Moving forward, together: The next 5 years in healthcare

The days of siloed operations in healthcare are long over, be it related to data storage, hospital-physician relationships or population health initiatives. One of the emerging trends in healthcare delivery is the unification of stakeholders and relevant parties to improve the quality of services provided to U.S. healthcare consumers.

At a keynote panel at the Becker's Hospital Review 4th Annual CEO Roundtable + CFO/CIO Roundtable in Chicago, healthcare leaders and executives discussed the next five years in healthcare and what the industry might look like in 2020. A key theme that repeatedly emerged in the panel was how healthcare organizations — providers, vendors or others — are realizing and harnessing the power of joining resources in old and new ways.

Consolidation, both traditionally and innovatively
Traditional mergers and acquisitions are trending upwards, as healthcare organizations align for any number of reasons.

Lynn Nicholas, president and CEO of the Massachusetts Hospital Association, sits in a unique position in that instead of overseeing one hospital or health system, she has an overall look of healthcare throughout Massachusetts. She said most of what is happening is hardwired in terms of classic mergers.

"I predict that within about five years, we will have probably five major health systems in the Commonwealth, and that's it," Ms. Nicholas said. There are currently 15 major hospital systems in the state, according to 2013 data from the Blue Cross Blue Shield of Massachusetts Foundation.

However, alongside classic mergers is a notable increase in nontraditional alignments between organizations as well.

Barry Arbuckle, PhD, president and CEO of Fountain Valley, Calif.-based MemorialCare Health System, said MemorialCare has seen an increase in transactions spanning the continuum of care. Instead of a conventional acquisition of an acute care hospital, Dr. Arbuckle said his system increasingly discusses taking a minority interest in hospitals. "What they're looking for is to piggy back on our system infrastructure because we've systemized everything," he said. "These freestanding hospitals whose longevity is questionable in most cases are looking not to become part of our system."

Additionally, Dr. Arbuckle said such an arrangement can be beneficial for health systems, as their system infrastructure is a business line. "I can spread overhead. I can pick up a little margin. If I have a piece of their balance sheet and align our incentives, when I bring them value, I benefit as well," he said.

Anthony Slonim, MD, DrPH, president and CEO of Reno, Nev.-based Renown Health, said acute care hospitals, especially rural ones, sometimes just need support from larger institutions in making decisions.

Renown Health serves an area covering 100,000 square miles. "It gets pretty desolate out there," Dr. Slonim said. "Those 30 or so rural hospitals are looking for partners, and I don't mean true asset partners in terms of the way they deliver care. It's really tough to run a rural hospital… Sometimes they just need a thought partner as they make this transition in figuring out what's going to be [best] for their community."

Partnerships in population health
The health of communities is the new focus for healthcare providers, and keeping people out of the hospital is the new goal. Even more than that, Dr. Arbuckle said hospitals' financial viability depends on this new approach to care.

"Begin moving away from a reliance on acute care revenue. If you find yourself in five years more than 75 percent, maybe 60 percent, reliant on acute care, you're on a path to oblivion," Dr. Arbuckle said.

Instead, health systems should geographically diversify their revenue streams. With a focus on population health, this includes developing a new delivery infrastructure and hiring people with backgrounds in public health. In fact, Dr. Slonim said his doctorate in public health is probably worth more to him than his medical degree, as the industry's focus shifts to population health and epidemiology.

Population health heavily relies on data, as each population's needs and characteristics are unique. What's more, in cities with multiple hospitals or provider systems, their patient populations likely overlap. As such, sharing patient population data with nearby organizations that may share patients or treat people with similar needs is a way to capitalize on resources.

Dr. Arbuckle discussed a joint venture between MemorialCare and Los Angeles-based Cedars-Sinai Health System that does just this. The health systems are in the fourth year of a five-year data system project that brings together all the data streams in both health systems.

"Together we have millions of records," Dr. Arbuckle said. "For me the excitement there is the data that's going to come out of it. Between the population at Cedars-Sinai and my folks at Long Beach, we meet in one of the most diverse cities in the U.S. What a wild variation of patients we now have in one aggregated data set, and we can now do really serious population health analysis."

Collaboration for a better use of data
As Dr. Arbuckle's story illustrates, data integration is critical for population health programs to be successful.

Daniel Barchi, CIO of Yale New Haven Health, shared a story at the Yale New Haven (Conn.) School of Medicine following the implementation of the system's EHR. "A magical thing happened once we flipped the switch of our EMR: Nobody could get any data."

He said different departments didn't know how to access their data because each department stored their data in separate locations. Following the go-live which integrated all the departments, the different teams were unsure of how to access their specific data sets.

The EMR go-live presented an opportunity for Yale New Haven to integrate its data and unite all the key players. "We needed to reinstate the ways we were [accessing] our data," Mr. Barchi said.

In a project Mr. Barchi said is more sociologic, political and psychological than technological, the system gathered all its data analytics experts for a weekly lunch. For approximately 90 minutes every Friday, the data analysts would discuss their data needs and who contacted who for certain types of data. "By the end of 18 months of this, all the people who clung so tightly to their data for so long realized [they're] all doing the same stuff. We should do it together," he said.

Final thoughts on togetherness
At the very beginning of the panel discussion, Rhoda Weiss, PhD, national healthcare consultant, asked the panelists what keeps them up at night. Mr. Barchi responded, in the context of data security issues, "There's everything that could go wrong. If I had to think of anything that's a concern of mine longer term, it's that we're figuring this out all on our own. How many hundreds of large systems there are, and every one of them is coming up with their own data policies. Although we're bright, intelligent people, the fact that we're making this up individually doesn't seem like the best way to go about it in the long term."

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