From ambulatory surgery centers to the rise of in-home care, the shift in care settings proves healthcare is in a disruptive period.
One of the hot topics at the 2020 MGMA Financial Conference was the shift in care settings. From the explosive growth of ambulatory surgery centers to the rise of in-home care, it’s clear we are in a period of extreme disruption in the healthcare industry. One of the biggest questions providers seemed to have was how they, and their practices, were going to be affected. We sponsored an educational session and were proud to have Thomas Campanella provide his experienced insights to the conference attendees.
Tom started the Q&A discussion defining disruption in healthcare as external factors that impact the status quo. He emphasized that we, as a society, cannot continue down this path of escalating healthcare costs. Here are a few questions and topics of discussion from his presentation:
Is there a particular stakeholder who is especially vulnerable to this disruption?
Hospitals are especially vulnerable because they’ve historically played a major role in the status quo “sick system” of healthcare. Their vulnerability increases because of their high fixed costs (e.g., infrastructure, technology, personal) and with the decrease in inpatient admissions and the growth in outpatient and care in the home setting, they become especially vulnerable to local, regional and national competitors, especially in this new age of transparency.
What are the causes of disruption in healthcare?
Active purchasers of healthcare services
The transition from passive to active purchasers in the following areas:
• Traditional Medicare to Medicare Advantage
• Traditional Medicaid to Medicaid Managed Care/PACE
• Fully-insured employers to self-insured employers
• Aggressively evolving commercial insurance companies
• Consumers with minimal out-of-pocket to HSAs
All of these shifts in how services are paid are leading to more transparency and more informed consumers who are demanding value-based care.
National & state health policies and regulations
The Affordable Care Act had a tremendous effect on the healthcare industry. Medicare and Medicaid policies and regulations are always evolving and as consumers are demanding more transparency, state and federal policy initiatives are being brought forth.
An increased focus on removing the barriers of social determinants of health to improve access to care combined with the aging baby boomer population and longer life expectancy, are disrupting the status quo by creating a major shift in care settings.
Advances in technology, science and discovery
These advances have allowed care that was previously only provided in a hospital setting to be provided in home. Innovations in healthcare has focused investments on giving people better access to primary care through offerings like telehealth.
Health IT is poised for explosive growth in areas like analytics, artificial intelligence, and mobile apps because it helps physicians deliver high-quality healthcare at a lower cost.
Which physician specialty is best positioned to be successful as a result of the disruption in healthcare?
When you hear the following terms, which specialty has the greatest impact on them?
• Managing risk
• Value-based health
• Population health
• Patient engagement
• Patient education
• Community engagement
• Social determinants of health
Primary care physicians will have the opportunity to take center stage as the trend of value-based care continues to climb.
Tom concluded his talk with some encouraging words. “This is the best time to be in healthcare,” he stressed. “During times of disruption, the organizations and employees that can make a difference will be rewarded tenfold.”
If you’re interested in the full discussion, you can listen to this webinar recording.
Ken Magness is a focused healthcare professional with more than a decade of experience in helping clients understand the true value of automation in the revenue cycle management process. As the Strategic Initiatives Leader at Quadax, Ken and his team are passionate about connecting with healthcare providers to help them create and leverage the appropriate technology solutions to optimize the revenue cycle process and improve the experience of their patients and staff.