution but part of it.

“You all look to us in clinical care and you can always rely on us to be the leaders in clinical care,” Bryant concluded, “but then we're going to have to look to you to work with us for the broader elements of community health.”

The health care paradigm is shifting.