Healthcare Trends and Implications2011–2016

Futurescan

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FuturescanCo-sponsored by:• Society for Healthcare Strategy and Market

Development of the American Hospital Association • American College of Healthcare Executives• With Support From Thomson Reuters and VHA Inc.

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American College of Healthcare Executives

• Professional society of more than 30,000 healthcare executives—Leaders Who Care

• Board certification in healthcare management as ACHE Fellows (FACHE®)

• Foremost continuing educator for the field• Leading healthcare management publications:

– Health Administration Press books– Journal of Healthcare Management, Frontiers of Health

Services Management and Healthcare Executive• Fulfilling our vision to be the premier professional

society for healthcare executives dedicated to improving healthcare delivery

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Society for Healthcare Strategy and Market Development

• Personal membership group of the American Hospital Association

• Serves more than 4,400 healthcare planning, marketing and public relations/communications professionals

• Committed to helping members meet the future with more knowledge and opportunity as their organizations work to improve health status and quality of life in their communities

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Futurescan Contributing Authors• Donald W. Seymour, Executive Editor• Jeffrey C. Bauer, Healthcare Policy: The Future of Health Reform• Paul B. Ginsburg, Payment: Reforms Poised to Spur Hospital Quality and

Efficiency Gains• Pankaj H. Patel and Mark Shields, Physician-Hospital Integration: Market

Trends, Health Reform Drive Closer Ties• Victor J. Dzau and Alex H. Cho, Primary Care: Filling the Primary Care

Supply Gap• Mark R. Chassin, Qualify and Safety: Reaping the Rewards of Process

Improvement Done Right• Paul Tang, Meaningful Use of Health Information Technology: From Public

Policy to Changing Care• Eric J. Topol, The Digital Wireless Revolution: Wireless Devices and their

Application in Healthcare• Ed Bennett, Social Media and Hospitals: From Trendy to Essential

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“Even small healthcare institutions are complex, barely manageable places. . . Large healthcare institutions may be the most complex organizations in human history.”

Peter Drucker

Post-Capitalist Society. New York, Harper and Row, 1993

(c) 2007 - The Governance Institute

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Actions We Should Start, Stop and/or Continue

We should start.....

We should continue.....

We should stop.....

Trend

Implications of this Trend?At least 1 positive, and 1 negative.

Implications of this Trend?

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Implications of this Trend?

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FutureScanning

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Healthcare Policy: The Futures of Health Reform

Healthcare Policy: Expect the Unexpected Healthcare reform could move in a number

of different directions—all at once.• Adopt a flexible, contingency approach to

planning.• Don’t wait for federal funding (e.g.,

demonstration projects) or mandates to develop new strategies and new business models.

• Proceed with appropriate caution.

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Healthcare Policy: Legislative Battles There will be attempts to repeal the Affordable

Care Act, but any new attempts to reshape healthcare at the national level are unlikely.• Be prepared to implement and respond to the provisions

of the new law.• Closely monitor health policy initiatives both nationally

and locally.• Carefully evaluate participation in the demonstration

projects and strategies promoted by CMS and the Secretary of Health & Human Services.

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Healthcare Policy: At Risk and Accountable Much of hospitals’ reimbursement will come from

“at risk” payment strategies or through an Accountable Care Organization.• Move forward on an IT infrastructure that can reliably

reflect clinical and administrative functions.• Look for ways to reduce waste and improve

processes.• Develop partnerships in the medical marketplace.

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Healthcare Policy: Comparative Effectiveness Comparative effectiveness research will

be widely used to inform clinical decision making.• Create an IT infrastructure to monitor the use

of protocols based on effectiveness research.• Help clinicians keep up to date on the newest

research findings.• Market your hospital’s care as being based on

the most up-to-date research available.

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Healthcare Policy:Look Outside Washington Few enduring improvements in the quality or cost

of healthcare will originate in the nation’s capital.• Make efforts to identify creative and resourceful providers,

purchasers, payors and others who are developing models to improve healthcare.

• Encourage disruptive innovations that improve care at lower cost.

• Network with colleagues in order to share resources and generate new ideas.

• Monitor state legislative actions closely.

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Payment: Reforms Poised to Spur

Quality and Efficiency Gains

Payment: Change is Coming The Affordable Care Act will bring the first real

change in Medicare payment structure in years. Medicaid and private payors will follow suit.• Partner with physicians in anticipation of bundled

payments.

• Carefully project how any new pilot payment structures would impact your organization’s finances.

• Use new payment mechanisms as a means of pursuing your organization’s mission of promoting population health.

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Payment: ACOs Many hospitals will partner with physicians

to develop Accountable Care Organizations (ACOs) in anticipation of reimbursement changes.• Understand that ACOs represent a “sea change” in

relationships with physicians.• Carefully structure employment plans for physicians.• Balance the anticipated decrease in inpatient volume

due to better disease management with an increase in insured patients.

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Payment: Value-Based Purchasing The shift to value-based purchasing mandated

by the Affordable Care Act will spread to private payors.• Implement checklists, practice protocols and other

strategies to ensure providers adhere to quality measures.

• Make sure that IT systems can reliably track the necessary (and yet to be determined) analytics.

• Make value a key negotiation strategy with private payors.

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Payment: Who Has the Leverage? The future leverage between private

payors and providers is uncertain. Both sides are concerned about losing ground.• Aggressively market your organization’s value in

providing quality, cost-effective care.• Anticipate changes in the structure of health

insurance plans and their impact on your finances.• Monitor the nature and structure of private insurance

plans created through insurance exchanges.

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Payment: Paying for More An increasing number of caregiver activities that can

potentially reduce costs and manage chronic disease (e.g., telephone or e-visits) will be reimbursed.• Make sure that information and management systems can

reliably capture these unconventional activities.• Promote these encounters by educating patients and caregivers

on the convenience and value of these activities.• Help physicians successfully integrate these activities into their

practices.

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Physician-Hospital Integration:

Market Trends, Health Reform Drive Closer Ties

Physician-Hospital Integration: Codependence The Affordable Care Act’s promotion of Accountable Care

Organizations (ACOs) and bundled payment mechanisms will mean that physicians and hospitals are codependent.• Reduce costs, including admissions, that don’t contribute to

positive outcomes.• Establish or expand physician leadership development

opportunities.• Develop contracts between physicians and hospitals that

integrate clinical functions and align incentives.• Evaluate the organization’s readiness to become an ACO.

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Physician-Hospital Integration: The Employed Physician The anticipation of healthcare reform has

already prompted many physicians to seek employment or close alliances with hospitals. This trend will only intensify.• Be sensitive to the lifestyle needs of younger

physicians.

• Create employment arrangements that incentivize physicians for quality and productivity.

• Develop or expand physician leadership development opportunities.

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Physician-Hospital Integration: Broader Missions With more physician partners, hospitals will

expand their mission statements to include care in pre- and post-hospital settings. • Engage the hospital’s board in setting a broader

agenda.• Investigate risk management issues regarding care

rendered outside the acute-care hospital.• Consider affiliations with other systems in order to

diversify services and gain access to capital.

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Physician-Hospital Integration: Beyond Stark Legal barriers (e.g., Stark and anti-kickback

laws) will be relaxed in order to promote physician-hospital collaboration and value-based healthcare.• Closely monitor federal regulations.• Develop compensation strategies to reimburse

physicians for additional services.• Provide administrative expertise and support as

office-based physicians reengineer their practices.

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Physician-Hospital Integration: Practice Management Skills Hospitals and systems will need managers with the

knowledge and skills to manage and coordinate physician practices.• Hire individuals with experience and expertise in

physician practice management.• Work with physicians to develop an infrastructure that

tracks and drives clinical performance.• Expand physician leadership and training

opportunities.

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Primary Care: Filling the Primary Care

Supply Gap

Primary Care: Unprecedented Demand The already growing demand for primary care

services will increase dramatically in 2014, the year that the Affordable Care Act expands coverage.• Work with educational institutions and provide scholarships

or tuition assistance to primary care students in exchange for future employment.

• Offer family practice clerkships to medical students.

• Develop partnerships with other community providers (e.g., FQHCs) that employ primary care physicians.

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Primary Care:Reliance on Extenders Within the next few years, the bulk of primary

care services will be provided by clinical extenders. Insurance companies will reimburse these services.• Work with local colleges and universities to promote

enrollment in PA, NP and other health professions programs.

• Re-examine the traditional ratios of PAs and NPs to physicians.

• Help physicians learn to collaborate with physician extenders to ensure continuity of care.

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Primary Care: Retail Clinics

Retail clinics will continue to proliferate and provide relatively low-cost routine primary care services.• Look for opportunities to place hospital-sponsored

clinics in busy retail establishments.• Partner with existing retail clinics to market the more

acute services available at your facility.• Be sensitive to the concerns of physicians who may

lose volume to retail clinics.

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Primary Care: Impact of Reform The development of Primary Care Medical

Homes and Accountable Care Organizations will result in tighter clinical integration between hospitals, primary care and specialty care.• Monitor federal regulations and the results of

demonstration projects closely.

• Make sure information systems can reliably integrate the clinical and management functions.

• Work with physician leadership to ensure the medical staff is up to date on guidelines and other care standards.

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Primary Care: New Models Demand for traditional primary care services will

continue to outpace supply in the foreseeable future, necessitating the development of new models and approaches.• Work with nursing leadership to ensure your facility’s

nurses are practicing to the full extent of their education and training.

• Monitor trends in education and public policy. • Look for novel approaches and ways that IT can

extend the reach of primary care providers.

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Quality and Safety: Reaping the Rewards of Process Improvement

Done Right

Quality and Safety: The Process Improvement Mandate With reimbursements declining and CMS no

longer paying for poor quality, hospitals will intensify their process improvement initiatives.• Provide staff training in Robust Process Improvement

(RPI) techniques.

• Use RPI tools and techniques throughout the organization.

• Empower all employees to lead improvement efforts.

• Emphasize leadership’s role in promoting improvement efforts.

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Quality and Safety:Renewed Efforts Despite increased awareness and effort since To Err is

Human, hospitals have made little progress in reducing adverse events and preventable deaths. Efforts will intensify with payment reform.• Create an organizational culture where safety is a core

value.

• Look for ways—electronically or other—to monitor patients frequently and consistently.

• Empower all employees to suggest improvements in the care process that will reduce errors and patient harm.

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Quality and Safety:Less Waste and Risk Hospitals will use process improvement

techniques to reduce waste, including the overuse of health services, and to reduce patient risk.• Work with medical staff to promote the use of

evidence-based clinical guidelines.• Reduce the amount of duplicate diagnostic and other

tests through the use of EHRs and PHRs.• Make sure process improvement efforts include a

focus on reducing unnecessary care.

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Quality and Safety:Controlling Infections Infection Control will begin with the

admissions process.• Consider screening all inpatients for MRSA at

admission.• Appoint a Director of Infection Prevention and Control,

a senior-level person with clinical and managerial experience.

• Intensify efforts to ensure hand hygiene compliance.

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Quality and Safety: Nursing Citing quality and safety benefits, an increasing

number of hospitals will require nurses to have at least a baccalaureate degree.• Provide scholarships and other incentives for associate degree

and diploma nurses to obtain the baccalaureate degree.• Work with local colleges and universities to promote the

nursing profession.• Make sure the Chief Nursing Officer is a full participant in the

C-suite.• Determine whether Magnet Status is a reasonable objective for

your organization.

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Meaningful Use of Health Information Technology:

From Public Policy to Changing Care

Meaningful Use of HIT:Bigger Budgets Hospital spending on IT is likely to double in the

next five years.• Work with IT staff to ensure you meet the requirements

necessary to apply for HITECH funding.

• Develop an IT system that integrates data across the continuum of care.

• Understand that an experienced Chief Medical Information Officer is critical.

• Hire or develop additional skilled IT professionals.

• Allocate budget funds for staff training.

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Meaningful Use of HIT: Connecting Physicians Hospital EHRs will be interoperable with those of

their physicians, promoting greater coordination of patient care.• Use an experienced Chief Medical Information Officer to assist

with the transition, including educating reluctant physicians on the value of EHRs.

• Partner with physicians and the medical staff in the design of the physician interface.

• Be sure that physician and patient confidentiality concerns are addressed.

• Provide training for physicians on using the system.

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Meaningful Use of HIT:The Connected Patient Providers will be connected electronically

with their patients.• Provide patients access to their medical records in a

format that is easy to understand and use.

• Address concerns about confidentiality of records.

• Make information available that will help patients maintain and improve their health.

• Install information systems that will allow home monitoring and e-visits with patients.

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Meaningful Use of HIT:No More Paper Hospitals will shift all of their records to an

electronic platform, making paper charts obsolete.• Plan for ways to archive existing records and/or transfer

them to an electronic format.• Choose IT vendors wisely so that the system supports all

necessary processes.• Position monitors in strategic locations so that patient

records are easily accessible.

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Meaningful Use of IT:The End of Fee-for-Service Payment will be based on performance, outcomes

and ACO arrangements that reward shared savings rather than volume.• Use process improvement strategies to achieve greater

efficiencies and improve care.• Make sure that your IT infrastructure can capture the

analytics necessary to measure outcomes and demonstrate value.

• Work with the medical staff to improve care based on well-validated clinical indicators.

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Meaningful Use of HIT: Mergers and Acquisitions The administrative and financial demands

of meeting meaningful use requirements will prompt consolidation across the industry.• Assess your organization’s capabilities and determine

if a merger is a reasonable strategy.• Look for ways to collaborate with other providers in

the community on the administrative costs and expertise of IT.

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The Digital Wireless Revolution:

Wireless Devices and their Applications in Healthcare

The Digital Wireless Revolution: A New Type of Band-Aid A Band-Aid-like adhesive strip worn on a

patient’s wrist or skin will monitor vital signs, physical position and activity.• Determine which type of monitoring (e.g., complete

vitals, heart rate alone, glucose for diabetics) fits best with your facility’s strategic direction.

• Determine which beds outside of ICU should be equipped for routine patient monitoring.

• Provide the necessary IT backup.

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The Digital Wireless Revolution: Web-Based Care Management Web-based platforms will be used for the daily

management of diabetic and other outpatients with

chronic conditions.• Work with physicians to invest in a platform or platforms

that will support care management systems.

• Design systems that can also be used for diagnostic purposes (e.g., monitoring heart rhythm).

• Use care management systems to promote your organization’s interest in maintaining health and reducing expensive inpatient episodes.

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The Digital Wireless Revolution: E-Visits The use of e-mail and e-visits will become

commonplace for follow-up and routine care and will improve the efficiency of ambulatory care.• Educate physicians and patients on the value and

convenience of e-visits.• Work with health plans to ensure that compensation

for e-visits is reasonable and fair.• Work with physician leaders to develop guidelines for

the appropriate use of e-visits.

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The Digital Wireless Revolution: Pocket Imagers Pocket-sized imaging devices will provide

high-resolution results in any location at a fraction of the cost of inpatient scans. • Strategic plans should address the future of your

inpatient imaging center.

• Consider using pocket-sized ultrasound devices in a variety of settings.

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The Digital Wireless Revolution: iPads Meet Healthcare iPads or other tablet-type devices will be

widely used as point-of-care aids and as versatile administrative tools.• Provide tablets and the appropriate medical and

healthcare apps to key members of the clinical staff.• Have IT staff routinely monitor the development of

new hardware and software applications.• Make sure that wireless connections are strong

throughout your facility.

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The Digital Wireless Revolution: Apps for Patients Hospitals will routinely provide patients with

apps for wireless devices that can be used for the registration process, scheduling follow-up visits and accessing health information.• Be prepared to address any confidentiality concerns that

patients may have.

• Use apps to promote your facility’s strengths and contribution to community health.

• Incorporate the creation and use of apps into strategic and marketing plans.

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Social Media and Hospitals:From Trendy to Essential

Social Media and Hospitals: Essential Healthcare providers will use popular social media

(Facebook, Twitter and others) to market their services and maintain a presence in the online community.• Develop a plan for the use of social media. Make it part of

the strategic planning process.

• Monitor the social media presence of local competitors.

• Make staff time available to monitor your organization’s image in real time and respond to any online complaints in a timely fashion.

• Use input from social media to improve the patient experience.

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Social Media and Hospitals: Educate and Market Hospitals will use social media to educate

the community and recruit future patients.• Create forums or discussion boards where patients can

learn about disease conditions.

• Encourage key physicians or managers to create blogs that showcase your organization’s mission and strengths.

• Use platforms like Twitter for crisis management or to educate the community on current health concerns.

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Social Media and Hospitals: Get Physicians on Board Patients will expect their physicians to

communicate electronically and to use social media.• Provide training opportunities for physicians in the use

of electronic media.• Provide support in creating staff physicians’ social

media presence.• Link staff physicians’ social media presence with that

of the hospital.

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Social Media and Hospitals: Help for Knowledge Workers Physicians and other knowledge workers will use

social media and networking to decrease the amount of time they spend searching for information.• Investigate the use of internal collaborative tools like

Yammer and Socialcast.• Establish guidelines for the use of social media tools

by employees.• Dedicate staff time to keeping current with the rapidly

evolving social media field.

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Social Media and Hospitals: Participatory Medicine and Healthcare Patients, armed with information gained from online

networks, will expect direct and clear answers from hospital workers.• Hospital leaders must learn about and recognize the value

of social media and use it in their interactions with staff and the community.

• Encourage employees’ use of social media in the workplace as a means to enhance the caregiving process.

• Direct patients to hospital-sponsored social media that addresses their health concerns.

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“‘We will do everything for everybody’ has never been a viable value proposition for any successful business model that we know of—and yet that’s the value proposition … of general hospitals.”

Clayton M. Christensen, Jerome H. Grossman, MD, and Jason Hwang, MD

The Innovator’s Prescription: A Disruptive Solution for Health Care (2009)

FuturescanThis presentation was adapted by Mary Stefl, PhD, Chair, Health Care Administration, Trinity University, from Futurescan: Healthcare Trends and Implications 2011–2016.

Futurescan 2011 is available for purchase from Health Administration Press. Single copies (order code 2175) are $45. Packages of 15 copies (order code 2175BN) are available for a discounted price of $395. Order online at ache.org/HAP or call the ACHE/HAP Order Fulfillment Center at (301) 362-6905.

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Healthcare Trends and Implications2011–2016

Futurescan

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