Advancing Through the Chaos of Transformation

Plain-old, everyday kinds of changes are hard for most people. Even simple changes in routine or business-as-usual are often disruptive and uncomfortable. When we magnify the scale of change to encompass the transformation of an entire industry, the disruption and discomfort can become enormous. The healthcare industry, according to The World Bank, represents approximately 17.7 percent of our nation’s economy, and the industry is going through a massive transformation.

In one way or another, we’re probably all dealing with at least some of the changes that are occurring in healthcare, and that is generating a lot of anxiety and heated public debate. The launch of the health insurance marketplaces across the country has been fraught with problems, especially in states that opted not to set up the marketplace but let the federal government do it. Online computer systems have not been up to the task, and people have been frustrated. Political fighting at the federal and state levels has made progress difficult and has deepened divisions in our society.

For some, the response seems to be to throw up our hands and say, “It can’t be done, it’s a train wreck — let’s go back to yesterday and start over.”

The fact is we cannot go back. Where we were three or five or even 10 years ago was not sustainable. We must advance through the current chaos if we are to transform our nation’s healthcare environment into something that is sustainable, equitable and effective. Achieving that kind of change—however global in scope—will happen at the local level through collaboration among health providers, policymakers, community leaders, employers, payers, and consumers.

Let’s start with the health insurance marketplaces. In the absence of a state-run health insurance marketplace, local governments, faith organizations, healthcare providers, payers, and consumer advocacy groups across Dallas-Fort Worth are collaborating on efforts to educate people about their options for accessing health insurance coverage and helping them sign up for affordable coverage.

Texas Health Resources believes that helping Texans access affordable health coverage could benefit all Texans because people who have access to prevention, early diagnosis, and treatment have better health outcomes in the long run, and are more likely to be productive contributors to our communities.

The start of a massive social endeavor, such as implementing health insurance marketplaces, is often chaotic. The Medicare Part D program to cover prescription medicines—launched in 2006 under the George W. Bush administration—was also bumpy at first. Now that program is helping senior citizens who might not otherwise be able to afford the medicines they need. If we work together, we will once again advance through the chaos to a transformed and improved situation.

But what happens after people who have not had health insurance get coverage? Who will take care of them? We do not have enough physicians and nurses to meet the expanding needs of an aging and growing population. Will that lead to another form of disruption and chaos, this time in the emergency room or doctor’s office? We cannot wait for others to impose solutions; we must move forward through the chaos, develop new approaches, and create the future we want to live in.

Texas Health has been moving forward with a 10-year strategy that we launched in 2006, knowing that the years ahead would be full of change and uncertainty. We built into our strategy the ability to be flexible and to adapt to the ever-evolving forces of politics, technology, and demographics.

At the core of our strategy is the idea of physician-directed population health that emphasizes keeping people healthy and out of the hospital. It focuses on improving outcomes and increasing value to consumers. This model puts physicians in leadership positions at every level of the health system and takes an integrated approach to the entire continuum of care from education and prevention to primary care, to acute and specialty care, rehabilitation, home care, and palliative care.

Texas Health does not own every piece of the continuum—we collaborate and partner with physicians, other healthcare providers, employers, and payers to bring order to a fragmented environment of care. Together, we are advancing through the chaos.

No matter how many nurses, physician assistants, and nurse practitioners physicians have by their side, they cannot change the upward trajectory of healthcare costs if consumers don’t take personal responsibility for improving their own health.

Just as it will take years of focused effort to transform the healthcare system from a fee-for-service, volume-based approach to a value-based model focused on outcomes, changing the way people think about and act on their own health will take time. But doing so is critical to bending the cost curve away from its upward trajectory.

According to research by Healthways, personal behaviors are 50 percent to 70 percent of what influences health but we spend only 4 percent of our healthcare dollars to change behaviors. DFW area employers lose approximately $17 billion each year due to employee health issues. That is in addition to the cost of providing employee benefits.

To support physicians in transforming healthcare in the North Texas region, Texas Health has launched several initiatives focused on helping the people of our communities know more about their health, change their health behaviors, and improve the health and well-being in every aspect of their lives.

Early in 2013 we launched some online tools, such as the Daily Challenge on, that help people think about simple things they can do each day to make small, meaningful improvements in well-being.

In collaboration with our strategic partner Healthways, the city of Fort Worth and the Fort Worth Chamber, we recently launched an initiative to make Fort Worth a Blue Zones Project city. Blue Zones are communities that have purposefully created a more livable, walkable, bike-able, and socially engaged community. Blue Zone communities in other parts of the country have measurably lowered healthcare costs, increased productivity, and improved the quality of life for residents in those communities, according to data from Healthways and Blue Zones, LLC.

We also recently announced the Texas Health Population Health, Education, and Innovation Center. The Center will serve as the nexus for sharing best practices, disseminating information about innovative approaches, leading physician-directed population health initiatives, and coordinating community-based well-being collaboration.

Texas Health and many other healthcare organizations in Texas and across the nation are advancing through the chaos and investing for a long-term result. The past was unsustainable, the present is often chaotic and contentious. The future—if we collaborate and advance through the chaos—can be the bright, healthy community we all want to live in. We can transform the healthcare system into one that is sustainable, equitable, and effective.

Douglas D. Hawthorne is the CEO of Texas Health Resources.

Posted in Expert Opinions.
  • Elaine

    It is awesome to be a part of the Texas Health organization where leaders will put their best minds & hands forward to be a part of the solution instead of sitting by pointing fingers and watching things fall apart around us. From where I sit weather sink or swim the decisions made in this country effects each of us; our families and the community in which we live and work. So, why not do as Mr. Hawthorne has said “lets put our best foot forward, roll up our sleeves and fight to make what looks like a hopeless mess sustainable and effective. Each of us can help in some way; if nothing else but by making some lifestyle changes for our-self and for our families to help keep our bodies, minds & spirits healthier. Change what we put into our bodies & motivate our households to eat healthier, walk and or exercise more. Get regular checkups as well as change our mindsets; how we view life and living healthy. Let us be and example to those around us and help motivate those around us to also be a part of the solution. If we don’t take care of us & our households, we can’t expect someone else too. If we would change our lifestyles even a little, we would save a lot in healthcare expenses. The decisions made in this country do effect our lives and those around us weather we agree or disagree with them. We can always choose to take the high road and do what WE can to make the best of decisions that we had no part in making. If someone gives us a bag of lemons, lets not complain wishing they had given us oranges; just use them to lemon aid, add some ice and drink up! I think this was a great article by Mr. Hawthorne. Thanks for sharing it!