Amid Uncertainty, Healthcare Marches On

by | Nov 17, 2016

futureEarlier this week I attended ATLAS, the Annual Thought Leadership on Access Symposium organized by Kyruus. The event brought together healthcare policy experts as well as healthcare organization (HCO) leaders who are driving efforts to improve patient access to care. The presentations and panels covered a lot of ground, but altogether they addressed several key points that center on a common narrative.

Life goes on. Amid the uncertainty about the future of the Affordable Care Act, speakers largely agreed with our analysis of what the future holds for healthcare: An intact MACRA, an expanded Medicare Advantage, a renewed push for payer market consolidation, a transition to block grants and state authority for Medicaid, and a renewed focus on pay for performance, in various forms. These factors all suggest that the fundamental mission of HCOs since the ACA went into effect – to provide higher-quality care at a lower cost – will not change.

Transitions of care are nuanced. Discussions about transitions of care often focus on life after hospital discharge – whether a patient is right for post-acute care, home care, or a skilled nursing facility, for example. While these are important decisions, with far-reaching and expensive consequences if they are wrong, there are far more nuanced transitions that occur far more often, whenever a patient is confronted with a minor ailment or unfamiliar condition. That’s where patient access – a next-generation call center that handles scheduling and referrals for an entire HCO – can “transition” patients to the appropriate care venue.

The future PCP should be a primary care provider. The notion of the PCP as the center of value-based care isn’t necessarily new, but there’s a lot of care that can be offloaded from a physician to a nurse practitioner or physician’s assistant – egos and state regulations notwithstanding, mind you. Beyond that, the organization of provider offices into formal or informal teams can help patient access groups better refer incoming and returning patients to the right team member. There’s no reason for someone with the flu to visit an ear, nose, and throat specialist – and there’s no reason for someone who needs to see a gastroenterologist to visit a PCP, NP, or retail health clinic.

Listen to those community doctors. HCOs must come to terms with the fact that, at a practice level, physicians are better than analytics solutions at identifying high-risk patients, said Venrock’s Bob Kocher. Beyond the spreadsheets and dashboards, they know who answers phone calls, refills prescriptions, and benefits from caregiver support. Focus on predictive analytics at a population level instead, Kocher said.

Pilot less, but do it with more gusto. Kocher also cautioned HCOs against throwing pilot program after pilot program against the wall to see if it sticks. Getting a pilot right requires vendor partnership(s), and that can be difficult when there are several dozen vendors. It’s better to take on fewer pilots but to commit more fully to them. Tying these projects to physician compensation boosts the odds that they are taken seriously and, over time, woven into clinical workflows.

Redefine ROI to focus on value. It’s a common refrain among healthcare leaders these days, but the traditional business definition of ROI doesn’t always apply to the investments that HCOs make. With patients increasingly able to choose where to be treated, something which is only likely to increase under the new administration, ROI is as much about demonstrating the cost of getting things wrong. ROI must therefore be redefined to emphasize the value of an investment – patient retention, improved outcomes, better quality of life, and so on. Yes, these are “soft” numbers, but important to long-term success of any HCO.

Define the “product.” Modern healthcare can accomplish incredible things, but outcomes are expressed on a systemic level (to drive policy and reimbursement) and rarely on an individual level. As the industry continues to shift to value-based care, and as patients continue to behave like consumers, HCOs need to define their products in terms that patients can understand – the impact of a surgery or treatment plan, for example, or the cost (both monetary and physical) of doing nothing. Far too often, this conversation focuses on short-term, clinical outcomes rather than the long-term impact on well-being.

There’s no question that healthcare in the United States will continue to face challenging times, but the overall goal of care delivery remains the same. To paraphrase Pamela Ravare of Houston Methodist, it’s time to shift our gaze from the issues that keep us up at night to the issues that excite us when we wake up in the morning: Better care, better value, better workflows, and better outcomes. It’s a tall order, but it’s one that transcends ever-shifting federal policies, business models, and contracts.


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