When CATHERINE McNEAL JACOBSON '85 was promoted to chief financial officer at Rush Health Plans in Chicago in 1990, she thought she had "no business in the world" being a CFO at the age of 27. Today, as the new executive vice president for finance and strategy at Froedtert Health, a health system and academic medical center in Milwaukee, Cathy is once again poised to help another top-notch health system provide superior patient care and, bottom line, to make a difference in the lives of patients. Working with the health care reform bill is one of her priorities.
Although her academic expertise may have started with crunching numbers, Jacobson's heart is in providing quality care. Her strategy at Froedtert, a multi-hospital system, is focused on clinical integration: putting together the pieces of a health system that reach beyond the walls of a hospital. She stresses that finance is a service organization to support the rest of the organization — not the driver.
"How do I put together the right number of physicians, the right kind of physicians, as well as the hospital system that I need, to do a much better job of taking care of patients from a quality-outcomes perspective? A major part of my job involves the pressure point we are all facing: bringing down the cost of health care while taking good care of our patients," says Jacobson. "If you trace my career in health care back 22 years, it's always been about the patient. Nothing clouded that mission. I was taught the mantra, 'How do you create resources to take care of patients?' because that's what we should be doing."
The expansion of health care access
After reading an 88-page summary of the health care reform bill passed last March, Jacobson is focusing, strategically and financially, on the bill's number one intent: an expansion of health care access. "I learned early in my career that when you are in health care, you think you're always trying to do what's best for the patient, and you usually are; however, nothing changes behavior in health care and patterns of how you take care of patients more than the way you get paid."
Naturally, controlling cost is a concern, as the health care bill reduces Medicare spending over time, leaving less revenue to hospitals.The bill has little provision for changing the way physicians are paid, but the changes in payments put hospitals at risk for producing quality care. "Hospitals will be held more accountable," she says. "And that's a good thing. Health care is practiced in silos, and we're going to need to break that down. That's a challenge for the system going forward — a lot of change."
Challenges of the uninsured and insured
Perhaps the largest, single unknown in the health care reform bill, Jacobson says, is people who don't have insurance. The uninsured are expected to have access through a number of different programs, but predominately through "exchanges," where they buy insurance on a retail market in a state-run exchange. "No one knows exactly what shape those are going to take, or what they're going to pay," adds Jacobson. "What are employers going to do? Are they going to continue to provide health care, or figure the penalty is equal, so they let the state take them over? If the penalty is less, they win. Health care reform is going to be different state by state."
Reform is going to affect every American who carries insurance. First, it mandates expanded benefits from employer-based health care. The federal mandate increases the cost to people who have insurance, Jacobson says. Americans who don't benefit from one of the expansion items will see additional costs regardless of whether they personally benefit. Second, on a positive note, Americans who access the system will hopefully see a more patient-friendly view. "Right now, the system is more provider-centric than patient-centric," she says.
Americans should start to see a better coord-ination of care with a more connected system of physicians, home-health agencies, multi-hospital systems, and other types of providers. Some of that might come through health information technology, including accessing medical records and conversing with physicians online. Home-care coordinators may call to check on medication. "In other words, the system is making sure that you are managing your care," says Jacobson. "Under the reform bill, hospitals are being incentivized, or should I say penalized, by payment to make sure those types of scenarios occur to keep you out of the hospital."
Nevertheless, Jacobson believes what Americans fear most is a couple of years down the road. Americans with good health care insurance fear that their employers will choose to pay the penalties rather than continue to pay for insurance. Employers are doing the math. "That's what I would call an unintended consequence," she says. "The government opened up access and failed to put cost controls in place for employers. It could become more expensive to provide health care insurance than to kick it over to the state. So the significant unanswered question is, 'Will the health care reform bill really cut the cost of health care?' It will be 10 years before the reform can be evaluated because it will take that long to roll out the plan. Depending on how the political winds blow, some of it might be modified along the way."
Jacobson finds it hard to comprehend how each state will be able to expand the Medicaid program in concert with the federal mandates outlined in the bill. "Overall, with this bill, health care quite simply will be paid less per unit of service for providing care in the future than it is today — period," says Jacobson. "If we're going to provide a service and not get paid for it, we must make sure it's having an impact on our patient care."
Ties to Bradley
As the 2009–10 chairwoman of the board of the Healthcare Financial Management Association (HFMA), Jacobson continues to work with the national organization serving health care financial professionals, led by DICK CLARKE '71, president and CEO. When she was introduced to Clarke 15 years ago, one of his first comments was that he also was a Bradley graduate. "Under Dick's leadership and alongside my network of peers, I have grown professionally and learned phenomenal leadership skills," she says. Jacobson is now chairing a task force on health care reform to determine its impact on the industry and how the association can best serve its members by addressing health care reform issues. Visit h for more information.
Interwoven with Jacobson's Bradley experience is the fact that her husband, ERIC JACOBSON '89, graduated with an engineering degree from Bradley. "We have fantastic memories of social opportunities and great classes, but we 'shared' quite different Bradley experiences four years apart," she says. "Eric and I brought our children, Claire, 14, Emily, 12, and Kevin, 10, to campus last spring when we visited Eric's brother, WES JACOBSON '82 in Dunlap," she says. "Between the three of us, we covered 12 years at Bradley, and we never leave campus without a visit to Avanti's."