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Four Long-Term Health Care Changes on the Horizon
Health care is already changing before hospital leaders’ eyes, but several longer-term trends will emerge over the next several years, according to a report from the Healthcare Financial Management Association.
Most of the innovations that health care leaders say they are excited about have less to do with medical advances and more to do with improving how health care is accessed, provided, and paid for in the U.S., the report says. Experts point to pioneering approaches that will likely become commonplace in health care over the next 5 to 15 years, particularly in four areas: new care delivery options, revamped clinical teams, data analytics, and value-based payment models.
New Care Delivery Options
Immediate Answers. The traditional way of dispensing health care is longitudinal and fragmented, with lots of days between value-producing office visits, says Douglas L. Wood, MD, cardiologist and medical director of Mayo Clinic’s Center for Innovation. What the country needs instead is a system that provides answers to questions immediately, making it easier for patients to make more informed choices so they can go about their lives with less disruption and anxiety. Wood believes this is the system of the future.
“Say a patient with shortness of breath sees his primary care physician, who recommends consultation with a cardiologist,” he explains.” Typically, that physician will call my office to arrange a visit sometime in the next two days to four weeks — which will require the patient to take additional time off from work. But suppose I am readily available, at the time of that first office visit, to talk with the physician and listen to the patient. I can make a quick decision about whether the problem is likely to be serious or not and even decide on what next steps we should take.”
Mobile Care. In this new system, 10 to 15 years down the road, much more care will be delivered where the patient is — at home, at work or school, even traveling — using onsite and mobile clinics.“Maybe a company that has a handful of salespeople with potential health risks has a regular regional sales meeting,” Wood speculates. “We could see them all together on the same day by traveling with an optimized care team — a physician, a nurse, maybe a physician assistant — to that location.”
Remote Monitoring. New technological applications for engaging, communicating with, and delivering care to patients will be “huge” over the next 15 years, according to Suzanne Anderson, Virginia Mason Health System executive vice president, CFO, and CIO. As a result, providers will be able to serve more patients with existing resources.
“There will be more monitoring of chronic conditions through mobile apps, in which the patient provides information that feeds directly into our EHR system, which will be able to evaluate those data,” she predicts. “If, say, a diabetic’s glucose levels are within a predetermined range, the information is just recorded for future reference. If the glucose levels are problematic, both caregiver and patient will get a message saying ‘We need to connect.’ And, if something changes with a patient, we will be able to send her information that’s relevant to the new stage of her disease.”
Acute Care Clinics. Molly Coye, MD, chief innovation officer at UCLA Health, believes the future will see the mushrooming of a new phenomenon: freestanding emergent and urgent care clinics that treat patients with acute but non–life-threatening conditions, including wounds and fractures, which comprise 13% to 27% of emergency department (ED) cases. With lower overhead, such clinics already are charging a third to a fifth of the cost of equivalent care in an ED — with no facility fees, no appointments necessary, and more diagnostic capabilities.
Revamped Clinical Teams
By 2030, increased emphasis on population health, personalized care, and preventive approaches will expand the health care worker model beyond simply doctors and nurses, the article predicts. To prepare for those changes, health care leaders must help develop a system and processes that let all practitioners practice at the top of their licenses, doing things they are uniquely trained to do and that have the greatest value, according to Philip A. Newbold, CEO of Beacon Health System in Indiana.
“Physicians would mainly work with the very sick, the five to 10 percent that bounce back into the ER and account for most readmissions and a disproportionate amount of resources,” Newbold says. “And then you have a wide range of new players — nutritionists, physical and occupational therapists, exercise physiologists, stop-smoking coaches, social workers, care coordinators, health coaches — doing what they do best to help the healthy stay out of trouble and people with chronic conditions manage their risk factors.”
Sorting through large amounts of historical clinical data to identify past patterns (e.g., at-risk populations, early symptoms of disease, and utilization) opens windows to the future — and makes it possible to improve outcomes by homing in on best practices, the report says. The same is true with financial data, population health data, supply-chain data, facility-design data, and so on. For this reason, says Anderson, data analytics — predictive analytics, in particular — will explode in the next 15 years.
“I think this capability is in its infancy in terms of technology, but as it grows to adulthood, we’ll see amazing changes in care,” she says. “For example, if we can identify biomarkers for sepsis, we might be able to predict which patients are especially vulnerable even before they come into the hospital, so we can monitor them very closely.”
Value-Based Payment Models
One of the greatest difficulties facing hospitals and health care systems today comes from trying to serve two masters at once: the value-based reimbursement of the future and the volume-based reimbursement so deeply embedded throughout the industry, according to the report. Innovations are needed to help health care professionals make the transition.
Pay for Meeting Personal Goals. Some of the most radical changes in the next decade or so will be shifts in payment systems to accommodate the changes in goals and delivery systems, the report predicts.
“Right now, there’s a lot of time spent arguing over who’s getting how many dollars,” says Anderson. “As we get into more accountable care (with a small ‘a’), providers will be forced to either develop straightforward calculations for bundled payments, or really start thinking as a single, integrated system.”
Guaranteed Quality. The idea of a guarantee of quality is definitely coming, says Anderson. In fact, Virginia Mason introduced a new warranty program for total hip and knee replacement patients in September 2014. The concept is simple: an organization that agrees to assume the costs of avoidable, surgery-related complications is an organization that has a major incentive to deliver high quality care.
Anderson explains: “Say a person comes into a hospital for a knee replacement and develops an infection. She becomes delirious and tries to get up on her own to go to the bathroom, falls, and breaks a hip, gets the hip replaced, finally goes home — only to develop an embolism and be readmitted immediately.”
Currently, under the fee-for-service payment system, most hospitals get paid for taking care of the knee, the infection, the hip, and the embolism. The hospital of the future will get paid for the knee, period.
“So unless they want to go out of business, they will get pretty darn good at what they do,” says Anderson.
The Insurance Marketplace. According to Joseph M. Zubretsky, senior executive vice president of National Business at Aetna, population health, which is fast becoming the holy grail of the health care system, is about bringing providers, patients, and payers into a “digitized community” with completely revamped business and clinical processes to improve quality and drive down costs. Over time, he says, the structural lines between providers and payers will blur, if not disappear.
“Providers know that to have a sustainable business model in the future, they will need to participate in the insurance marketplace,” Zubretsky says. “There are three ways this can be achieved: a provider-owned health plan that is powered by an insurance company; a 50/50 joint venture; or an arrangement in which the insurance company is the legal entity that conducts the business while the provider participates in the underwriting cash flow.”
Sources: FierceHealthcare; April 26, 2015; and HFMA Leadership E-Bulletin; April 21, 2015.