Lack of coordination in providing healthcare is a major contributor to overspending. Ours has been a system without real care coordination. Integration is difficult, but necessary. Anticipating this change, hospitals, physician groups and payers have begun a quiet scramble to secure the role of general contractor.
Success as a general contractor in healthcare requires at least five key assets: an esteemed local brand; financial capital to develop necessary infrastructure; control of patient relationships; the ability to aggregate lives in groups; and the ability to manage risk. Since no one entity singularly possesses all of these features, healthcare players are joining forces and combining the necessary assets to be accountable for clinical and financial outcomes.
For instance, while hospitals generally possess a strong community brand and have enough capital to invest in the IT and administrative infrastructure necessary to attract and coordinate care, hospitals do not have control of patient lives, the ability to aggregate groups of lives, or experience taking risk. Many hospitals will seek to add these missing pieces by forming, merging or partnering with health plans and physician practice groups. The data makes this consolidation clear. For the first time more than 50% of physician practice groups are owned by hospitals and that figure is growing.
Payers have a recognizable brand (not always favorable), sufficient capital, experience managing risk, and the ability to aggregate lives. Though they have relationships with patients, their level of patient control is questionable. This explains, in part, why insurers have begun to compete with hospitals in acquiring physician practices, clinics and service companies.
There have been a notable number of combinations among large health-services companies. They understand that to develop the capacity to improve care and reduce costs, they must scale and innovate in order to achieve needed efficiencies for payers and providers. Healthcare companies must follow a path not unlike other sectors where economic realities and technological advancement have made consolidation, integration and collaboration necessities for survival. Consumers have benefited because they received better value.
The Greek philosopher Heraclitus made famous the idea that nothing endures but change. While change is admittedly difficult, healthcare consolidation holds great promise. It will unleash a healthcare system that provides more attention to patients and more accountability to budgets. The combination of human compassion and economic dispassion will become the winning formula in healthcare.
Former HHS secretary
Former Environmental Protection Agency administratorFormer governor of Utah
Founder and chairman