Accelerating Healthcare Transformation – The Incumbent Organizations are Center Stage

The disconnected nature of our healthcare system often lets patients down, contributes to physician burnout, and yields subpar outcomes to the point that getting quality, affordable, and timely care can sometimes feel impossible.

We need to change the way healthcare is delivered — making it seamless, comprehensive, and coordinated – so the onus is no longer on the patient or their caregivers to self-manage and advocate for care. The system itself must be set up to do that.

As we consider what is required, we should not dismiss the important role established healthcare organizations including health systems, payers, and physician organizations must play in the transformation.  

Why are incumbent organizations so central to the future of healthcare?

These organizations provide the vast bulk of care delivery across America. Even as newer disruptive companies emerge, it is hard to imagine a transformation scenario that does not include, in great measure, the existing incumbent institutions. Further, as disease burden continues to rise, our care delivery system while not yet optimized, remains necessary and crucial in many communities across the country.

Many incumbent systems serve as anchors in their communities, doing important advocacy, philanthropy, and health equity work. They typically take an all-population approach, serving every person in the community, something COVID made evident. They are also positioned to serve as aggregators and integrators of care across the continuum.

But the incumbents are facing headwinds never seen before and we, as an industry, need them to transform and remain relevant. Ultimately, the rate of transformation in healthcare will be directly proportional to the rate of transformation of these incumbent organizations. To remain relevant, the incumbents will need to get many things right. 

Lead boldly.

Incrementalism masquerading as transformation will not get the job done. To create healthcare that supports all patients, populations, providers, payers, and payment models, we must have new thinking. Incumbent organizations should play a big role in driving discussions within their communities and at the national level to define the future of a sustainable healthcare system based on value. We need leaders to support decisions and strategies that truly change care delivery, and that may be unpopular and deemed risky today but will, in time, be hailed as smart and visionary.

Prioritize integration, navigation, and coordination of care.

We often use the terms “healthcare system” or “systems of care”, yet rarely reflect on what it means to operate as a system. A system is a set of parts interacting to achieve a goal with inter-relationships and inter-dependencies between the parts. Both the parts and their interactions are critical to achieve the value of any system. In healthcare, we largely focus on the parts (e.g., hospitals, clinics, medical groups) rather than creating seamless integration and coordination between those parts. The result is fractured, inefficient, costly, and imprecise care.

The aggregation of healthcare organizations through mergers and acquisitions has created “systems of systems”, adding layers of complexity to an already complex ecosystem. To tackle the disconnectedness, we must double down on synergistic coordination, seamless data systems, team-based care, and new processes that support patients and physicians.

Transform in a multidimensional way.

Many healthcare organizations tend to define success too narrowly, even when tackling big, transformational goals. To transform towards value, we must look across multiple dimensions. As an example, while the financial dimension is an important one, simply changing physician compensation structures will not in and of themselves create lasting transformation. There are also clinical, cultural, and behavioral dimensions to consider. There are leadership, management, and human resources dimensions also. Thinking about transformation across multiple dimensions allows for a density of solutions necessary to create a tipping point for success.

Empower clinicians with patients at the center.

As value-based payment models become increasingly more prevalent, it is crucial to support clinicians and keep patients at the center of care. Supporting clinicians means providing them with the necessary resources to enable them to make informed decisions about patient care. Keeping patients at the center of care means involving them in care processes, considering their preferences and values, and providing them with coordinated, comprehensive care. By prioritizing clinician support and patient-centered care, we will improve success in value-based care models within the incumbent organizations, while also providing high-quality care to patients.

Transforming healthcare is a journey, with deeply personal aspects. By working with incumbent organizations to transform to a value-based system, we’ll transform care delivery within our communities. And we’ll change the experience for ourselves and our loved ones too.

Dr. Matt Hanley is the Chief Market Executive at Navvis, a leading population health company. Dr. Hanley leads efforts to accelerate healthcare transformation and the transition to value-based care in partnership with health systems, physician organizations, and health plans. A healthcare visionary and executive, Hanley is board-certified in emergency medicine. Prior to Navvis, Dr. Hanley held key leadership roles at SSM Health and Atrium Health.

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