Report: Social and Economic Factors Disrupting Health Care Are Here to Stay

Extraordinary times call for extraordinary measures

The escalating pressure on providers to dramatically change how they organize and deliver care will continue in the years ahead, according to a report from Modern Healthcare. Bottom line-oriented employers, cash-strapped families, and tax-starved governments will insist on it.

Health care costs in the U.S. for most of the past four decades have grown faster than the rest of the economy, hitting $3.2 trillion in 2015—nearly one-fifth of the gross domestic product, according to the report. Along with this climb, the government has cut reimbursements, and employers have put their employees on high-deductible plans. In 2016, more than 50% of insured employees had deductibles exceeding $1,000, up from 10% in 2006.

Insurers, too, are feeling the weight of rising costs and have begun to switch to value-based reimbursement, which puts further pressure on everyone else to change how care is delivered, the report notes. But even as insurers embraced the regulations and value-based incentive plans, such as accountable care organizations (ACOs), bundled payments, and shared savings contained in the Patient Protection and Affordable Care Act, many appear willing to accommodate themselves to a system where consumer-driven medicine plays a significant role.

That will only increase the pressure on providers to push for lower costs, higher quality, and more patient-focused care, the report says. Their financial survival will depend on succeeding at new models of delivering care.

To meet the imperative to deliver higher-quality, lower-cost care, providers are increasing their focus on the patients they serve. Medicare has created incentives to promote this behavior, basing a large share of its hospital value-based purchasing rewards and penalties on patient responses to a postdischarge survey. Hospital officials are also learning that patient-centric care is good for outcomes, the report adds.

With consumers bearing a greater share of health care costs, they are demanding more information about quality and costs. To measure how well they’re performing at delivering that consumer experience, health care systems are using a net promoter score, a metric common in the retail industry. It gauges how loyal a customer is to a provider by asking a single question: How likely are you to recommend our company, product, or service to a friend or colleague?

One way to improve the patient’s experience—and to save money doing it—is to take a cue from the consumer world and go digital, the report suggests. For example, New York-Presbyterian Hospital is looking at converting a significant amount of its interactions with patients to being done via telehealth. Apps to open communication are another way health care is learning from other industries.

As value-based care takes hold, health care systems are feeling more pressure to increase efficiency. One way to do this is to turn some tasks over to the patients, the report says. Beth Israel Deaconess in Boston, for instance, is testing virtual assistant-facilitated self-scheduling. Staff who would otherwise be scheduling could be freed to tend to other tasks, such as care management.

Finally, the report notes that most systems developing lower-cost, patient-centered models soon realize that they must enter realms that have traditionally been outside of health care but are essential to helping some of the most expensive patients in their facilities. The so-called social determinants of health—food, housing, employment, social relationships, and education—can defeat the best care plans.

That means systems must engage patients in unconventional ways to get ahead of potential health issues. Penn Medicine in Philadelphia, for example, has a community health program through which health workers help patients reach their goals, sometimes even working out with them at local gyms. Such a care model requires leaving the hospital and interacting with patients more often.

Source: Modern Healthcare; April 11, 2017.