The U.S. health care market is changing on almost a daily basis, driven primarily by the implementation of the Affordable Care Act, and all efforts to corral the continuing runaway costs that affect every corner of the health system.
More and more, success or failure for most organizations will be tied directly to their ability to bend the cost curve and demonstrate improvements in healthcare outcomes. As a result, we are now increasingly seeing more early-stage approaches to lowering costs and more patient-centric forms of care, including the rapid rise of accountable care organizations and virtual care services.
The changes in today’s healthcare system are also paving the way for some unexpected alliances. We have recently seen a number of new collaborations among big pharmaceutical companies, payers, and providers focused on improving health outcomes.
The pilots of these efforts have played a critical role in moving the whole industry toward a more outcomes-focused approach and are setting the stage for more holistic, incentive-based partnerships or “collaborative care networks” that include providers and various other players such as research/academic medical centers, contract research organizations, or payers and life sciences companies. The intent of such networks is to develop a common sense of purpose or collective intent, target a specific disease category or patient population, and apply the collective knowledge of the group to better predict and improve outcomes.
Ultimately, the goal of such networks would be to establish life-long relationships with patients. As incentives get realigned, most proactive provider organizations realize that they face disruption in the future as they work to build the many partnerships that will be required to meet the demands of patient experience, pre- and postacute care, lifestyle care, and guaranteed health outcomes. Until recently, a hospital that overlooked an antibiotic or gave poor instructions to a patient on his or her discharge from the hospital could anticipate a perverse reward: the chance to bill the patient again should more treatment become necessary. Penalties for readmission and never events and the promotion of new bundled payment programs are ushering in a new era. As this trend intensifies, providers will need to leverage evidence- and consensus-based best practices, optimize workflows, adopt packaged pricing, and create explicit accountabilities with a “warranty” to deliver patient-centric care.
In tomorrow’s healthcare system, providers will be rewarded not for the number of procedures they perform, but for their ability to provide holistic care and keep people healthy. To reap such rewards, organizations will need to think differently about how they can collaborate with other healthcare stakeholders in creating value and how they can adopt patient-centricity into every facet of their operations.
(For related insights, see Ramko, K., Wadhwa, S., and Blanchford, M., “5 Insights for Executives: The Power of Collective Intent,” Ernst & Young LLP, 2013).
William A. Fera, MD, is a principal and the clinical transformation leader in Ernst & Young LLP’s Health Care Advisory Services practice.
Sanjeev Wadhwa is a principal and the R&D and patient adherence leader in Ernst & Young LLP’s Life Sciences Advisory Services practice.
The views expressed herein are those of the authors and do not necessarily reflect the views of Ernst & Young LLP.
Publication Date: Wednesday, May 01, 2013