As we enter 2017, leaders in the healthcare industry will compete on optimized operations, the ability to thrive using new payment models, and patient care outcomes and experience. Though the industry’s agenda this year is broad in scope, it’s tied together by one common priority: generating results that are not only financial, but that optimize the patient experience and facilitate a greater exchange of ideas across stakeholders in the industry.
Population Health. It’s increasingly critical that healthcare providers understand the diverse needs of sub-groups within a population, driven by a range of characteristics including age, gender, disease type, or ethnicity—to name a few. For example, among the Emerging America population, the Hispanic and Latino communities illuminate a largely untapped opportunity. This group, which represents over 55 million in the US population,1 has traditionally been underserved and is disproportionately impacted by several serious diseases, including cancer, asthma, and diabetes.
Recent trends in the uninsured rate highlight the healthcare opportunity within the Hispanic and Latino communities. Across the general population, only 24.7 percent of Hispanics were uninsured in the first nine months of 2016, down from more than 40 percent in 2013. Despite the improvement, the rate remains well above the uninsured rate for other racial and ethnic groups, including non-Hispanic black (15.1 percent uninsured), non-Hispanic Asian (8.5 percent uninsured) and non-Hispanic white (7.8 percent uninsured) adults.2 While Hispanic adults saw the greatest gains in insurance coverage, indicating that many now have improved access to healthcare services, there remains substantial unmet need within this population.
Leading retailers and financial institutions already recognize the influence of the Hispanic population, delivering products and services that resonate with the population segment’s culture, needs, and values. In 2017, healthcare providers must continue to catch up, leveraging solutions such as bi-lingual patient portals and clinicians that better engage population segments through tailored, population-specific customer experiences.
Cost Reduction. Cost reduction, capacity, and productivity will also remain at the top of the healthcare agenda in 2017 for both payers and providers. While providers have focused on cost reduction in the last several years, payers will begin to follow-suit, looking at new cost-cutting solutions such as call center consolidation and self-service provider account management platforms.
Value-based Payments. All of the discussion about value-based payments over the last few years will culminate in increased implementation this year. Though California was an early adopter of capitation in the 1990s, we’ll start to see other regions coast-to-coast take their own approaches to value-based care this year.
Virtual Care. In several years, we’ll look back on 2017 and realize that virtual care was in its earliest, most foundational stages. Telehealth, as one component of virtual care, is beginning to evolve the patient experience, but that’s only the beginning when it comes to industry-wide digital transformation. At-home digital monitoring illuminates the contrast between new technology and old-school care. It’s a contrast that healthcare industry must begin to resolve in 2017 as it designs a new, end-to-end virtual care model.
Disruption Across the Industry Ecosystem. There are several emerging trends in the interaction among industry stakeholders:
- The power of the healthcare consumer will continue to accelerate. The continued growth of high deductible plans is rapidly converting the patient/member into being a healthcare consumer. The healthcare consumer is now shopping for healthcare services, actively comparing services and prices in the marketplace. This trend will only accelerate as pricing transparency, outcomes, and expectations increase for payers and providers.
- We anticipate a noticeable contrast in strategic priorities between non-profit and for-profit medical institutions. As academic medical centers look to expand their networks to fund clinical trials, for-profits will be focused on optimizing the implementation of new payment models amidst the broader industry-wide shift to value-based payments.
- With public sector payers emerging as a leader in the adoption of value-based payments- and as the private sector continues to move in a similar direction- we’ll see increased alignment between the sectors in 2017. This alignment will facilitate a greater exchange of ideas between public and private sector that will ultimately surface new opportunities.
- The movement from Hospital to Home accelerates. As this movement happens, the focus will be self-care and supported care delivered in the home. Virtual health, new delivery models to support home care, new jobs, and caregivers will be deployed to deliver these services in the home environment, supported by a set of virtual and on-site services.
- Hospitals and payers are seeking new and more effective ways of communication with physicians and patients. As a result, we’re seeing an explosion of app solutions aimed at addressing this need. Nearly all notable payers and providers have invested in experiments in the space.
- Healthcare’s focuses this year span multiple functional priorities – from new payment models, to improved patient care through greater cultural understanding and engagement. As we consider these emerging priorities side-by-side, the central theme of the healthcare agenda comes into focus. Short-term financial return is merely one end goal when it comes to the industry’s investments this year. More tailored patient care, optimized digital solutions, and a greater exchange of ideas across the industry are all benefits that will continue to fuel innovation in 2017 and beyond.
1 U.S. Census Bureau (2015). Projections of the Size and Composition of the U.S. Population: 2014 to 2060. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf
2 Martinez, Michael E. M.P.H, M.H.S.A; Zammitti, Emily P. M.P.H; Cohen, Robin A. Ph.D. U.S. Department of Health and Human Services, National Center for Health Statistics. (February 2017). Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–September 2016. Retrieved from https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf