When patients do need care, employers and insurers are directing them to get it in less-expensive outpatient facilities, a trend that has also squeezed hospitals' earnings, he said. Meanwhile, healthcare providers continue to take on more financial risk for patient care.
Those realities, coupled with the political uncertainty around the ACA, mean cost management is growing in importance even as it becomes more difficult to accomplish.
"All organizations recognize that in times of uncertainty, in the short run and the long run, recognizing that there's a ceiling on price, getting your economic house in order is an issue," said Dr. Kaveh Safavi, senior managing director for the global healthcare business at Accenture.
Most healthcare companies have already done the "easy stuff" to strip out costs, such as managing beds, squeezing savings out of the supply chain and changing up staffing, Safavi said. To get beyond that, Accenture is emphasizing the deployment of digital technologies to ramp up productivity.
Providers are seeking to understand and manage the total cost of an episode of care across the continuum of the healthcare system. Managing costs on a per capita basis is "more important today than five years ago, and it's because so many organizations are signing at-risk contracts" with payers including Medicare, Medicaid and commercial insurers, said Joseph Damore, vice president of population health management at Premier. "Across the country, that's growing very rapidly."
Even though the Trump administration in August canceled two mandatory bundled-payment models and scaled back a third, Damore and other consultants believe the nation's push toward value-based care won't slow down. Bipartisan support for alternative payment models, such as accountable care organizations, and the Medicare Access and CHIP Reauthorization Act, or MACRA, remain strong.
The rise of consumerism in healthcare is also likely to continue, driving a need among providers and payers for guidance on how to become more consumer-friendly and making the care experience more seamless and convenient, said Vaughn Kauffman, a practice leader and partner in PricewaterhouseCoopers' health industries unit.
"That's another issue we talk to consultants about quite a bit: What are some ways that people are trying to deal with this idea that the patient is becoming more and more responsible for their healthcare expenses?" said Duke's Stover. "What are some unique and innovative patient-friendly ways to engage with them so that they can be flexible and be able to pay their bills, but we can also continue to get the cash flow we need to fulfill our mission? These are the things every health system in the country is wrestling with."