- Significant change can be slow in healthcare, but transformation in response to key trends is becoming more prevalent, according to survey findings.
- The need to start viewing patients as true consumers is factoring into strategic initiatives at many organizations.
- More organizations are looking to move to value-based payment, with challenges around data seen as a stumbling block.
A recent survey finds healthcare providers working to incorporate key trends in their strategic planning, leading to innovations in care delivery and operations.
The shifts have been accelerated by the COVID-19 pandemic, said Al Campanella, president of the healthcare analytics company DataGen, but they also can be seen as a continuation of a push that began back in 2008.
That year, the Institute for Healthcare Improvement established the Triple Aim. Two years later, the Affordable Care Act codified value-based payment (VBP) reforms.
“It does take 10 or 12 years to adopt major change in healthcare,” Campanella said. “We’re finally seeing a tipping point that’s pretty close. People are really saying now, ‘Change is not something we’re flirting with. It is absolutely what we’re doing.’
“Hospitals can’t just implement things around the edges,” he added. “They have to truly innovate if they’re to remain competitive.”
Consumerism as an impetus for change
The provider-based survey, conducted by Sage Growth Partners and DataGen, included responses from 103 C-suite members and practicing physicians.
Among respondents, the most frequently cited driver of change was “patients have a desire for convenience” (76%). That was followed by rising healthcare costs (66%) and heightened competition (57%).
The need to treat patients as true consumers is spurring changes in care delivery. The evolution revolves around a customer expectation of 24/7 access to trusted providers, with enhanced care coordination processes, Campanella said.
At Health First, a Florida-based integrated delivery network that was represented in the survey, “Improving the patient experience and taking digital tools to the customer in a way they consume them in everyday aspects of their lives are our priority,” said William Walders, CIO and senior vice president of operations support.
To that end, he said, the organization is establishing a digital infrastructure that will “reduce friction” in areas such as bill payment, provider selection and medical record access.
Taking hospital care into the home
Organizations recognize the need to expand care delivery beyond hospital settings. Among home-based care initiatives, survey respondents see remote patient monitoring (17%) and telehealth visits (16%) as programs most likely to grow “significantly” over the next five years. Already, 76% use telehealth and 49% use remote monitoring to serve patients with acute conditions.
At Health First, previous monitoring services focused on specific conditions such as diabetes and hypertension, Walders said. Now the organization is taking a more holistic focus.
“We've aggregated those tools as tool sets and then really created what the industry knows as ‘hospital at home,’” Walders said. “We're very optimistic about that. In particular with the spike of the delta [variant] and other demands on our acute spaces, we were able to admit certain diagnoses to the home, and that gave us great flexibility.”
Remote patient monitoring has proven its worth in various areas at Intermountain Healthcare, said survey respondent Angelo Giardino, MD, PhD, chair of the Department of Pediatrics at the University of Utah School of Medicine and chief medical officer at Intermountain Primary Children’s Hospital in Salt Lake City.
An example is Intermountain’s cystic fibrosis care program, in which tracking patients’ height, weight and nutritional intake is vital. Instead of asking families to come in for visits at least four times per year, Intermountain can provide them with a scale and measuring devices.
“And then you can collaborate with them in a value-based environment,” Giardino said. “You can get really credible biometrics from them, and you can deliver great care — they're getting the right dose of medication, their nutrition is being closely monitored, but they don't have to drive 150 miles.”
For many services, Giardino said, “We're probably going to be challenging ourselves to say, ‘Do you really need to come into the facility for this part of your care?’ In a value-based environment, that works fine. In a fee-for-service model, that's catastrophic financially.”
In the survey, 60% of respondents anticipated that their inpatient footprint would decrease over the next five years. Campanella cited the growth of ambulatory surgical centers, urgent care centers, private imaging centers and labs, and multifunctional retail clinics, along with the expansion of stand-alone telehealth companies.
With the amount of private-equity money flowing into those ventures, he said, they likely will grow in scale during the next five or 10 years and continue to siphon off traditional hospital services.
Pushing into value-based arrangements
The emphasis on VBP strategies was seen in survey responses, with 70% of respondents saying their organization participates in risk- or value-based programs and 58% anticipating that additional contracts would be implemented over the next year.
“Not only do we think it's the right thing to do, it [also] gives us a lot of autonomy and flexibility within a payment envelope,” Intermountain’s Giardino said. “We can decide how to deliver that care. It’s all woven in on the clinical side [with] quality improvement and standardizing care, reducing unexplained variation. A lot of those initiatives come together in the population health realm.”
Concern about data integration (43%) was the most frequently cited response regarding obstacles to succeeding in value-based arrangements.
For Health First, as with other large health systems, synthesizing data from numerous sources and translating it into actionable insights is a major undertaking. For example, Walders needs to make sense of data from 430 distinct clinical systems within the organization.
That helps explain why Health First views its data optimization strategy as a four-year journey that is about halfway over.
The process involves “extracting that [data], putting it in something that's real, having a provenance integrity to understand that what’s represented is accurate,” Walders said. “And then the data enablement component of teaching people the power it [has] and how to use it is kind of the last part.”
The transition to VBP is daunting, Giardino said, but progress is taking place across the industry.
“I don't see the sky falling,” he said. “Healthcare has been ‘in turmoil’ for at least five or six decades. It's just a rough-and-tumble professional world. We've got to be really good stewards with the resources that we have.”