The Healthcare Delivery System of Tomorrow – the End of Hospitals?

Three Major Predictions for the Future of Healthcare

While many thoughts and dialogues were shared at the recent U.S. News and World Report Healthcare of Tomorrow conference in Washington D.C., an underlying theme of change and progression in our existing healthcare delivery system was evident. We as consumers will help drive those changes as we push for a better healthcare experience, more convenience and reduced costs. During the conference, many healthcare leaders came together to share views on how our healthcare system may be evolving in the near future.

1. The conversion of reimbursement models to value-based payments continues, but not at an accelerated pace.

   The industry continues to move toward increased value-based care, which is paying providers and facilities on a different set of criteria that include patient quality measures, outcomes, and patient satisfaction, among others.

   This has produced an interesting mix of strategic partnerships and alliances, and the lines between traditional healthcare organizations are blurring.

   One example is Amgen, the large biotech company partnering with Humana to conduct an outcomes-based research study. Another new partnership is CVS and Aetna. While some insurance carriers have offered value-based benefit plans which incentivize individuals to seek out high-value care versus low-value care, they have not become widely accepted.

   Another change in the reimbursement model strategy is the proliferation of referenced-based pricing, which limits the payment to a facility for a covered service at the Medicare rate plus some escalator. This has been shown to significantly lower facility costs, if accepted, over the traditional negotiated fee-for-service discounts. The general consensus at the Healthcare of Tomorrow conference was that discussions about value-based care will certainly continue.

2. Patient care will shift away from hospitals.

   Chairman and Chief Executive Officer of Aetna, Mark Bertolini feels a home setting or a close-by retail clinic is often the least expensive and most convenient location for a patient. Bertolini states, “If you have to go to the hospital, we have failed you. What if that were the way the system was designed?”

   Telemedicine is a great example of how Concierge Medicine is emerging. The patient’s home becomes the setting for the delivery of primary care. According to Christopher Northam, the Vice President for Hospital Corporation of America, telehealth is no longer a novelty and the focus is shifting from the technology to the clinical outcomes and is only expected to become more mainstream. Northam predicts this shift will ultimately, “shut down hospitals.”

   Dr. David Tsay, the Associate Chief Innovation Officer at the New York-Presbyterian Innovation Center agrees that change is forthcoming and hospitals will morph into intensive care units and operating rooms with the rest of care being done in the convenience of the patient’s home. Patients as consumers will continue to drive these changes.

3. Social determinants of health need to be paid attention to.

   Emerging evidence has found that factors like security, nutritious food and affordable housing play a fundamental role in creating positive health outcomes. Bertolini noted that a person’s ZIP code is often a bigger indication of life expectancy than their genetic code. He went on to say it makes sense for payers to be thinking about social determinants of health because diseases can be prevented and savings realized.

As Bertolini points out, “paying for an Uber ride, food, or fuel assistance is cheaper than one ER visit.”

It’s clear that changes in the healthcare industry are on the horizon but consumers will only help to dictate the type of reform we see. Unfortunately, with the current state in Washington, we cannot legislate the types of change that will create positive modifications to our existing healthcare system. We need to continue to bring healthcare innovations and new ideas to the table and implement them.

To learn more about how these delivery systems and emerging trends impact your organization, reach out to your OneDigital representative today.