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There are three key trends for the potential success of healthcare organizations in regards to financial stability. The first trend is that patients are more in control of their own health care. According to Langley (2017), the old healthcare model of treating acute illnesses is evolving into a model with increasing focus on the patient, disease prevention, and the ongoing management of chronic diseases. Today's healthcare market allows consumers to take charge of their healthcare in a new way. Readily accessible data and information allow patients to have open dialogues with their doctors about diagnosis and treatment options (Langley, 2017). Cost estimators increasingly help consumers understand the intersection of cost and quality in assessing their care options. With the new need to provide tools for patients about pricing, resources, and care options, healthcare consumerism is on the rise. Consumers expect to have everything at their fingertips with virtually no wait time, therefore healthcare organizations must adjust accordingly. Information and services must be readily available and accessible. Patient expectations drive health care organizations to look for ways to achieve them including incorporating new technologies (Langley, 2017). With so much more data being transferred from patients to providers and vice versa, organizations must invest heavily in servers, wireless infrastructure, routers, and security software to keep communication efficient and safe (Langley, 2017). Additionally, end users devices are needed for physician and staff to input the data during patient visits. Finally, as tele-health becomes more available to patients, organizations must ensure they are equipped with video equipment and monitors to make proper evaluations (Langley, 2017). The cost of implementing and sustaining this technology is achieved through meeting patient expectations and supporting their need to participate in their overall health.
The second trend is new and alternative provider payment models. New provider payment models are emerging as increased cost pressures are driving payment models away from FFS (fee-for-service) approaches to those that better align incentives for cost control and high-quality delivery of patient care. According to a 2016 Wolters Kluwer Health Survey, 9 of 10 physicians cited shifting reimbursement models and the financial management of practices as their top challenges (Martin, 2016). Competition among providers and increasing pressure from public and commercial payers to lower costs and to improve care are driving them away from long-standing volume-based healthcare models and toward value-based care models. These models seek to more fully align payment and objective measures of clinical quality. According to Martin (2016), the concept of pay-for-performance (P4P) emerged as a more popular tactic for aligning provider payment with value. Under the typical P4P model, financial incentives or disincentives are tied to measured performance; they may also involve performance thresholds, improvement thresholds, or relative performance cutoffs. The bundled payment or episode-of-care model provides a single negotiated payment for all services for a specified procedure or condition, such as pregnancy and birth, knee and hip replacement surgery, and certain cardiac procedures. As a primary care–driven initiative, the medical home focuses on building a team of professionals, such as physicians, registered nurse case managers, medical assistants, and in some cases, pharmacists, that is responsible for coordinating the care of patients across the healthcare continuum (Martin, 2016). Shared-savings arrangements represent a potentially higher level of reward for providers. Although per-member per-month payments and FFS rate increases generally cover only the added infrastructure and staff resources, shared savings can be an enticing incentive because providers who offer patient-centered medical homes are often challenged to maintain their previous productivity levels (Martin, 2016). Although these new models have the potential to encourage care coordination, improve quality, and control costs, there are many challenges in implementing them. Many of the new models are being implemented by adjusting the FFS payment rather than replacing it, and their potential to be truly transformative may be limited. The success/sustainability of new payment models will depend in part on identifying and incorporating lessons learned by early adopters.
The third trend is investments in technology. According to Richards (2017), in the past, technology in healthcare organizations meant a handful of computers, some digital monitoring equipment, and a few pieces of imaging equipment. In today’s healthcare environment, technology such as hybrid operating rooms, da Vinci robots and other surgical technology lines, 3D ultrasound and imaging equipment, are improving care every day. Technology has never been aligned with providing care directly to the patient, and as more and more physicians are trained on these devices, it is important for organizations to invest in these new technologies (Richards, 2017). Also, every organization has some type of EMR system, where patient records, internal communications, and diagnostic results are all shared on tablets, apps and Cloud computing networks. According to the American Hospital Association (AHA), hospitals and providers are stratifying their top investment priorities around clinical upgrades and technology enhancements (Richards, 2017). About 45 percent are to upgrade or replace medical equipment, 24 percent were a mix of medical, IT, and software, and 15 percent were IT and office upgrades and renovations, with (Richards, 2017). According to Richards (2017), “investing in modern clinical care and technology can bring a better patient experience with a greater chance to improve health outcomes and treatment options. These investments can also make the consumer better understand stand their healthcare options; therefore, potentially using the healthcare system more efficiently” (p. 85). Investing for the future can provide the opportunity for innovative financial modeling in improve revenue streams and new procedures to mitigate illnesses and diseases (Richards, 2017). With all of these trends the one thing for certain is that there will be changes. To prepare, many healthcare organizations are taking proactive measures to be safe, such as conserving cash, updating security equipment, and keeping staff informed of the latest regulations. Although changes can be intimidating, healthcare will adapt and get even better.
Langley, F. (2017). Strategic Trends that Impact Healthcare Decision-Making in the New Marketplace. Journal of Healthcare Management, 2(4), 206-224.
Martin, P. (2016). Improving quality and value in the U.S. health care system. Journal of Quality Healthcare, 11(8), 172-198.
Richards, T. (2017). The financial sustainability of health systems. Journal of Healthcare Economics, 7(5), 81-117.