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The Health Care Industry Current State and Future Potential

Jun 15, 2016

Over the past few months, I have attended numerous health care industry conferences where CEOs and CFOs were asked to share their insight on the current state of health care and where they see the potential for this industry in the near future. Although many of the themes were similar, I was able to take away the following eight concepts, some of which may surprise you.

The future of the health care industry is unclear.
Since the presidential candidates do not have (or have not shared) a vision for how they see health care in the U.S. in the coming term, there is a great deal of uncertainty looming among health care CEOs. One thing is for sure—population health remains a top priority for the health care industry. Large hospitals and health systems believe it is their responsibility to pioneer advancements in patient outcomes. Small to mid-size health systems are focusing on this as well, but have the added pressure of remaining viable in this market. The lack of clarity in our health care future will continue to cause angst among providers, payers, and patients.

Provider burnout.
Studies show 54 percent of physicians exhibit one or more symptoms of burnout (depersonalization and low personal satisfaction seem to be significant factors). Provider emotional burnout is becoming a national epidemic according to the CEO of a major health system, and this system is employing team-based care and other strategies to respond to this crisis. For example, one large hospital system has imbedded behavioral health and pharmacy resources in their primary care clinics to create a truly integrated team to care for their patients, thus assisting providers with the incredible challenge of managing health. The disparity of pay between primary care providers and specialists is also a contributing factor to burnout. Since the role of primary care continues to be a critical component of population health, this will need to be addressed if we are to attract more physicians in the primary care field.

Data is captured on every aspect of the health care process but accessing and understanding it is almost nonexistent.
Hospital CEOs have a challenge accessing and using data to make decisions. Larger, more sophisticated hospital systems are using data for predictive analytics, which is used to make pioneering decisions to improve health. Smaller hospitals and health systems lack the sophistication necessary to perform predictive analytics and therefore need access to data simply to increase efficiencies, cut costs, and improve the patient experience. It will be very difficult for any health care entity to manage population health without significant investments in data analytics.

Passion for a better patient experience.
Customer service remains king in this industry. With new competition from retail outlets, it is becoming more critical that health systems make it easier for patients to access services. Larger systems are shifting their thinking from the traditional focus of the doctor as the “star” to the health system as the “star” in order to drive service from the patients’ perspective.
As an example, one of the nation’s largest hospitals is offering refunds of deductibles and coinsurance amounts to patients who do not have an excellent experience. The hospital has developed an automated feedback loop on its website for patients to use to selfadjust out-of-pocket amounts based on their overall experience. It also uses this model to obtain feedback and to improve the care process.

Coopetition – the new collaboration.
The quote from the movie The Godfather sums up this concept— “keep your friends close; keep your enemies closer.” Coopetition is a combination of collaboration and competition through which organizations focus on building something new together. They continue some of their traditional focuses while they build new services together with their former competitors. Careful selection of “partnerships” is important in this effort in order to build relationships with others who have the drive to innovate and create something bigger and better together. The convergence of hospitals, physicians, health insurance, post-acute, retail, ambulatory, and community is the new coopetition model of the future. Some health systems are going directly to employers with their quality and value propositions and skipping the health insurance middleman all together.

Precision medicine.
It is time we took the “guess work” out of medicine. The days of trial and error are numbered in health care. Some large health systems are using genome testing and other methods to increase the precision medicine initiative directed by President Obama. It is likely that this practice will continue to grow and become available to more patients in the very near future.

Progressively larger systems emerging.
The thrust toward expanding systems into larger footprints in order to manage a greater population is moving forward faster than ever. There is a consistent push, even among the “super systems,” to continue growing across geographies. Systems are looking beyond the traditional hospital and physician candidates for expansion. They are now looking for post-acute partners such as skilled nursing facilities and home health agencies in order to create a network of provider types to manage population health.

Putting logistics in the equation.
A national health care system is using logistics in the forefront to better manage the health of its Medicaid managed care population. It has taken population health to a whole new level—using logistic principles much like FedEx or Amazon to get the right care to the population at the right time. It offers a 24/7 dispatch system connected to emergency response teams, 24/7 behavioral health walk-in clinics, mobile clinics where needy MA patients congregate (in homeless areas of the city), home care, and all other resources available to this population. Its ability to reduce admissions and ED visits has been impressive. Overall it is the total cost of care and the measurable health improvements in the population that matter under these types of population health initiatives. This innovative process turns the delivery of health care upside down.


Tina Nazier, MBA, CPC
Director, Strategic Alignment
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