Like a lot of business people, I travel quite a bit…and airline miles are golden. Even for those who only travel a couple of times a year, airline miles can help make leisure travel more attainable. Airlines have successfully changed the behavior of their customers by making them feel like they are members of a club. These members might get free access to airport lounges, discounts on hotels, or even occasional upgrades from a middle seat (the true Holy Grail for airline travel).
For the US health care system, as we move toward a financial model that is based on value rather than volume, keeping people healthy and out of the hospital will be key. Rather than seeing people as patients, health systems should treat them more like members—something health plans already do (to varying degrees). People who feel like they are part of a club might be more receptive to efforts to keep them healthy. Improving the patient experience can help strengthen customer loyalty, build reputation and brand, and, perhaps, improve the health of our nation.
In a fee-for-service (FFS) model, health systems generate more revenue when patient volume increases. Under a value-based model, a person who shows up at an emergency room (ER) or a doctor's office becomes an expense rather than a source of revenue. In 2019, health systems and hospitals will likely move toward this value-based model at a faster pace than in previous years. But to succeed, they will need to work more closely with health plans. Here are five trends that I expect could impact health plans, health systems, and patients in 2019:
- Convergence and collaboration between health systems and health plans will become more important: As we move into 2019, the most successful health plans will likely be those that are able to connect consumers to their health care. Health plans are the only players in the health care ecosystem that have a complete dataset for each insured patient. This information will be important for health systems and physicians as they become more responsible for the long-term health of patients. Health care providers need health plans for their technology and their expertise in managing care, and health plans need providers because they understand care delivery and clinical effectiveness. Both sides should leverage each other's strengths to create a better and stronger health system in the US.
- Health systems will continue to focus more on the patient rather than the illness: The Medicare Access and CHIP Reauthorization Act (MACRA) is more than three years old, but we are just beginning to see its impact on hospitals and health systems. We expect the law will affect health systems more profoundly in 2019, as more of them choose to take on shared and full-capitation risk contracts. There were a few early MACRA adopters in 2016 and 2017, and the trend accelerated in 2018 as health plans forged closer relationships with health systems to share risk. Many health systems are trying to figure out how to put their arms around the entire continuum of care. Historically, this has been more of the responsibility of health plans, which have always existed in a value-based world. In a value-based payment model, health systems and doctors should consider the full cradle-to-grave spectrum of care within a fixed premium payment. This could be another opportunity for health plans and providers to collaborate.
- Technology could help move patients to the center: Physicians spend 21 percent of their time on non-clinical paperwork.1 This takes away from the time they spend with patients—and can contribute to burnout. Artificial intelligence (AI), robotics, and cognitive technologies could automate many of daily duties for physicians and clinicians and give them more time to practice medicine. Over the next three to five years, 100 percent of health care providers expect to make significant progress in adopting these technologies, according to our Human Capital Trends research. However, those respondents also acknowledged that they haven't made much progress yet. We believe that both enabling technologies (like EHRs) and emergent technologies (like blockchain, AI, etc.) will help improve the connectivity and engagement among health systems, health plans, and patients and families. Rather than requiring a patient to physically meet with a doctor, data from a patient's EHR could be used to help manage chronic illnesses without the patient having to meet with a clinician—another market signal that speaks to the increased focus on wellness for 2019.
- More patients could consider virtual health: Very few of us really enjoy going to the doctor, which causes some people to wait until a condition worsens before seeking care. This mentality drives up costs, including expenses related to ER visits. Virtual health could help patients communicate directly with caregivers. The technology can help physicians see more patients, deal with rising clinical complexity, and support patients as they take a greater role in their own care. However, just 14 percent of physicians have implemented technology that allows them to conduct virtual visits with patients, and only 17 percent use the technology for physician-to-physician consultations, according to the results from our 2018 Physician Survey on virtual care. This could be because implementation is often costly for providers, and many organizations are still weighing the return on investment, as well as existing fee-for-service reimbursement rules. Health system leaders should determine when physicians and other caregivers should be at the site of care delivery and when their work can be performed virtually. Last summer, the US Centers for Medicare and Medicaid Services (CMS) proposed that Medicare pay physicians for virtual check-ins and other tech-enabled services. Telehealth is also becoming a common feature in commercial health plans. As of 2016, 74 percent of large employer-sponsored health plans had incorporated telehealth into their benefits (up from 48 percent in 2015).2
- There will be more focus on population health: Population health takes a broad look at the management of outcomes for all of a health system's patients. Specifically, population health includes efforts to use health care resources more effectively and efficiently to improve the lifetime health and well-being of a specific population. In addition to disease prevention, population health activities include promoting health and well-being. In recent years, there has been an increased focus on the social determinants of health, and the recognition by health care stakeholders that many of the factors that influence our health have less to do with health care and more to do with our environment, our stressors, our income and education, and our level of social interactions and sense of community. While health care organizations might be grappling with how to measure the ROI of these efforts, they can be critical as we shift to a focus on wellness. We expect to see the social determinants of health continue as a hot-button issue in the new year.
The truth is, we need to reduce injury and illness, and we need to manage chronic disease more effectively to reduce utilization and resource consumption. We should give people incentives to engage with the health system as early as possible to keep them healthier. That keeps costs down. We are still going to get sick, but we likely won't get as sick if we get patients (or members) into the system sooner and deal with health issues in real time before they become too acute.
The year 2000 is nearly two decades behind us, and the future of health is closer than we think. My colleague Doug Beaudoin recently sketched out a vision for health in the year 2040. He predicted that by then, health care stakeholders will be working cooperatively to improve the health of individuals and populations. I agree that we are headed in that direction, but to ensure we stay on the right trajectory, health plans, health systems, and patients should start to work more collaboratively with each other in 2019 and in subsequent years.
- Physicians Foundation 2016 Survey of America's Physicians