Transcript Futurescan - American College of Healthcare Executives

Futurescan
Healthcare Trends and Implications
2011–2016
1
Futurescan
Co-sponsored by:
• Society for Healthcare Strategy and Market
Development of the American Hospital Association
• American College of Healthcare Executives
• With Support From Thomson Reuters and VHA Inc.
2
American College of Healthcare Executives
• Professional society of more than 30,000 healthcare
executives—Leaders Who Care
• Board certification in healthcare management as ACHE
Fellows (FACHE®)
• Foremost continuing educator for the field
• Leading healthcare management publications:
– Health Administration Press books
– Journal of Healthcare Management, Frontiers of Health
Services Management and Healthcare Executive
• Fulfilling our vision to be the premier professional
society for healthcare executives dedicated to improving
healthcare delivery
3
Society for Healthcare Strategy and Market
Development
• Personal membership group of the American Hospital
Association
• Serves more than 4,400 healthcare planning, marketing
and public relations/communications professionals
• Committed to helping members meet the future with
more knowledge and opportunity as their organizations
work to improve health status and quality of life in their
communities
4
Futurescan Contributing Authors
•
•
•
•
•
•
•
•
•
Donald W. Seymour, Executive Editor
Jeffrey C. Bauer, Healthcare Policy: The Future of Health Reform
Paul B. Ginsburg, Payment: Reforms Poised to Spur Hospital Quality and
Efficiency Gains
Pankaj H. Patel and Mark Shields, Physician-Hospital Integration: Market
Trends, Health Reform Drive Closer Ties
Victor J. Dzau and Alex H. Cho, Primary Care: Filling the Primary Care
Supply Gap
Mark R. Chassin, Qualify and Safety: Reaping the Rewards of Process
Improvement Done Right
Paul Tang, Meaningful Use of Health Information Technology: From Public
Policy to Changing Care
Eric J. Topol, The Digital Wireless Revolution: Wireless Devices and their
Application in Healthcare
Ed Bennett, Social Media and Hospitals: From Trendy to Essential
5
“Even small healthcare institutions are
complex, barely manageable places. . .
Large healthcare institutions may be the
most complex organizations in human
history.”
Peter Drucker
Post-Capitalist Society. New York, Harper and Row, 1993
6
Actions We Should
Start, Stop and/or Continue
We should start.....
We should continue.....
We should stop.....
(c) 2007 - The Governance Institute
7
FutureScanning
Trend
Implications of this Trend?
Implications of this Trend?
Implications of this Trend?
Implications of this Trend?
Implications of this Trend?
At least 1 positive, and 1 negative.
Implications of this Trend?
8
Healthcare Policy:
The Futures of
Health Reform
9
Healthcare Policy:
Expect the Unexpected
Healthcare reform could move in a number
of different directions—all at once.
• Adopt a flexible, contingency approach to
planning.
• Don’t wait for federal funding (e.g.,
demonstration projects) or mandates to
develop new strategies and new business
models.
• Proceed with appropriate caution.
10
Healthcare Policy:
Legislative Battles
There will be attempts to repeal the Affordable
Care Act, but any new attempts to reshape
healthcare at the national level are unlikely.
• Be prepared to implement and respond to the
provisions of the new law.
• Closely monitor health policy initiatives both nationally
and locally.
• Carefully evaluate participation in the demonstration
projects and strategies promoted by CMS and the
Secretary of Health & Human Services.
11
Healthcare Policy:
At Risk and Accountable
Much of hospitals’ reimbursement will come from
“at risk” payment strategies or through an
Accountable Care Organization.
• Move forward on an IT infrastructure that can reliably
reflect clinical and administrative functions.
• Look for ways to reduce waste and improve
processes.
• Develop partnerships in the medical marketplace.
12
Healthcare Policy:
Comparative Effectiveness
Comparative effectiveness research will
be widely used to inform clinical decision
making.
• Create an IT infrastructure to monitor the use
of protocols based on effectiveness research.
• Help clinicians keep up to date on the newest
research findings.
• Market your hospital’s care as being based on
the most up-to-date research available.
13
Healthcare Policy:
Look Outside Washington
Few enduring improvements in the quality or
cost of healthcare will originate in the nation’s
capital.
• Make efforts to identify creative and resourceful providers,
purchasers, payors and others who are developing models
to improve healthcare.
• Encourage disruptive innovations that improve care at
lower cost.
• Network with colleagues in order to share resources and
generate new ideas.
• Monitor state legislative actions closely.
14
Payment:
Reforms Poised to Spur
Quality and Efficiency Gains
15
Payment: Change is Coming
The Affordable Care Act will bring the first
real change in Medicare payment structure in
years. Medicaid and private payors will follow
suit.
• Partner with physicians in anticipation of bundled
payments.
• Carefully project how any new pilot payment
structures would impact your organization’s finances.
• Use new payment mechanisms as a means of
pursuing your organization’s mission of promoting
population health.
16
Payment: ACOs
Many hospitals will partner with physicians
to develop Accountable Care
Organizations (ACOs) in anticipation of
reimbursement changes.
• Understand that ACOs represent a “sea change” in
relationships with physicians.
• Carefully structure employment plans for physicians.
• Balance the anticipated decrease in inpatient volume
due to better disease management with an increase
in insured patients.
17
Payment:
Value-Based Purchasing
The shift to value-based purchasing mandated
by the Affordable Care Act will spread to private
payors.
• Implement checklists, practice protocols and other
strategies to ensure providers adhere to quality
measures.
• Make sure that IT systems can reliably track the
necessary (and yet to be determined) analytics.
• Make value a key negotiation strategy with private
payors.
18
Payment:
Who Has the Leverage?
The future leverage between private
payors and providers is uncertain. Both
sides are concerned about losing ground.
• Aggressively market your organization’s value in
providing quality, cost-effective care.
• Anticipate changes in the structure of health
insurance plans and their impact on your finances.
• Monitor the nature and structure of private insurance
plans created through insurance exchanges.
19
Payment: Paying for More
An increasing number of caregiver activities that
can potentially reduce costs and manage
chronic disease (e.g., telephone or e-visits) will
be reimbursed.
• Make sure that information and management systems can
reliably capture these unconventional activities.
• Promote these encounters by educating patients and
caregivers on the convenience and value of these
activities.
• Help physicians successfully integrate these activities into
their practices.
20
Physician-Hospital
Integration:
Market Trends, Health
Reform Drive Closer Ties
21
Physician-Hospital Integration:
Codependence
The Affordable Care Act’s promotion of Accountable
Care Organizations (ACOs) and bundled payment
mechanisms will mean that physicians and hospitals are
codependent.
• Reduce costs, including admissions, that don’t contribute
to positive outcomes.
• Establish or expand physician leadership development
opportunities.
• Develop contracts between physicians and hospitals that
integrate clinical functions and align incentives.
• Evaluate the organization’s readiness to become an ACO.
22
Physician-Hospital Integration:
The Employed Physician
The anticipation of healthcare reform has
already prompted many physicians to seek
employment or close alliances with hospitals.
This trend will only intensify.
• Be sensitive to the lifestyle needs of younger physicians.
• Create employment arrangements that incentivize
physicians for quality and productivity.
• Develop or expand physician leadership development
opportunities.
23
Physician-Hospital Integration:
Broader Missions
With more physician partners, hospitals will
expand their mission statements to include care
in pre- and post-hospital settings.
• Engage the hospital’s board in setting a broader
agenda.
• Investigate risk management issues regarding care
rendered outside the acute-care hospital.
• Consider affiliations with other systems in order to
diversify services and gain access to capital.
24
Physician-Hospital Integration:
Beyond Stark
Legal barriers (e.g., Stark and anti-kickback
laws) will be relaxed in order to promote
physician-hospital collaboration and value-based
healthcare.
• Closely monitor federal regulations.
• Develop compensation strategies to reimburse
physicians for additional services.
• Provide administrative expertise and support as
office-based physicians reengineer their practices.
25
Physician-Hospital Integration:
Practice Management Skills
Hospitals and systems will need managers with the
knowledge and skills to manage and coordinate
physician practices.
• Hire individuals with experience and expertise in
physician practice management.
• Work with physicians to develop an infrastructure that
tracks and drives clinical performance.
• Expand physician leadership and training
opportunities.
26
Primary Care:
Filling the Primary Care
Supply Gap
27
Primary Care:
Unprecedented Demand
The already growing demand for primary care
services will increase dramatically in 2014, the
year that the Affordable Care Act expands
coverage.
• Work with educational institutions and provide
scholarships or tuition assistance to primary care students
in exchange for future employment.
• Offer family practice clerkships to medical students.
• Develop partnerships with other community providers
(e.g., FQHCs) that employ primary care physicians.
28
Primary Care:
Reliance on Extenders
Within the next few years, the bulk of primary
care services will be provided by clinical
extenders. Insurance companies will reimburse
these services.
• Work with local colleges and universities to promote
enrollment in PA, NP and other health professions
programs.
• Re-examine the traditional ratios of PAs and NPs to
physicians.
• Help physicians learn to collaborate with physician
extenders to ensure continuity of care.
29
Primary Care: Retail Clinics
Retail clinics will continue to proliferate
and provide relatively low-cost routine
primary care services.
• Look for opportunities to place hospital-sponsored
clinics in busy retail establishments.
• Partner with existing retail clinics to market the more
acute services available at your facility.
• Be sensitive to the concerns of physicians who may
lose volume to retail clinics.
30
Primary Care: Impact of Reform
The development of Primary Care Medical
Homes and Accountable Care Organizations will
result in tighter clinical integration between
hospitals, primary care and specialty care.
• Monitor federal regulations and the results of
demonstration projects closely.
• Make sure information systems can reliably integrate the
clinical and management functions.
• Work with physician leadership to ensure the medical staff
is up to date on guidelines and other care standards.
31
Primary Care: New Models
Demand for traditional primary care services will
continue to outpace supply in the foreseeable
future, necessitating the development of new
models and approaches.
• Work with nursing leadership to ensure your facility’s
nurses are practicing to the full extent of their
education and training.
• Monitor trends in education and public policy.
• Look for novel approaches and ways that IT can
extend the reach of primary care providers.
32
Quality and Safety:
Reaping the Rewards of
Process Improvement
Done Right
33
Quality and Safety: The Process
Improvement Mandate
With reimbursements declining and CMS no
longer paying for poor quality, hospitals will
intensify their process improvement initiatives.
• Provide staff training in Robust Process Improvement
(RPI) techniques.
• Use RPI tools and techniques throughout the organization.
• Empower all employees to lead improvement efforts.
• Emphasize leadership’s role in promoting improvement
efforts.
34
Quality and Safety:
Renewed Efforts
Despite increased awareness and effort since To Err is
Human, hospitals have made little progress in reducing
adverse events and preventable deaths. Efforts will
intensify with payment reform.
• Create an organizational culture where safety is a core
value.
• Look for ways—electronically or other—to monitor
patients frequently and consistently.
• Empower all employees to suggest improvements in the
care process that will reduce errors and patient harm.
35
Quality and Safety:
Less Waste and Risk
Hospitals will use process improvement
techniques to reduce waste, including the
overuse of health services, and to reduce patient
risk.
• Work with medical staff to promote the use of
evidence-based clinical guidelines.
• Reduce the amount of duplicate diagnostic and other
tests through the use of EHRs and PHRs.
• Make sure process improvement efforts include a
focus on reducing unnecessary care.
36
Quality and Safety:
Controlling Infections
Infection Control will begin with the
admissions process.
• Consider screening all inpatients for MRSA at
admission.
• Appoint a Director of Infection Prevention and
Control, a senior-level person with clinical and
managerial experience.
• Intensify efforts to ensure hand hygiene compliance.
37
Quality and Safety: Nursing
Citing quality and safety benefits, an increasing
number of hospitals will require nurses to have at
least a baccalaureate degree.
• Provide scholarships and other incentives for associate
degree and diploma nurses to obtain the baccalaureate
degree.
• Work with local colleges and universities to promote the
nursing profession.
• Make sure the Chief Nursing Officer is a full participant in
the C-suite.
• Determine whether Magnet Status is a reasonable
objective for your organization.
38
Meaningful Use of Health
Information Technology:
From Public Policy to
Changing Care
39
Meaningful Use of HIT:
Bigger Budgets
Hospital spending on IT is likely to double in the
next five years.
• Work with IT staff to ensure you meet the requirements
necessary to apply for HITECH funding.
• Develop an IT system that integrates data across the
continuum of care.
• Understand that an experienced Chief Medical Information
Officer is critical.
• Hire or develop additional skilled IT professionals.
• Allocate budget funds for staff training.
40
Meaningful Use of HIT:
Connecting Physicians
Hospital EHRs will be interoperable with those of
their physicians, promoting greater coordination
of patient care.
• Use an experienced Chief Medical Information Officer to assist
with the transition, including educating reluctant physicians on
the value of EHRs.
• Partner with physicians and the medical staff in the design of the
physician interface.
• Be sure that physician and patient confidentiality concerns are
addressed.
• Provide training for physicians on using the system.
41
Meaningful Use of HIT:
The Connected Patient
Providers will be connected electronically
with their patients.
• Provide patients access to their medical records in a
format that is easy to understand and use.
• Address concerns about confidentiality of records.
• Make information available that will help patients maintain
and improve their health.
• Install information systems that will allow home monitoring
and e-visits with patients.
42
Meaningful Use of HIT:
No More Paper
Hospitals will shift all of their records to an
electronic platform, making paper charts
obsolete.
• Plan for ways to archive existing records and/or
transfer them to an electronic format.
• Choose IT vendors wisely so that the system supports
all necessary processes.
• Position monitors in strategic locations so that patient
records are easily accessible.
43
Meaningful Use of IT:
The End of Fee-for-Service
Payment will be based on performance, outcomes
and ACO arrangements that reward shared savings
rather than volume.
• Use process improvement strategies to achieve
greater efficiencies and improve care.
• Make sure that your IT infrastructure can capture the
analytics necessary to measure outcomes and
demonstrate value.
• Work with the medical staff to improve care based on
well-validated clinical indicators.
44
Meaningful Use of HIT:
Mergers and Acquisitions
The administrative and financial demands
of meeting meaningful use requirements
will prompt consolidation across the
industry.
• Assess your organization’s capabilities and determine
if a merger is a reasonable strategy.
• Look for ways to collaborate with other providers in
the community on the administrative costs and
expertise of IT.
45
The Digital Wireless
Revolution:
Wireless Devices and their
Applications in Healthcare
46
The Digital Wireless Revolution:
A New Type of Band-Aid
A Band-Aid-like adhesive strip worn on a
patient’s wrist or skin will monitor vital signs,
physical position and activity.
• Determine which type of monitoring (e.g., complete
vitals, heart rate alone, glucose for diabetics) fits best
with your facility’s strategic direction.
• Determine which beds outside of ICU should be
equipped for routine patient monitoring.
• Provide the necessary IT backup.
47
The Digital Wireless Revolution:
Web-Based Care Management
Web-based platforms will be used for the daily
management of diabetic and other outpatients with
chronic conditions.
• Work with physicians to invest in a platform or platforms
that will support care management systems.
• Design systems that can also be used for diagnostic
purposes (e.g., monitoring heart rhythm).
• Use care management systems to promote your
organization’s interest in maintaining health and reducing
expensive inpatient episodes.
48
The Digital Wireless Revolution:
E-Visits
The use of e-mail and e-visits will become
commonplace for follow-up and routine care and will
improve the efficiency of ambulatory care.
• Educate physicians and patients on the value and
convenience of e-visits.
• Work with health plans to ensure that compensation
for e-visits is reasonable and fair.
• Work with physician leaders to develop guidelines for
the appropriate use of e-visits.
49
The Digital Wireless Revolution:
Pocket Imagers
Pocket-sized imaging devices will provide
high-resolution results in any location at a
fraction of the cost of inpatient scans.
• Strategic plans should address the future of your
inpatient imaging center.
• Consider using pocket-sized ultrasound devices
in a variety of settings.
50
The Digital Wireless Revolution:
iPads Meet Healthcare
iPads or other tablet-type devices will be
widely used as point-of-care aids and as
versatile administrative tools.
• Provide tablets and the appropriate medical and
healthcare apps to key members of the clinical staff.
• Have IT staff routinely monitor the development of
new hardware and software applications.
• Make sure that wireless connections are strong
throughout your facility.
51
The Digital Wireless Revolution:
Apps for Patients
Hospitals will routinely provide patients with
apps for wireless devices that can be used for
the registration process, scheduling follow-up
visits and accessing health information.
• Be prepared to address any confidentiality concerns that
patients may have.
• Use apps to promote your facility’s strengths and
contribution to community health.
• Incorporate the creation and use of apps into strategic and
marketing plans.
52
Social Media and Hospitals:
From Trendy to Essential
53
Social Media and Hospitals:
Essential
Healthcare providers will use popular social media
(Facebook, Twitter and others) to market their services
and maintain a presence in the online community.
• Develop a plan for the use of social media. Make it part of
the strategic planning process.
• Monitor the social media presence of local competitors.
• Make staff time available to monitor your organization’s
image in real time and respond to any online complaints in
a timely fashion.
• Use input from social media to improve the patient
experience.
54
Social Media and Hospitals:
Educate and Market
Hospitals will use social media to educate
the community and recruit future patients.
• Create forums or discussion boards where patients can
learn about disease conditions.
• Encourage key physicians or managers to create blogs
that showcase your organization’s mission and strengths.
• Use platforms like Twitter for crisis management or to
educate the community on current health concerns.
55
Social Media and Hospitals:
Get Physicians on Board
Patients will expect their physicians to
communicate electronically and to use
social media.
• Provide training opportunities for physicians in the
use of electronic media.
• Provide support in creating staff physicians’ social
media presence.
• Link staff physicians’ social media presence with that
of the hospital.
56
Social Media and Hospitals:
Help for Knowledge Workers
Physicians and other knowledge workers will use
social media and networking to decrease the amount
of time they spend searching for information.
• Investigate the use of internal collaborative tools like
Yammer and Socialcast.
• Establish guidelines for the use of social media tools
by employees.
• Dedicate staff time to keeping current with the rapidly
evolving social media field.
57
Social Media and Hospitals:
Participatory Medicine and
Healthcare
Patients, armed with information gained from online
networks, will expect direct and clear answers from
hospital workers.
• Hospital leaders must learn about and recognize the value
of social media and use it in their interactions with staff
and the community.
• Encourage employees’ use of social media in the
workplace as a means to enhance the caregiving process.
• Direct patients to hospital-sponsored social media that
addresses their health concerns.
58
“‘We will do everything for everybody’ has
never been a viable value proposition for
any successful business model that we
know of—and yet that’s the value
proposition … of general hospitals.”
Clayton M. Christensen,
Jerome H. Grossman, MD,
and Jason Hwang, MD
The Innovator’s Prescription: A Disruptive Solution for Health Care (2009)
59
Futurescan
This presentation was adapted by Mary Stefl, PhD,
Chair, Health Care Administration, Trinity University,
from Futurescan: Healthcare Trends and Implications
2011–2016.
Futurescan 2011 is available for purchase from Health
Administration Press. Single copies (order code 2175)
are $45. Packages of 15 copies (order code 2175BN)
are available for a discounted price of $395. Order
online at ache.org/HAP or call the ACHE/HAP Order
Fulfillment Center at (301) 362-6905.
60
Futurescan
Healthcare Trends and Implications
2011–2016
61