Healthcare is in the midst of groundbreaking change, moving from a B2B model to a B2C model, and from physicians and administrators as the boss to patients as the boss. In every industry where consumers are empowered, there are winners and losers. Here's how to get on the winning side.
1. Rapid expansion of bundled payment and community-based care models
The incentives that determine how healthcare providers get paid are changing. Under the current fee-for-service model, doctors get paid for every patient they see, every test they run, and every procedure they perform. We’re starting to see a move to bundled payment plans and value-based care, where hospitals and physicians are reimbursed for doing a really good job taking care of patients proactively, regardless of how many procedures or tests they run. And, ideally, the design of this business model really is to do less traditional, physical medicine and more community care.
Leaders like Oak Street Health in Chicago, Landmark Health in New York, and Iora Health in Boston are saying, forget the past. Their main business relies on a value-based model and they put their people, processes, and technology behind this concept. They’re showing you can absolutely win in this new model and we expect to see other providers follow suit.
2. Home as the new care setting
Care is moving outside of the hospital and into the home and community. We need to understand how to organize care this way because, when you do, it’s more affordable, more convenient, and it’s a better experience for the patient. And the resources needed to move care to the home are shifting. We’re starting to see hospitals ask: “How do we invest in home care and communities so the cost of care is lower and it’s a more convenient care setting for our patients?”
Think about a hospital room. It has instrumentation and equipment, a nurse call button, and healthcare professionals who are quickly able to triage in the room. None of that exists in the home. We’re starting to see telemedicine solutions and virtual care solutions that allow a nurse or doctor to “see” a patient in their home. Livongo, for example, has developed technology for patients with diabetes to wirelessly sync their blood-sugar screening results to their own devices and those of their healthcare providers or coaches.
3. Air traffic control for healthcare
Insurance companies are beginning to reimburse patients for home devices to monitor blood pressure, weight, caloric intake, and other clinical indicators. Care providers are no longer just waiting for patients to call and say they’re not feeling well. Instead, they’re monitoring patients remotely and seeing changes happen, sort of like air traffic controllers.
Communication is key when patients are monitored in their home. In a hospital, you have nurses, social workers, doctors, pharmacists, and a whole team of other care providers all under one roof. The next major step, and what we’re doing with our Prepared Health network, is to create a virtual experience for the entire healthcare team so they can communicate with each other--and help patients and families stay connected--even though they may not physically be under the same roof.
4. Physicians prescribe more than drugs
When patients are ill, physicians may prescribe education or a community health worker or a mobile disease management platform into which they can dock. They may prescribe a digital scale or a heart-failure monitoring device. It won’t just be drugs. We’ll see a lot more of these innovations become standard of care.
5. Data-driven care transitions
Data is finally showing up in healthcare. The challenge now is to use data to activate the right level of care at the right location at the right time. There’s a multi-step journey when a patient leaves the hospital to go to a short-term rehab center like a skilled nursing facility. Today, the referral process happens primarily through faxes and phone calls. That’s been the standard in the healthcare industry for a while and it’s woefully inefficient. We’re reimagining this entire journey with the Prepared Health network by using data to help hospitals determine the correct destination for their patients. This data allows hospitals to figure out which rehab center accepts a patient’s insurance, has current availability, has the right level of equipment and staffing, is highly rated by Medicare or has low readmission rates.
6. Evidence-based community interventions
Choosing a post-acute care setting is often based on a patient’s skilled requirements and doesn’t take into account what else a patient may need. For example, let’s say it’s determined that a 70-year-old man who has a knee replacement surgery is progressing with physical therapy and can be safely discharged to his home. But there’s other data that indicates he lives alone, is struggling with meal preparation, and can’t manage his 10 prescribed medications. How do we use that insight to bring the right level of care to the patient? How do we create a hospital-like experience in his home that’s more affordable and convenient, and that may also prevent him from returning to the hospital? This is where utilizing the appropriate data comes into play.
7. Fully automated authorizations
Prior authorization is a whole other bump in the road. You may think your patient needs an acute inpatient rehab stay but will insurance approve it? The insurance company often requires more assessments and additional documentation by the physical therapist before it approves a patient’s rehab stay. This, in turn, requires more time and coordination by the healthcare team, and more faxing and phone calls. In the end, who ends up waiting? Everyone. And waiting leads to frustration for both patients and providers. Using data strategically to inform insurance authorization can make the process smoother and it allows everyone to work towards the common goal – a speedy recovery.
8. Fewer dropped calls
Data can also inform all parties, in real time, how care is proceeding after a patient leaves the hospital and moves to the next care setting. For example, a home health referral was accepted but did the patient actually receive the care? We hear all the time about dropped calls -- a health worker knocks on a patient’s door and the family doesn’t answer, or they say they never agreed to care and send the provider away. And that dropped call is never communicated upstream. If it was, the hospital could get involved and offer more education or planning to the patient and family so everyone is on the same page and care can proceed as expected.
9. Discharge to community health workers
Personal caregivers come in different forms: family caregivers, professional caregivers like home health aides and visiting nurses, physicians who make house calls, and even community health workers. Sinai Health System in Chicago has a really strong community health worker program where people in the community are trained to be care navigators and guides. If I’ve had a heart procedure, for example, someone from my local church is going to knock on my door and make sure I know my medications, help me make appointments, and even see if I need a ride to my next doctor’s visit. So how do we empower these community health workers? We need to put tools in their hands to help them operate at a higher level and allow them to communicate efficiently with the healthcare team.
10. Professionalization of family caregivers
There are 43 million Americans who are family caregivers and the rate at which people are moving into the caregiver role is massive. Most will be taking care of a parent or another adult, providing uncompensated care that they’re not trained or certified to deliver. The number of people who are going to need care is far outpacing the supply we have in the market. Fifty-five percent of nurses will retire in the next five years, so it’s a fight for talent. We’re starting to see innovative organizations think about how to organize caregivers, both personal and professional, and coach them with tools, technology, and access to education, so they’re better equipped to deliver care.
Even insurance companies and government agencies are starting to see the potential of family engagement. Just like patients are discharged from a hospital to skilled nursing facilities or with home health providers, what if you could discharge a patient to a family member who has received coaching on how to take care of their loved one? What if, by doing so, you can reduce readmissions to the hospital? We’re going to hear more about this in the coming year.
With the passage of the CARE Act, hospitals in 14 states will now be required to offer training to designated caregivers. When patients are discharged, the designated caregiver will be notified and offered either live or recorded after-care training as part of an overall discharge plan.
Last January, the RAISE Family Caregivers Act was signed into law to develop a national strategy to support family caregivers. This, to me, is awesome. When healthcare innovations are supported by government regulation, and payers focus on how to keep people at home safely, we know that this is the cornerstone of the future.
This story first appeared on Becker's Hospital Review.