Top Predicted Healthcare Trends of 2016

20 January, 2016

Top Predicted Healthcare Trends of 2016

The nation's healthcare system will undergo tremendous changes in 2016. While macro factors are at play, some of the greatest challenges will be finding ways to respond to new payment models, consumer expectations, as well as changing organizational operations, facilities, and culture to respond to population health strategies. Here's a look at the trends and factors that will have the greatest impact during 2016:

Macro Issues: A Changing Industry

  • The World is Shrinking. Consolidation is one of the biggest phenomena occurring in every arena of healthcare. While we can expect the regulatory approvals for the major payer transactions to be resolved during 2016, keep an ear to the ground for additional mergers. As the number of players shrinks, this will impact both payer and provider strategies, particularly in markets where the payer mix is already highly concentrated. In the provider realm, there will be additional eyes focused on these actions as the Federal Trade Commission will continue scrutiny of provider consolidations, including hospital and medical group acquisitions. "It will be essential to demonstrate direct consumer benefit related to efficiency, access and quality, both pre- and post-merger," said Laura Jacobs, president, GE Healthcare Camden Group. Watch for consolidation to take many forms -- not just asset mergers but many other types of affiliations and integrated relationships.
  • Innovation Will Rock the Boat. From technology, to new models of care, to new approaches to patient experiences, innovation will cause ongoing marketplace disruption. Private equity dollars will continue to flow into mobile technology, while new primary care delivery models and telehealth will offer different ways to engage consumers. In addition, retail giants like CVS and Walgreens/Rite-Aid will push further into care delivery, pressuring traditional providers to enhance access, change delivery models, and/ or forge partnerships to address this issue. At the same time, healthcare organizations will be required to enhance efforts to improve the patient experience far beyond measuring patient satisfaction -- the experience must be exceptional at every encounter -- from electronic to face-to-face visits.
  • Expansion and Redefinition of Health Systems. Health systems will continue to expand their physician enterprise, although many will be challenged by the financial strain of operating large employed models. Compensation redesign to move away from strictly productivity-driven models will be a priority. Expansion and merging of clinically integrated networks will continue, as a vehicle to align incentives in population health and value-based payment models, as well as minimize the need for "owning and controlling" the continuum. Expect ongoing development or expansion of provider-owned health plans as either a counterweight to the highly concentrated payer market or a means of taking global risk with payers or employers. Meanwhile, payers will extend their reach into the care delivery space, acquiring physician practices and clinical networks.

Follow the Money

  • Transparency and the Pocketbook. Pressures related to price and cost -- along with the adjacent need for transparency -- will drive more transformation. Consumer scrutiny will play an increasing role in this dynamic as high deductible plans force them to pay closer attention to price. As a result, lower-cost alternatives will have a competitive advantage. Because payer rate increases will be in the low single digits (if at all), any upside will require participation in some value-based payment, such as shared savings or pay-for-performance. In addition, thanks to the new budget bill, new provider-based clinics will not be reimbursed any more than physician practices. These pressures will continue to force more efficiencies across the continuum related to patient throughput and require operating cost reductions, moving from cost-per-unit to cost-per-episode basis.
  • The Variety Show: Value-Based Payments. Value-based initiatives may radically change referral patterns and the need for effective population health management. For an example, consider the 2015 introduction of the Comprehensive Care for Joint Replacement (CJR) model for Medicare -- with a roll-out in 2016. There is no way to predict how quickly new similar initiatives could strike your market. In addition, as employers introduce narrow networks to better control costs, some markets will experience acceleration of employer direct contracting. Further, the "foot in two canoes" analogy will have to change to recognize the proliferation of payment models beyond a strict definition of fee-for-service vs. fee-for-value. The cacophony of models ranging from strictly fee-for-service to pay-for-performance, care management/patient-centered medical home, bundled payment, shared savings/ACO, full or partial risk/capitation, and beyond will continue to add administrative, strategic, operational, and financial complexity to most organizations. Trying to make sense of this blend of payment structures from both a financial and care model perspective will cause more confusion before the fog clears.
  • Increased Focus on Post-Acute Care. The spotlight will shine on post-acute care, thanks to population health management models and bundled payment. We'll see the emergence of "preferred" networks of providers providing these services, as well as repurposing acute care facilities to meet the needs of post-acute patients. More transactions involving post-acute providers -- home health, skilled nursing, rehabilitation, hospice ­-- will create increased upheaval in this realm of healthcare.

Inside the Walls

  • Patient Volume: The Seesaw Effect. Changing dynamics in the healthcare system will have a give-and-take impact on patient volume. While new payment models will decrease acute hospital utilization, the continued expansion of Medicaid and the insured population through the public exchanges will push additional patients through the doors. Additional factors feeding demand across the spectrum include an aging population and the ongoing rise of obesity and chronic disease. Although urgent care, better care management and redesigned primary care models will eventually deflect patients from the emergency department, the ultimate impact of these initiatives will take a while, requiring these areas of hospital to operate at (or over) capacity.
  • The People Factor. Change cannot occur without effective leadership, leading to an increased demand for clinical leaders who can help drive transformation. Participation in population health management will increase competition, as well as cost, for these capabilities. At the same time, there will be leadership turnover as mergers/consolidations occur and as systems evolve from "holding company" to "operating company" models (and sometimes back again). Finally, be on the lookout for union activity, which may be sparked in some regions due to cost pressures and reductions in force.
  • The Makeover. As administrators "rationalize" clinical service lines, they will strive to reduce variation in quality and cost across health systems. Physician alignment with these moves will be crucial. Simultaneously, consolidations and mergers will spawn a new wave of facility planning to repurpose or enhance the efficiency of existing structures.
  • The Rise of IT and Turf Wars. One area where capital will continue to flow: IT tools and resources. The need for new structures for data governance within health systems will be driven by the proliferation of population health tools and analytical systems. And in a related development, watch for a tug-of-war between CIOs and business unit leaders. Turf battles may ensue on selection of systems and data management.
13:05 min
#33 - Mary Martin, MPA, FACHE, and Chief Operating Officer and Matthew Rougeux, MHA, Assistant Vice President, Patient Flow of Duke University Health System Cover Image
In this podcast, Jeff Terry is joined by Mary Martin, MPA, FACHE, and Chief Operating ...
Apr 8 · 13:05 min
In this podcast, Jeff Terry is joined by Mary Martin, MPA, FACHE, and Chief Operating Officer and Matthew Rougeux, MHA, ...
Apr 8 · 13:05 min
20:28 min
#32 - Matthew Metsker, Director, Mission Control at Franciscan Health Cover Image
In this episode Jeff Terry is joined by Matt Metsker, who is the Division Director of ...
Mar 24 · 20:28 min
In this episode Jeff Terry is joined by Matt Metsker, who is the Division Director of mission control at Virginia Mason ...
Mar 24 · 20:28 min
20:56 min
#31 - Dr. Matthias Merkel, Oregon Capacity System - The First Near-Time All-Hospital Bed Capacity System Cover Image
In this podcast, Jeff Terry, GE Healthcare welcomes Dr. Matthias Merkel of Oregon Health ...
Mar 3 · 20:56 min
In this podcast, Jeff Terry, GE Healthcare welcomes Dr. Matthias Merkel of Oregon Health and Science University. They ...
Mar 3 · 20:56 min
13:55 min
#30 - Dr. Jessica Schlicher, Physician on Duty Program at Franciscan Health Cover Image
In this podcast Jeff Terry, GE Healthcare, is joined by Dr. Jessica Schlicher, who is a ...
Mar 2 · 13:55 min
In this podcast Jeff Terry, GE Healthcare, is joined by Dr. Jessica Schlicher, who is a family medicine physician, and ...
Mar 2 · 13:55 min
12:20 min
#29 - Jen Naylor, Observation Pt Expediter at Tampa General Cover Image
In this podcast episode Jeff Terry, CEO Command Centers, GE Healthcare interviews Jen ...
Feb 8 · 12:20 min
In this podcast episode Jeff Terry, CEO Command Centers, GE Healthcare interviews Jen Naylor, Managing Director, GE ...
Feb 8 · 12:20 min
10:20 min
#28 - Andy Day, Real Time Forecasting with Machine Learning Cover Image
Andy Day and Jeff Terry provide examples for when AI is used in Forecasting. They cover ...
Feb 4 · 10:20 min
Andy Day and Jeff Terry provide examples for when AI is used in Forecasting. They cover examples including forecast ...
Feb 4 · 10:20 min
18:59 min
#27 - Ian Worden, MBA, MS, MA, HFMA, CPA, System Vice President and Chief Operating Officer, Virginia Mason Franciscan Health. Cover Image
Join us for a podcast conversation between Jeff Terry, GE Healthcare and Ian Worden, ...
Feb 1 · 18:59 min
Join us for a podcast conversation between Jeff Terry, GE Healthcare and Ian Worden, System Vice President and Chief ...
Feb 1 · 18:59 min
17:34 min
#26 - Mary Alice Ragsdale, MSN, MBA, RN VP Operations COO, St. Anthony Hospital COO, Mission Control & Virtual Health Services​ Cover Image
Interview with Mary Ragsdale, COO of Virginia Mason Franciscan Health, St. Anthony’s ...
Jan 27 · 17:34 min
Interview with Mary Ragsdale, COO of Virginia Mason Franciscan Health, St. Anthony’s Hospital and Mission Control. Mary ...
Jan 27 · 17:34 min
20:49 min
#25 - Jim Scheulen, CAO, Johns Hopkins Capacity Command Center Cover Image
On this podcast, Jeff is joined by Jim Scheulen, Chief Administrative Officer of Capacity ...
Jan 21 · 20:49 min
On this podcast, Jeff is joined by Jim Scheulen, Chief Administrative Officer of Capacity Management and Emergency ...
Jan 21 · 20:49 min
11:37 min
#24 - Gabriella Devine, Treatment Team Workload at OHSU Cover Image
Jeff Terry and Gabriella Devine discuss how OHSU Mission Control implemented Treatment ...
Jan 13 · 11:37 min
Jeff Terry and Gabriella Devine discuss how OHSU Mission Control implemented Treatment Team Workload Tile, a new app ...
Jan 13 · 11:37 min
21:16 min
#23 - Meg Rivera, Tamas Fixler, Patient Manager at AdventHealth Cover Image
This episode describes the use, configuration and deployment of Patient Manager Tile at ...
Dec 22 · 21:16 min
This episode describes the use, configuration and deployment of Patient Manager Tile at eight AdventHealth hospitals in ...
Dec 22 · 21:16 min
11:01 min
#22 - Patient Manager Tile - A Personal Command Center for Caregivers Cover Image
This is Patient Manager, the Tile that puts a command center at every caregiver’s ...
Oct 29 · 11:01 min
This is Patient Manager, the Tile that puts a command center at every caregiver’s fingertips. Patient Manager helps ...
Oct 29 · 11:01 min
04:39 min
#21 - Patient Manager Tile - Profiles and Search Cover Image
It's so important that users can work at speed in the Patient Manager Tile. This video ...
Oct 15 · 04:39 min
It's so important that users can work at speed in the Patient Manager Tile. This video shows a bit about profiles and ...
Oct 15 · 04:39 min
04:19 min
#20 - Patient Manager Tile with Downgrade Module Cover Image
Who is ready and eligible for downgrade to another level of care? All information at once.
Oct 5 · 04:19 min
Who is ready and eligible for downgrade to another level of care? All information at once.
Oct 5 · 04:19 min
05:52 min
#19 - Advanced Illness Tile Cover Image
The Real Time all-the-time Tile helps to manage the cohort of patients who have advanced ...
Sep 28 · 05:52 min
The Real Time all-the-time Tile helps to manage the cohort of patients who have advanced illness and may be planning ...
Sep 28 · 05:52 min
07:02 min
#18 - Patient Manager Tile Introduction Cover Image
The Patient Manager Tile a game changer for two reasons: it enables multidisciplinary ...
Jul 14 · 07:02 min
The Patient Manager Tile a game changer for two reasons: it enables multidisciplinary teams to problem solve in Real ...
Jul 14 · 07:02 min
06:25 min
#17 - Procedural Snapshot Tile Cover Image
The Procedural Snapshot Tile provides situational awareness as well as patient-level ...
Jul 9 · 06:25 min
The Procedural Snapshot Tile provides situational awareness as well as patient-level actionable alerts to help keep ...
Jul 9 · 06:25 min
06:34 min
#16 - Obstetrics and Neonatal Tile Cover Image
Following an evidence-based standard of care, the Obstetrics and Neonatal Tiles improve ...
Jul 7 · 06:34 min
Following an evidence-based standard of care, the Obstetrics and Neonatal Tiles improve the situational awareness for ...
Jul 7 · 06:34 min
06:14 min
#15 - Anesthesia Exceptions Tile Cover Image
The Anesthesia Exceptions Tile is used to coordinate and assist the flow of complex ...
Jun 30 · 06:14 min
The Anesthesia Exceptions Tile is used to coordinate and assist the flow of complex procedural cases across an array of ...
Jun 30 · 06:14 min
07:37 min
#14 - ED Expediter Tile Cover Image
The ED Expediter Tile is useful in advancing patients through emergency departments and ...
Jun 25 · 07:37 min
The ED Expediter Tile is useful in advancing patients through emergency departments and providing patient level alerts ...
Jun 25 · 07:37 min
06:02 min
#13 - Transfers Tile Cover Image
The Transfers Tile aggregates information on the individual patients queued to transfer ...
Jun 23 · 06:02 min
The Transfers Tile aggregates information on the individual patients queued to transfer into the system.
Jun 23 · 06:02 min
14:18 min
#12 - Discharge Barriers Tile Cover Image
The Discharge Barriers Tile outlines the key actions the care team can take to facilitate ...
Jun 18 · 14:18 min
The Discharge Barriers Tile outlines the key actions the care team can take to facilitate patients who are identified ...
Jun 18 · 14:18 min
10:31 min
#11 - Boarders Tile Cover Image
The Boarders Tile provides facility and system level visibility to all inbound pressure ...
Jun 16 · 10:31 min
The Boarders Tile provides facility and system level visibility to all inbound pressure on the system to take patients ...
Jun 16 · 10:31 min
14:43 min
#10 - Capacity Snapshot Tile Cover Image
The Capacity Snapshot Tile provides insight on bed capacity both in the moment and after ...
Jun 11 · 14:43 min
The Capacity Snapshot Tile provides insight on bed capacity both in the moment and after we process decisions.
Jun 11 · 14:43 min
07:36 min
#09 - Critical Resources Tile Cover Image
From State-level to Unit-level, Real Time awareness of available beds.
Jun 9 · 07:36 min
From State-level to Unit-level, Real Time awareness of available beds.
Jun 9 · 07:36 min
06:46 min
#08 - Infectious Disease Tile Cover Image
The Infectious Disease Tile was developed in response the COVID-19 pandemic. It provides ...
Jun 4 · 06:46 min
The Infectious Disease Tile was developed in response the COVID-19 pandemic. It provides visualization of patient load ...
Jun 4 · 06:46 min
05:08 min
#07 - Post Acute Placement Tile Cover Image
The Post Acute Placement Tile is used to reduce excess days and facilitate outplacement ...
Jun 2 · 05:08 min
The Post Acute Placement Tile is used to reduce excess days and facilitate outplacement of patients from an inpatient ...
Jun 2 · 05:08 min
06:49 min
#06 - Imaging Expediter Tile Cover Image
The Imaging Expediter Tile provides Real Time visibility to available capacity by ...
May 28 · 06:49 min
The Imaging Expediter Tile provides Real Time visibility to available capacity by modality and supports operational ...
May 28 · 06:49 min
04:20 min
#05 - Care Progression Tile Cover Image
The Care Progression Tile provides hospitals the ability to track patients throughout ...
May 26 · 04:20 min
The Care Progression Tile provides hospitals the ability to track patients throughout their inpatient stay.
May 26 · 04:20 min
05:15 min
#04 - Risk of Harm Tile Cover Image
The Risk of Harm Tile provides visibility to track variations in practice versus hospital ...
May 21 · 05:15 min
The Risk of Harm Tile provides visibility to track variations in practice versus hospital defined care plans.
May 21 · 05:15 min
05:51 min
#03 - Seniors Care Tile Cover Image
The Seniors Care Tile helps ensure geriatric inpatients outside the geriatric unit ...
May 19 · 05:51 min
The Seniors Care Tile helps ensure geriatric inpatients outside the geriatric unit receive best practice care in ...
May 19 · 05:51 min
08:46 min
#02 - Discharge Planning and Escalation Tile Cover Image
The Discharge Planning Tile empowers rounding across the system by providing a fast way ...
May 14 · 08:46 min
The Discharge Planning Tile empowers rounding across the system by providing a fast way to review patients, log ...
May 14 · 08:46 min
06:34 min
#01 - Clinical Deterioration Tile Cover Image
The Clinical Deterioration Tile brings real-time, all-the-time awareness of the status of ...
Aug 1 · 06:34 min
The Clinical Deterioration Tile brings real-time, all-the-time awareness of the status of the most critically ill ...
Aug 1 · 06:34 min