• What Will Health Care Look Like in 5-15 Years?

    Lauren Phillips Apr 21, 2015

    Senior executives and innovation officers from Mayo, UCLA, Virginia Mason, Aetna, and Beacon Health System point to pioneering approaches that will likely become common place in health care over the next five to 15 years, particularly in four areas: new care delivery options, revamped clinical teams, data analytics, and value-based payment models.

    Ask people on the street what ground-breaking innovations they hope to see in health care during the next five to 15 years, and they might first think about miraculous medical discoveries like the cure for cancer or a vaccine against Ebola.

    The five healthcare leaders interviewed for this article also have high hopes for medical advances—and point to exciting discoveries that are already alleviating pain and suffering. For instance, at Seattle’s Virginia Mason Medical Center, a radiation oncologist is working with surgeons to administer a single dose of intraoperative radiation therapy in the operating room to women with breast cancer who meet certain criteria, eliminating weeks of radiation treatment post-surgery, says Suzanne Anderson, executive vice president, CIO, and CFO.

    Virginia Mason’s Suzanne Anderson, executive vice president, CFO, and CIO

    Virginia Mason Health System executive vice president, CFO, and CIO Suzanne Anderson makes a point during a conversation with Steve Schaefer, vice president of finance. (Photo: Bob Riedlinger)

    However, most of the innovations that healthcare leaders say they are excited about have less to do with medical advances and more to do with improving how health care is accessed, provided, and paid for in this country. This makes sense. While medical science has advanced at rapid speed over the last 60-70 years, the cost of health care has spun out of control, the level of quality is inconsistent, and the patient experience is in need of repair. In other words, it’s the way we deliver care that really needs a mammoth dose of innovation.

    Here are some of the healthcare delivery trends that progressive leaders from provider and payer organizations expect will become common place in five to 15 years—if not sooner.

    New Care Delivery Options

    New paradigms in healthcare delivery will make care more affordable, more convenient, and more responsive.

    Immediate answers.The traditional way of dispensing health care is longitudinal and fragmented, with lots of days between value-producing office visits, says Douglas L. Wood, MD, cardiologist and medical director of Mayo Clinic’s Center for Innovation. What we need instead is a system that provides answers to questions immediately, making it easier for patients to make more informed choices so they can go about their lives with less disruption and anxiety. Wood believes this is the system of the future.

    “Say a patient with shortness of breath sees his primary care physician, who recommends consultation with a cardiologist. Typically, that physician will call my office to arrange a visit sometime in the next two days to four weeks—which will require the patient to take additional time off from work. But suppose I am readily available, at the time of that first office visit, to talk with the physician and listen to the patient. I can make a quick decision about whether the problem is likely to be serious or not and even decide on what next steps we should take.”

    Mobile care. In this new system, 10-15 years down the road, much more care will be delivered where the patient is—at home, at work or school, even traveling—using onsite and mobile clinics.

    “Maybe a company that has a handful of salespeople with potential health risks has a regular regional sales meeting,” Wood speculates. “We could see them all together on the same day by traveling with an optimized care team—a physician, a nurse, maybe a physician assistant—to that location.”

    Philip A. Newbold, CEO of Beacon Health System in Indiana, anticipates that home care will be used extensively to manage higher-risk populations, including big users of the emergency department (ED).

    Home care is the least expensive site of care, Newbold points out, and the place where people with their own support systems are most comfortable. “We’ll use sensors and early warning systems—this person hasn’t taken her medications, that person is gaining too much weight—to trigger a phone call or a visit to head off a problem. That way, family or neighbors could be educated as well: If this happens, here’s what you do; if that happens, call this number.”

    See related sidebar: Beacon Health System Educates Staff on Innovation

    Remote monitoring. New technological applications for engaging, communicating with, and delivering care to patients will be “huge” over the next 15 years, according to Anderson. As a result, providers will be able to serve more patients with existing resources.

    “There will be more monitoring of chronic conditions through mobile apps, in which the patient provides information that feeds directly into our EHR system, which will be able to evaluate those data. If, say, a diabetic’s glucose levels are within a predetermined range, the information is just recorded for future reference. If the glucose levels are problematic, both caregiver and patient will get a message saying ‘We need to connect.’ And, if something changes with a patient, we will be able to send her information that’s relevant to the new stage of her disease.”

    See related article: How Mobile Health Is Changing Care Delivery

    One telemonitoring development already proving its clinical efficacy is the depression automated remote monitoring system (D-ARMS), developed by the Los Angeles County Department of Health Services in partnership with the University of California. This is a phone system that makes multiple simultaneous outbound calls to patients at high risk for depression on both a scheduled and data-triggered basis and collects touchtone or spoken responses to recorded questions.

    “By generating provider alerts in real time, it appears to be a viable, high-tech alternative to human monitoring in disease management programs—at 5 percent of the cost,” says Molly Joel Coye, MD, MPH, chief innovation officer at UCLA’s Institute for Innovation in Health, which maintains an international innovation inventory.

    Molly Coye, MD, chief innovation officer of UCLA Health

    Molly Coye, MD, chief innovation officer of UCLA Health speaking at “Los Angeles Innovates—Meeting New Demands for Access to Healthcare,” at Martin Luther King Jr., Community Hospital. (Photo: Reed Hutchinson/UCLA)

    Remote monitoring can also be used to encourage healthcare staff to adopt best practices. One example is a wearable, electronic hand-hygiene prompter, which promises to slash healthcare-acquired infection rates and, with them, hospital length of stay and related costs. The technology tracks clinicians’ hand washing and delivers a sound or vibration to prompt washing between patients, along with data reports that summarize compliance rates by location and department.

    Acute care clinics. Coye believes the future will see the mushrooming of a new phenomenon: freestanding emergent and urgent care clinics that treat patients with acute but non-life threatening conditions, including wounds and fractures, which comprise 13 percent to 27 percent of ED cases. With lower overhead, such clinics already are charging a third to a fifth of the cost of equivalent care in an ED—with no facility fees, no appointments necessary, and more diagnostic capabilities.

    An Evolving Workforce

    All the experts concur: By 2030, the care delivery team will look very different than it does today. There are a lot of reasons—among them the shift in focus to population health, to prevention and wellness, to more localized and personalized care, to more affordable approaches to treatment approaches—but they all call for an expansion of players beyond the traditional physician and nurse.

    The key, says Newbold, is to develop a system and processes that let all practitioners practice at the top of their licenses, doing things they are uniquely trained to do and that have the greatest value.

    See related article: Expanding the Primary Care Team

    “Physicians would mainly work with the very sick, the 5 to 10 percent that bounce back into the ER and account for most readmissions and a disproportionate amount of resources, Newbold says. “And then you have a wide range of new players—nutritionists, physical and occupational therapists, exercise physiologists, stop-smoking coaches, social workers, care coordinators, health coaches—doing what they do best to help the healthy stay out of trouble and people with chronic conditions manage their risk factors.”

    A good example of a new team member who is trained to support patients in self-management and adherence to prescribed treatments is the nurse extender clinical aide, a care coordinator concept that Coye is enthusiastic about. Working under the close supervision of a nurse or physician and using tablets to communicate with their supervisors during patient encounters, these aides can be trained in three to four weeks to work with patients with specific diagnoses in clinics, EDs, home visits, and over the phone. Nurse extender clinical aides are currently being used in six sites nationally, including the Heart Health at Home program offered by the University of Virginia Health System.

    In the past, says Coye, patients would come in every three or six months if they had a serious chronic disease and see the physician for 15 minutes. “In the future, such a patient will work with a clinical aide and, in many cases, may not need to see the physician more than once every couple of years.

    Studies of the effect of a clinical aide program found that 74 percent of non-acute pediatric ED visits and 62 percent of walk-in pediatric cases were resolved without seeing a physician. In one pilot for post-discharge management of heart failure patients, there was a drop of 58 percent in 30-day all-cause readmissions and 77 percent in heart failure-related readmissions, according to a summary.

    Big Data Opportunities

    Another development that promises to affect health care is the tremendous growth in the amount of usable data being generated in health care today.

    Data analytics. Sorting through large amounts of historical clinical data to identify past patterns (e.g., at-risk populations, early symptoms of disease, utilization) opens windows to the future—and makes it possible to improve outcomes by homing in on best practices. The same is true with financial data, population health data, supply chain data, facility design data, and so on.

    For this reason, says Anderson, data analytics—predictive analytics, in particular—will explode in the next 15 years. “I think this capability is in its infancy in terms of technology, but as it grows to adulthood, we’ll see amazing changes in care. For example, if we can identify biomarkers for sepsis, we might be able to predict which patients are especially vulnerable even before they come into the hospital, so we can monitor them very closely.”

    See related article: Predictive Analytics: Pinpointing How to Best Allocate Patient Resources

    Data infrastructure.One key to making this happen is technological readiness, says Joseph M. Zubretsky, senior executive vice president of National Business at Aetna. “Historically, the industry has done an “abysmal job of being able to integrate and synthesize clinical and claim information. Now we are creating tools and capabilities that allow both kinds of information to be combined, read, interpreted, and acted on. But organizations must have the basic infrastructure—what we call the pipes—to keep data flowing in multiple directions with higher veracity and velocity.”

    Another necessity, says Zubretsky, is a clinical decision support platform that uses algorithms to glean facts from data sets and get them to providers in real time. Finally, we need to determine how to best share relevant data and information, such as evidenced-based treatment protocols and costs of care, with patients and their families, empowering them to participate in clinical decision making.

    “Given the range of generations that interact with the healthcare system, from infants to people in their 90s, this will require using many different modalities to communicate in the way patients prefer—paper, mobile, phone, email.”

    In the coming years, Zubretsky believes, technological developments in all three areas (technological infrastructure, decision support platforms, and mobile communication devices) will allow providers and payers to thwart disease progression and curb unnecessary hospital admissions and ED visits—all the things necessary for the ultimate goal: true population health management.

    Value-Based Payment Models

    One of the greatest difficulties facing hospitals and healthcare systems today comes from trying to serve two masters at once: the value-based reimbursement of the future and the volume-based reimbursement so deeply embedded throughout the industry. Innovations are needed to help us make the transition.

    Pay for meeting personal goals. Some of the most radical changes in the next decade or so will be shifts in payment systems to accommodate the changes in goals and delivery systems.

    “Right now, there’s a lot of time spent arguing over who’s getting how many dollars,” says Anderson. “As we get into more accountable care (with a small ‘a’), providers will be forced to either develop straightforward calculations for bundled payments, or really start thinking as a single, integrated system.”

    Once they do, Wood says, providers will no longer be paid for providing services to people but for keeping people healthy. “Patients will determine the status of their total functioning—physical, behavioral, mental—based on highly personal goals and insurers will pay me a certain amount of money annually to care for a person’s heart disease in a way that meets those goals.

    Douglas L. Wood, MD, medical director for Mayo’s Center for Innovation

    Douglas L. Wood, MD, medical director for Mayo’s Center for Innovation (in foreground) talks with his team. (Photo: Mayo Clinic)

    “They might actually pay me a bonus if I’m able to improve a patient’s level of functioning. We might set up a risk contract, so that if the patient encounters a lot of problems, I might potentially have to pay a financial penalty.”

    According to Wood, one result of this arrangement will be an end to the administrative nightmare we’ve created with our obsession with documentation, which stems from the need to precisely measure the input labor and supply costs of every service and then allocate those back across physician groups.

    “When we’re being paid for our results, we can largely ditch all this structure.”

    See related article: Partnering Around Value-Based Payment

    Guaranteed quality. The idea of a guarantee of quality is definitely coming, says Anderson. In fact, Virginia Mason introduced a new warranty program for total hip and knee replacement patients in September 2014. The concept is simple: an organization that agrees to assume the costs of avoidable, surgery-related complications is an organization that has a major incentive to deliver high quality care.

    Anderson explains: “Say a person comes into a hospital for a knee replacement and develops an infection. She becomes delirious and tries to get up on her own to go to the bathroom, falls and breaks a hip, gets the hip replaced, finally goes home—only to develop an embolism and be readmitted immediately.”

    Currently, under the fee-for-service payment system, most hospitals get paid for taking care of the knee, the infection, the hip, and the embolism. The hospital of the future will get paid for the knee, period.

    “So unless they want to go out of business, they will get pretty darn good at what they do,” says Anderson.

    This appears to have been the case at Geisinger Health System, which implemented a warranty for coronary artery bypass eight years ago and has since improved adherence to a 40-metric list of bypass best practices from 56 percent to almost 100 percent.

    The insurance marketplace. According to Zubretsky, population health, which is fast becoming the holy grail of the healthcare system, is about bringing providers, patients, and payers into a “digitized community” with completely revamped business and clinical processes to improve quality and drive down costs. Over time, he says, the structural lines between providers and payers will blur, if not disappear.

    “Providers know that to have a sustainable business model in the future, they will need to participate in the insurance marketplace, says Zubretsky. “There are three ways this can be achieved: a provider-owned health plan that is powered by an insurance company, a 50/50 joint venture, or an arrangement in which the insurance company is the legal entity that conducts the business while the provider participates in the underwriting cash flow.”

    The Big Learning Curve

    The big learning curve for everyone in the healthcare industry over the next five to 15 years, says Newbold, is moving from just making the medical model more efficient to implementing the health model.

    This, he says, encompasses three new competencies:

    • Keeping the healthy out of trouble
    • Helping people manage their risk factors and chronic conditions
    • Better managing the sickest five to 10 percent of patients so they don’t need frequent ED visits and hospitalizations and don’t consume excessive resources

    This offers plenty of scope for innovation. And, according to industry leaders, there is plenty of radical innovation on the horizon.

    See related sidebar: UCLA Health Puts Innovation to the Test

    Lauren Phillips is the president of Phillips Medical Writers, Ltd., in Bellingham, Wash.

    Quoted in this article:
    Suzanne Anderson is executive vice president, CIO, CFO, Virginia Mason Medical Center, Seattle.

    Molly Joel Coye, MD, MPH, is chief innovation officer, Institute for Innovation in Health, UCLA Health, Los Angeles.

    Philip A. Newbold is CEO, Beacon Health System, South Bend, Ind.

    Douglas L. Wood, MD, is medical director, Center for Innovation, Mayo Clinic, Rochester, Minn.

    Joseph M. Zubretsky is senior vice president, national business, Aetna, Hartford, Conn.

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