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Keith Loria is a contributing writer to Medical Economics.
Healthcare executives and consultants told us which strategic trends to look out for - before COVID-19.
COVID-19 has disrupted American healthcare. But there are still important non-COVID-19 trends to keep an eye on.
1) Wellness: Real Deal, Not a Passing Fad
As the cost of healthcare in this nation continues its relentless climb, health system and managed care executives are focusing on the development of strong population health programs and preventive care initiatives as a way to keep patients healthy and avoid chronic conditions that drive up drug and medical services expenditures.
Anthony Viceroy, CEO of Westmed Medical Group, a multispecialty group in Westchester County, New York, and Fairfield County, Connecticut, believes that “wellness” is not just a popular trend or a passing fad. “By preventing or delaying chronic diseases, such as diabetes, hypertension, and heart disease, we can help improve the quality of care for patients, while reducing unnecessary costs in the system,” he says. “It is our belief that the only way to bend the cost curve of healthcare is to champion disease prevention and to promote healthy habits outside of the exam room.”
Viceroy says at Westmed they have noticed that millennials are better than boomers and other generations when it comes to being participants in their own healthcare. They are proving to be more mindful of activities that promote wellness and disease prevention. “This demographic readily adopts innovation and technology to help them track their heart [health], weight, nutrition, and fitness,” says Viceroy.
He adds large medical groups like Westmed have an important role to play in partnering with patients to help them stay out of the hospital and be the healthiest versions of themselves. “I think as a result, you will see more outpatient practices and healthcare systems using data and community health programs to keep patients healthy outside of the doctor’s office.”
2) Data Mastery: Do or Die
As 2020 unfolds, Scott D. Hayworth, MD, believes there will be a growing - and increasingly urgent - need to collect and analyze data.
“Over the past decade, value-based reimbursement and compensation have become more dominant. Providers who cannot tap into the power of data collection, analysis, and guided action will simply not survive,” says Hayworth, who is president and CEO of CareMount Medical in Chappaqua, New York. “Patients are demanding, and payers are rewarding more cost-effective, versatile, and accessible systems of care.”
Depending on in-house resources likely won’t be the way to go. Data management service businesses will become essential partners to many provider groups and institutions, to manage both population health and the increasingly personalized care, says Hayworth.
3) Focus on Individual Impact
John Showalter, MD, MSIS, chief product officer of Jvion, a healthcare analytics and AI firm in suburban Atlanta, says that with a CMS evaluation showing that the next generation of ACOs aren’t saving money, population health will be seen as less effective. “I think that will lead to a trend of increasing focus on individual impact,” he says. “There will be a move from cohort management to individual risk management; specifically, there will be an increased discussion about how AI can help.”
4) The Medical-Social Support “Mash-Up”
Don McDaniel, CEO of Canton & Company, a Baltimore healthcare consultant, believes there will be a continued focus on “mash-ups” that go beyond traditional healthcare services spending and include social services, housing, nutrition, and the like.
“This is the year that I think we’ll find out if SDoH [social determinants of health] can be more than a science experiment,” he says. “There’s been lots of money spent on initiatives, but the jury is out in terms of return. So, can the various actors positively impact detrimental community, social and environmental impacts to improve health status and to reduce the amount spent on vulnerable, underserved populations?” In McDaniel’s estimation, integrated delivery systems that are at risk for the cost of caring for populations are in the strongest position to tackle SDoH projects.
5) Data as Barrier Breaker
Kurt Waltenbaugh, founder and CEO of Carrot Health, a Minneapolis SDoH and health data company, says greater access to consumer information will increase the industry’s ability to pinpoint barriers to health at the individual level. “Access to a broader array of consumer information will expose the role that upstream barriers, the so-called social determinants of health, play in continuously rising healthcare costs,” Waltenbaugh says. “More data will help us better understand how to remove those barriers and pinpoint healthcare down to the individual consumer level.”
Part of the reason for the lack-until recently-of insight into SDoH until recently, he says, is the barriers are not evenly distributed. They tend to cluster in disadvantaged communities, which are disproportionately affected by declining health and rising costs. This year, Waltenbaugh says, he expects to see interventions based on broader consumer information emerge from the pilot stage and be deployed on a larger scale. “However,” he adds, “this scale deployment will only happen in areas where ROI has been demonstrated over a 12-month period. Any longer will require policy and funding changes, which are not currently on the horizon.”
6) Pharmacists as Deliverers of Medication Optimization
Varun Goyal, co-founder and CEO of Indiana-based Illuminate Health, believes medication optimization-making sure patients get the right dosage and support to stay adherent-is needed for every disease. Who better to deliver on the promise of medication optimization than pharmacists? “Providers and payers are now rethinking the role of pharmacists on their care teams,” he says. “Across the country, healthcare organizations are attempting to expand the scope of practice to allow pharmacists to extend patient oversight and assist with outpatient care.”
Healthcare organizations of all stripes are recognizing that pharmacists can help them realize the potential of value-based care. “By realizing the value of pharmacists and incorporating them to provide this patient-centered care model, they can help to reduce costs, ensure safe and accurate medication therapy, and help prevent patient readmissions and chronic disease progression,” says Goyal.
7) Big Data’s Second Act: Security
For the past several years, the transformative power of big data and AI has been a hot topic of conversation, and there’s some reality behind it too. “More recently, however, thanks to well-publicized incidents around data security and access, the conversation has pivoted to the dangers of increased access to data, and how to manage this risk,” says Eric Peterson, healthcare expert at PA Consulting. “Solving this problem will require significant cross-industry collaboration, which can obviously be challenging.”
8) Developing a Holistic Access Strategy
Bill Stinneford, senior vice president and healthcare lead at Buxton, a healthcare intelligence company in Fort Worth, Texas, notes that one of the hottest healthcare trends is a “holistic access strategy.” Stinneford notes, “In the last five years, there has been a tremendous rise in outpatient location expansion within the healthcare industry. Retailers like CVS and Walgreens have opened thousands of clinics, and urgent care facilities have boomed. Even health systems have jumped on the trend by partnering with retailers or opening their own outpatient facilities.”
Among the reasons for this shift: It’s where the money is. The money is there because of reimbursement rates and incentives to keep nonemergency patients out of the emergency department. “Outpatient facilities are an important tool in the strategy to lower healthcare costs,” Peterson says. “But the factors that make a healthcare provider successful in an outpatient setting are very different from the factors that lead to success in a traditional inpatient environment.”
In Peterson’s view, success in outpatient healthcare hinges on understanding and integrating three factors into a holistic strategy: consumer knowledge, retail real estate fundamentals, and traditional healthcare performance drivers.
Keith Loria is an award-winning journalist who has been writing for major newspapers and magazines for close to 20 years.