Around 10,000 Americans turn 65 years old every day, gaining access to Medicare benefits. The number of Medicare beneficiaries is expected to continue growing in the next five years, and health systems are making changes to keep up.
In 2020, around 73 million Baby Boomers were eligible for Medicare benefits, and by 2030 all Baby Boomers will be Medicare-eligible, according to the Census Bureau. Advances in medicine and healthy lifestyle mean people are living longer and demanding more from their care.
"In the next five years, the most significant disruptor to healthcare will be the capacity challenges associated with the 'silver tsunami' of baby boomers hitting the age of healthcare consumption," said Jonathan D. Washko, MBA, FACPE, NRP, AEMD, Assistant Vice President, CEMS Operations, Northwell Health; Assistant Professor, Department of Emergency Medicine, Pre-hospital and Disaster Medicine, Zucker School of Medicine at Hofstra, Northwell Health. "In this environment, coupled with lowering revenues, staffing shortages and higher expenses, healthcare is being forced from an abundance mindset to one of scarcity."
Mr. Washko sees the shift causing leaders to reconsider care delivery models. He predicts movement away from traditional operations to care delivery models based on intelligent and intentional design for better outcomes, lower costs and faster results.
"Solutions will require shifts to care in the home, new operational care models, and technology integration," said Mr. Washko. "These will allow the medicine being delivered to be effectively and efficiently optimized, vastly improving the productivity of existing and net new capacity."
The increasing capacity issues are top of mind for large and small health systems. Shelly Schorer, CFO of the California division of CommonSpirit Health, said the increased aging population will likely strain Medicare, inpatient care and healthcare capacity in some regions. But the health system isn't sitting back and waiting to see what happens.
"Anticipated regulatory challenges post-election will influence healthcare operations. The looming recession may alter how individuals access healthcare and treatment based on affordability," she said. "Despite these headwinds and challenges, at CommonSpirit we are prepared to pivot and meet the changing needs of our communities by accurately predicting and addressing their healthcare needs efficiently."
In addition to the increased volume of Medicare patients, health systems are preparing for the upcoming coverage changes. CMS aims to transition all eligible Medicare fee-for-service and Medicaid beneficiaries to plans with a value-based component to reign in the total cost of care.
"This represents the greatest market disruption on the near-horizon," said Ryan Nicholas, MD, chief quality officer at Mercy Medical Group in Folsom, Calif., part of CommonSpirit. "This has prompted Mercy Medical Group to move rapidly into value-based care with focus on total cost of care and network integrity."
Dr. Nichols said Mercy Medical Group's Medicare Advantage population increased 24% in the last year and they're projecting additional 28% growth in the next 12 months. The swift shift to value-based care and Medicare Advantage plans has prompted the medical group to think differently about site of service and invest in additional resources.
"Expanding ambulatory services and improving access for primary care services to reduce unnecessary ED utilization and shorten length of stay is our top priority," Dr. Nichols said.
Alon Weizer, MD, chief medical officer and senior vice president of Mount Sinai Medical Center in New York City, has also made changes to innovate and implement value-based care policies. He said the entire team is embracing innovative solutions to meet current and future patient needs, especially as Medicare rolls out TEAMS in the next few years, building upon the Comprehensive Joint Replacement model.
"This along with other risk and value based models will continue to drive integration of healthcare services and the value proposition through improving quality while reducing costs," said Dr. Weizer. "While we are investing heavily to be successful in these models through primary care expansion and technology that will help reduce the need for acute care services, we continue to focus our culture on providing safe and high quality care to our patients."