By Tom Clark, September 2016
“Getting There from Here”, held in Chicago on July 22-23, was a comprehensive ‘deep dive’ into the healthcare industry’s adaptation to revolutionary change to try to answer this question: How will healthcare sectors respond to unprecedented demands for transformation from selling health services to creating improved population health outcomes, more efficiently? Significant disruption to the status quo in healthcare delivery was described in detail by several healthcare industry luminaries.
The event was co-sponsored by the American Institute of Architects’ Academy of Architecture of Health and the American College of Healthcare Architects. The invitation-only annual conference includes 150 leaders among healthcare architects to prepare the profession to anticipate trends and better serve their health system clients.
1. Technology’s impact has only just begun.
George Morris, CIO of EMC Healthcare Solutions, and Linda MacCracken of Accenture, showed the impact of disruptive technologies. Although 71% of health consumers prefer in-person encounters with their providers today, this is evolving quickly with technology providing more consumer convenience with increased efficiency of care delivery. Last year, $4 billion in venture capital went to health-related technology development: On-line scheduling and self-check-in for appointments, on-line quality and cost comparison shopping for providers and services, and Uber-like monitoring of on-time service. Digital platforms will have a major increase over the next few years to expand the use of virtual doctor visits, telemedicine, and integration of our Fitbits with care providers to better monitor and manage our lifestyle, exercise and diet data.
2. Healthcare is moving away from hospital campuses and medical offices to improve convenience and access for patients while lowering costs.
Susan Dentzer, CEO of The Network for Excellence in Health Innovation, who presented “A Future of Healthcare without Walls”, showed how ProMedica in Ohio works through school-based nurses to improve students’ diet. Walmart, CVS, Safeway, and others now offer clinics in stores with hours that are convenient to their customers. Retail clinics are also popping up in neighborhoods. Presbyterian, Johns Hopkins, and Mt. Sinai are experimenting with home-based medical care for treatments that were formerly only provided in a hospital setting. Ascension Health, a 131-hospital system based in St. Louis, is partnering with Narayana Health, a Bangalore-based system to provide lower costs for patients by sending them to new hospitals in India and Cayman Islands, where labor costs are much lower, for major surgery. New to the market are businesses such as Uber Health which is experimenting with delivering nurses to workplaces for flu shots while Google, Apple and Facebook won’t be far behind the trend.
3. The real issue is that we must reduce the need for healthcare itself.
Both Morris and Dentzer both clearly identified the problems we must confront in improving population health while controlling costs:
- Socioeconomic and behavior factors (poverty, education, lifestyle) account for 70% of what affects health—this is what must be tackled by intervening ‘upstream’ to make a difference. Reimbursement is moving toward this strategy through managed care systems like Kaiser Permanente. Medicare, Medicaid and commercial health plans are also moving in this direction at a rapid pace.
- Donald Warne, MD, Chair, Dept. of Public Health and Professor, North Dakota State University, spoke on under-served American Indian communities. These communities have many of the same socioeconomic and lifestyle issues with their population health, exacerbated by poverty, racism, and isolation.
- Patients with complex conditions and poorly-managed chronic diseases comprise only 5% of the population, but they drive 50% of healthcare spending. We need to intensely manage these patients to help them live better lives and to reduce high-cost complications. However, many chronic diseases such as diabetes or heart disease can be prevented in the first place through a greater focus on community health.
4. Payment shifts will improve population health through Value Based Payment.
Ken Kizer, UC Davis Professor, noted that Value-Based Payment (VBP) is the only way to force providers to focus on outcomes rather than selling services. This year 30% of Medicare payments are VBP (Advantage program), expected to go to 50% by 2018. Commercial health plans are expected to be 75% VBP by 2020. Examples of Value-Based Payment healthcare delivery models include Patient-Centered Medical Homes HMOs and Accountable Care Organizations. Clinical integration is the tool to enable VBP to be implemented, bringing together all contributing organizations for a holistic health approach.
5. Care organizations will be transformed by integrated systems under value based and profit driven approaches.
David Johnson, CEO, 4Sight Health, on “Why the Healthcare Industry is Asset Heavy and Value Light”, clearly demonstrated how health systems selling services have no incentive to reduce costs and therefore cannot solve the value equation. He notes that currently “Supply creates its own demand”, which is unsustainable. For example, studies show that a market where there are more cardiac surgery centers tends to result in more cardiac surgeries being ordered for patients, often in lieu of other treatments or procedures that just as effective and less expensive. When the reimbursement is based on outcomes, providers quickly figure out how to deliver value and make a profit, as with most of our economy. This includes basic strategies:
- Consolidate complex services to the most efficient centers of concentration
- Distribute routine, standard healthcare services throughout the community for patient convenience
- Master chronic care management
6. Architects have an important role.
Kizer offers these emerging roles for architects:
- Facilitate connectivity between patients, health providers, and community organizations through facilities that are welcoming, open and flexible
- Create attractive destinations to promote healthful living and education
- Support multi-disciplined team care with workplaces that foster communication and teamwork
- Prevent provider burn-out with stress-reducing environments for caregivers
- Make the patient experience as pleasant and stress-free as possible