2016 in review: Helping hospitals and practices transition through five evolving opportunities

2016 was another transitional year for hospitals, health systems and practices. Health systems continued to consolidate, as well as migrate toward value-based care models and narrower networks. Hospital leaders faced uncertain budgets and a growing patient shift toward consumerist behaviors.

As we look forward, this year may seem relatively stable compared to the major undertakings coming in 2017.

Next year, the Medicare Access and CHIP Reauthorization Act (MACRA) takes effect, with its associated Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) programs. We will also have a new U.S. president bringing uncertainty to a landmark act that has dramatically shifted the healthcare industry over the past seven years.

Regardless of actions taken by a new administration and Congress, it's likely that patient demand for personalized care will continue to remain strong and that the industry will maintain its shift toward value-based payment models. Healthcare organizations of all shapes and sizes will need to continue working as efficiently as possible and adjust patient access strategies to accommodate more on-demand care.

As we consider what the new year brings, the following are five top challenges faced by healthcare leaders in 2016 and some insight into forward progress for a fruitful 2017:

1. Maximizing mergers & acquisitions
Merger and acquisition (M&A) activity among hospitals and health systems in the first half of 2016 was nearly identical to 2015. This year, 49 hospital deals were announced in the first six months compared to 48 deals announced in the first half of 2015.1

All of this M&A activity means that organizations need to align clinically and operationally to maximize all potential efficiencies. Integration requires a careful assessment of existing operations to look for hidden redundancies — especially at the outpatient clinic or practice level — that may hinder alignment. Merging EHR platforms is another monumental task, requiring clinical champions bridging clinical practice with workflow design. Blending cultures is also a difficult task during mergers. Bringing together different team approaches often requires an objective third-party advisor to evaluate differences and help find common ground.

2. Setting data-driven strategies
Establishing strong, consistent governance is important in any healthcare environment, but especially so in M&A situations. Overcoming cultural differences first, particularly among clinical leaders, should be an emphasis. Regardless of whether your organization is aligning M&A or not, achieving short and long-term organizational milestones requires a governance structure supported and driven by data.

Refining a governance structure means gathering not only the right people, but the right data to help determine short and long-term strategic goals, particularly as the complexity of payment models increase. Rather than sharing anecdotal evidence, leadership must start leveraging data — preferably from centralized repositories — to make key decisions such as how much risk to assume and how to allocate resources for value-based contracts. Leadership should also ensure the chief data or analytics officer is standardizing platforms, data delivery methods, request channels, and driving a culture of behavior change based on outcomes.

3. Halting leakage
Full waiting rooms and long waits for appointments were signs of a provider's success 20 years ago. However, in 2016, competitive markets and changing consumer expectations mean waiting is no longer tolerated. As out-of-pocket costs increase, patients will continue to behave more like consumers. For many patients, the ability to access care on-demand is more valuable than their provider relationships. They are willing to switch providers in favor of convenience.

To improve relationships, branding and patient retention, evaluate your organization's patient access strategy and find ways to decrease appointment wait times. Creating a patient access center that centralizes and streamlines the appointment scheduling process, for example, may be in a health system's best interest.

4. Tapping into telehealth
The adoption of telehealth services is another major trend that continues to grow. One recent survey indicates that 62 percent of patients from all age groups would be open to a web visit instead of an in-person appointment.2 Healthcare organizations that have not yet extended these services need to determine how to structure staffing and equip their facilities with the technology to support safe, efficient and secure telehealth encounters. Given that the same survey showed nearly half (46 percent) of patients would choose a provider who offered virtual care over one that did not, extending care through telehealth may also help improve retention.

5. Optimizing technology
While telehealth services may require hospitals to implement new technology, the opportunity also exists to optimize existing systems to deliver better or additional services. Many organizations in 2016 began evaluating their internal talent, tools, and best-of-breed technology for ways to gain efficiencies through standardization and other enhancements. Some found that advisors experienced with their mission-critical systems accelerated optimization by helping create goal-focused plans and off-loading work from internal IT staff. Although a time-consuming process, it is worth the time investment and may reveal net new ROI generating reward and practice growth.

As 2016 nears its end, the healthcare evolution is certain to continue as strong as ever. No matter what direction the industry goes, though, healthcare organizations will be well prepared if they maximize corporate relationships, make data-driven decisions, meet patient demands and take full advantage of invested technology.

About the authors:
Nancy Gagliano, M.D., is chief medical officer and Jaffer Traish is vice president of consulting services, both for Culbert Healthcare Solutions

1 http://www.levinassociates.com/pr1607hosp

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