Seven Things Healthcare Execs Can’t Stop Talking About

1. Staying relevant.

“Between the extremes of 100% prevention and 100% eradication of disease, healthcare will always remain a viable industry,” says Ruchin Kansal, leader of Virtusa’s digital business strategy group, Healthcare, Insurance and Life Sciences sectors. “However, given the unsustainable economic burden of healthcare and resulting pressure to disrupt the incumbent healthcare business model, the question healthcare execs are asking is how their business remains relevant, how do they defend the potential for disruption, and how do they drive growth?”

2. Providers acting more like payers.

Practices participating in alternative payment models like the Oncology Care Model are embracing payer best practices as they learn how to assume accountability for the cost and quality of patient populations, according to Charles Saunders, MD, CEO at Integra Connect.

“Leading practices are transforming to integrate multiple sources of patient data, risk stratify their populations, prioritize interventions including launching new care management and navigation capabilities, and achieve decreases in avoidable cost drivers such as inpatient stays and ER trips while revisiting appropriate end-of-life care,” says Saunders. “Skills, tools, and workflows that were once the exclusive domain of payers are now high among practices’ priorities.”

3. Amazon’s foray into healthcare.

Amazon’s decision to buy online pharmacy PillPack, as well as joining forces with Berkshire Hathaway, and JPMorgan Chase & Co. to address healthcare for their employees, has the industry standing at attention.

“Amazon’s singular focus on improving the customer experience in every business make them a welcome, vaunted entrant into the healthcare value stream,” says Srini Koushik, chief technology officer, Magellan Health. “This should cause all of us to really think about how we leverage our experience in the industry to deliver real value to our customers/members by helping them live healthy and vibrant lives.”

4. Potential implications of other new market entrants and the pace of vertical integration among payers, providers, retailers, and tech companies.

Some examples are United Healthcare’s Optum unit buying healthcare providers, the Cigna-Express Scripts deal, and CVS agreeing to buy Aetna. 

“Surprisingly many organizations still seem to believe that the disruption will impact others more than it will impact them,” says Liam Walsh, line of business leader for Healthcare & Life Sciences at KPMG, a tax, audit and advisory firm.

5. The role of end-of-life programs.

End-of-life programs are advancing the Triple Aim for patients with serious terminal illness, according to Saunders.

“The Humana acquisition news underlined an issue that was already top-of-mind for many specialists participating in value-based programs: the importance of incorporating appropriate, compassionate end-of-life care for patients,” he says. “Our data shows that even some of the largest oncology practices, for example, introduce end-of-life discussions too little and too late. While the practices are seeking to improve the situation with increased education and enhanced programs, part of the answer will also lie in the continued progress of precision care.”

6. Patient payments.

One of the challenges many are discussing is, “How do we drive patient payments while remaining consistent to a patient-centered model?,” says John Uselman, payment processing expert at Wind River Financial, a company that provides healthcare-specific payment processing technology solutions to health systems.

“How do we provide customers with payment options that make sense for them and the health provider? Normalizing data from multiple sources can provide front-line staff with the tools to have an informed, compassionate conversation with patients. Controlling denials, deploying payment estimation, and predictability tools allow for more transparent communication flow between providers and patients,” Uselman says.

7. Value-based care, pay-for-performance, and patient-centricity.

While these issues are on everyone’s mind, executives must not overlook the interdependence of these topics, says Jennifer Bright, acting executive director, the Innovation and Value Initiative, a collaboration of academics, patient advocacy organizations, payers, life sciences companies.

“Executives can benefit from models that integrate multiple measurement tools with the patient perspective at the forefront, so they can move beyond short-term price focus to assess real-world value,” Bright says.

Rick R. Suarez, vice president, U.S. market access, AstraZeneca, agrees. “With the dynamic external environment, there is a greater need than ever to move the system toward a focus on value and improved patient outcomes,” he says.