New healthcare policies are uncertain and meant to repeal the old ones, and may pose challenges for the health system.
FREMONT, CA: The health care policy of U.S. is still uncertain, but this health reform 2.0 could throw health systems a curveball. This uncertainty has forced leaders to evaluate their strategies, commitment to risk-bearing, delivery reform, and the rate of change for payment.
Following is the list of some common themes in health care leaders’ strategies:
1. Strategic growth:
Every healthcare organization wants to grow to specific heights. One can attain organic growth by increasing market share in primary service territory for key service lines and extending into geographically contiguous markets by planting footprints such as ambulatory care centers or primary care physician networks to capture referrals from competitors. Each health system should stay ahead of the curve to survive in the sector. One of the elements of growth is to collaborate with non-traditional health care actors, such as freestanding emergency rooms, retail clinics, and urgent care clinics.
2. Financial conformity:
Money or financial stability lays the foundation of health systems. It is rightly said that no money, no mission. All healthcare organizations must give priority to economic sustainability. The primary role of financial management in healthcare organizations is to manage money and risk in a way that helps to achieve the business goals of the organization. Finances are soured partly sometimes because of patient loads growth in Medicare and Medicaid. To stand firm in the competitive world and to provide efficient healthcare to all their patients’, healthcare should have organized financial management plans.
3. People and culture:
Every health system follows a value-based culture that drives the mission of the organization and guides the strategy and behavior. Some follow their religion-based values, and others adopt the principles of their religious sponsors. Other systems try to become the best workplace in the community. They are building respect, reliability, retention, and resilience among their employees.
4. Consumer engagement:
The healthcare system has recently started giving priority to consumer engagements. It is a call for a renewed partnership among the patients, caregivers, practitioners, and decision-makers in health and care management. The main aim of giving a leading role to patients is to make the process of care delivery more effective and efficient. Patient engagement may qualify the systemic relation that occurs between the demand and the supply of healthcare in different situations. A consumer has high-deductible plans and more responsibility to select methods and providers and to decide on patterns of care. Therefore, the health system is engaging consumers by establishing convenient locations, flexible hours of operation, and creative use of new consumer-facing technologies. Consumer opinions matter because they are a factor in financial success. Health systems have introduced several tools to optimize the consumer experience. Until now, one of the best determinants of consumer satisfaction is excellent service at a reasonable cost.
5. Physician interaction:
Physicians are involved in clinical and economic integration to improve care performance and improve provider loyalty. Almost all health organizations are undertaking some form of integration with doctors. There are three groups of physicians – employed multispecialty physicians, tightly engaged physicians, and community-based physicians. It matters on the interactions that they have with patients for the institution.
6. Value and affordability:
Consumers value low out-of-pocket costs by keeping doctors, convenience, and proximity. Health systems want to enhance value and affordability for various customers. For public purchasers, the criteria for value depend on patient satisfaction, cost-effectiveness, meaningful use of EHRs, and adherence to quality improvement principles. But it is different in the case of private purchasers value takes various forms like high quality and low unit costs on a fee-for-service, preferred provider organization basis, and innovative relationships with providers.
7. Population health:
Population health and risk-bearing strategy is another kind of approach in the policy. There are two types of health system leaders one who is eager to embrace risk and others those who don’t want to take the risk at all. Risk bearing poses a severe challenge for institutions, and no overall preferred risk-bearing strategies exist.
8. Clinical differentiation:
There are very few hospitals who are specialized in obesity, behavioral health issues, or care for the homeless. Most of the organizations are dealing with priorities like orthopedics, cancer, cardiovascular, and neurosurgery. Now many of the centers are concentrating on transplantation and precision medicine.
However, there are four critical uncertainties that recent changes in government policies and choices could influence:
1. Payment reform:
Continued payment reform is a matter of concern, bundled payment and value-based reimbursement will remain mostly untouched. Many CEOs expressed concern that commitment to bundled payment programs may not be as intense or urgent as it was earlier. Many CEO’s are waiting for clarification of policy.
2. Role of the states:
Change in policies will pose a challenge to health systems strategies plans and requires customization to adjust. Now CEO’s have to pay more attention to their policymakers who are playing are a significant role in determining strategies.
3. Affect financial sustainability:
Whatever may be the policy outcomes; it will harm the hospitals and will affect the economic dimensions of most of the strategic plans.
4. Consumer responsibility:
AHCA-type legislation will affect the consumers with pocket burdens. Consumers are seeking low budget services, but the high expenditure will create dissatisfaction among them.
Not all the CEO’s can stick to all the strategies exactly, but some of the CEO’s are ready to stay the course on the policies listed above. There is a significant agreement on these themes. Most CEOs have the opinion that the pursuit of high-value care, through strategic growth and clinical integration, with increased attention to population health, remains the most sensible strategy.