All the mainstream chatter and media coverage around healthcare this year covers up the fact that there is little real action and few success stories to point to. Expect 2014 to be the year that the industry gets taken to task on several key issues:
- On risk – The big headline is going to be the relative lack of traction for risk-based models. For all the talk about the benefits, the incentive is still in place for hospital systems to continue to leverage or create structural advantage in marketplaces – allowing them to pass along rates to payers and protect margins. This shift in models will not happen until hospitals and health systems have maxed out their OPEX savings and consumers are outraged enough with insurance costs to run to Kaiser-like models.
- On interoperability – At least one of the big vendors is going to get called out by the press or the government. Though everyone is claiming to be open and wanting to do what’s best for patients, someone will be exposed for maintaining – or even building – silos. No single standard will be the panacea – but at some point EMR companies must recognize that bidirectional interfaces must be supported for health systems to survive economically. Congress will be forced to put teeth into the interoperability recommendations made back in 2010 if the private sector cannot lead the way.
- On commercial insurance rates – They can only go up – way up – if things continue the way they are going. The penalties for non-coverage under the healthcare law are so infinitesimally small and the burden of registering is so high that the only people who will join are the sickest portion of the population under the age of 65. Without the young and healthy population involved to counterbalance the high-cost patients in the risk pool, payers will protect themselves and undermine the potential promise behind exchanges. In markets with more mature models of population and value based care (and corresponding exchanges), smart health systems will place their brand on the exchange and capture the volume in collaboration with payers – or suffer further commercial rate degradation.
- On health system priorities – Health systems must improve consumer engagement – positioning for improved at-risk management while creating longer-term loyalty. They must create programs to get better visibility on the care and health of their patients before and after hospitalization through home monitoring, patient portals, patient engagement and direct incentive strategies. In the end, this will help health systems threefold:
- Avoid costs and penalties through reduced readmissions and improved patient satisfaction
- Position the health system in the long-term to be a better partner for payers to work with when risk-based models start becoming the norm
- Attract and maintain stickiness of patients into their system in the near-term
Savvy health systems will also act quickly on the narrow window of healthcare intellectual property sales. By partnering with technology and service vendors, they’re going to create unique offerings – operationalizing new models and standards of care – that can then be sold to other systems.
- On consumerism – Healthcare will take its cue from Amazon. Amazon can sell anything from anyone to anybody and make it an “n=1” tailored experience – effortless and personalized. No matter the company selling through Amazon’s site, the shopper experiences a familiar and easy to navigate interface. Patients will demand the same transparency in their care – access to the various types of care where and when they want, without having to navigate endless complexity. And at the same time, providers want it too – a one-stop shop for aggregating data sources in a way that is customized to the individual clinician’s needs. This requires the right data, presented intelligently in context, with the ability to write back and execute decisions. Consumers will demand nothing less. Excuses of how unique and complex healthcare is and why this isn’t possible will echo off the walls for those in lonely rooms left behind.
Next year holds a lot of promise. Now let’s see where we end up.