As we talked about in the last blog post announcing our shift from events to strategic advisory work, “we saw what we had previously seen happen over the course of years start to happen in the span of weeks. The pace of change was speeding up, aggressively.”

A big part of the transition for our company was working through the specifics of that increased rate of change. What are the drivers and what are the consequences? In doing our own research, meeting people from across the industry, and reviewing our notes from the 2018 Health:Further Festival, we consolidated the current forces shaping healthcare into two high-level trends that will guide our work for the next year:

  • Care moving out of hospitals
  • The rise of the consumer

Contributing to the first trend are a number of factors, including:

  • Operational efficiency
  • Geographic considerations
  • Generational considerations
  • Payment models (Cost+ vs Capitation)
  • Changing engagement patterns

Contributing to the second trend are:

  • Greater focus on wellness and prevention instead of sick or episodic care
  • An increasing emphasis on mental and behavioral health
  • An increasing emphasis on vision, dental and hearing

And, finally, there are numerous horizontal issues that underpin both of the trends and cut across each of the contributing factors:

  • Cost of care/services
  • Social determinants
  • Access to care/services
  • Staffing and resources
  • Security
  • Regulation and public policy
  • Technology/IT

Care Moving Out of Hospitals

Care moving out of hospitals is an issue having a material effect on traditional healthcare providers today, right now. Reimbursement is changing, so providers must do more with less, meaning a greater focus on operational efficiency. Healthcare utilization patterns are wildly different between Millennials and Baby Boomers, the two largest age groups in the US. People are interacting with healthcare differently than in the past; for example, heading to an urgent care clinic instead of an ER, or having a procedure carried out at an ambulatory surgical center rather than a hospital. And more people are trying to stay at home in general. All of these things are altering the dynamics of healthcare today, and anything a traditional provider can do to improve outcomes and reduce costs is becoming necessary not just as a competitive advantage but in some cases for survival.

The Rise of the Consumer

Looking down the road we see the rise of the consumer as the emerging trend. This is an area that is beginning to have a direct effect on the healthcare system, but is still nascent. For example, patients are beginning to have a greater interest in managing their care more directly. However, the ability to do so is still limited because, ultimately, individuals are not the primary “customers” in that they aren’t writing (most of) the checks.

Some healthcare systems have rolled out programs focused on wellness and prevention to help their patients avoid a lifetime of meds and procedure or worse, acute incidents and hospitalizations. See Springboard from Geisinger Health System as a key example. (Reminder for full disclosure that our Chief Development Officer Steve Tremitiere was an advisor to Geisinger and worked on the Springboard program.) On the payer side, Cigna is taking a similar approach in focusing on food.

Mental health is another area that is getting massive attention across society. There is social pressure as well as medical evidence to support integrating mental and behavioral health into “traditional” physical healthcare. However, hurdles remain as reimbursement for mental/behavioral health services lags despite the Mental Health Parity Law and a severe provider shortage exists. Integration of mental and physical health is coming, but it is not an immediate operational concern for traditional providers.

Our Approach

This framework and these themes will define how we look at the healthcare industry this year. Our research, content, and programming will reflect the five contributing factors under Care Moving out of Hospitals and, to a lesser extent those falling under the Rise of the Consumer. We have already begun holding roundtable discussions with people working in all of these areas to continually gain insight into the challenges and opportunities surrounding each issue. In addition, we are digging through the academic literature for data and watching the news for bright spots – specific cases that demonstrate measurable improvement in one area or another.

We can’t talk to everyone out there, so please contact us at any time with comments, questions or suggestions. For starters, leave a comment below with your feedback on these two trends and their component factors.

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