Healthcare is facing an unprecedented time of upheaval. With so many changes reshaping the field, it can be difficult to predict the biggest issues lurking just around the corner.
Bill DeMarco, MA, CMC, is president and founder of Pendulum HealthCare Development, a company that creates and implements physician-driven networks, Accountable care organizations, clinically integrated networks and physician-sponsored health plans. Mr. DeMarco offers a peek at four of the most important trends on the cusp of impacting the healthcare industry.
1. Consolidation. Consolidation in healthcare — on all levels — is a major trend, but the full effect of these sweeping mergers and acquisitions has yet to be realized. "I see lots of consolidations of hospitals/health systems, which is actually a trap building a bigger cost center to reduce costs," he says. "The smart money is on the systems that unify their payer contracts not bricks and mortar. This offers the same result and a better ROI."
2. Narrow networks and litigation. Narrow networks continue to build steam, despite provider uncertainty. As exclusion grows, so does the possibility of litigation. "The narrow network lawsuits are just beginning and as plans get added into exchanges this year there will be lots of physicians locked out for price and quality," says Mr. DeMarco. "Practice management systems will need to show real performance data and new specialty networks will form to avoid being cut from the squad or replaced by hospital employed physicians."
3. ACO partnerships. "Of these 626 ACOs, 329 have government contracts, 210 have commercial contracts and 74 have both government and commercial contracts," he says. Going forward, many more will rise and fall. But, like all other maturing sectors of healthcare, the pendulum will swing from rapid growth to partnership formation. "ACOs will start acquiring one another and health systems will stop acquiring physicians and focus more on joint ventures they can re-contract or blow up whenever they need to."
4. Community health plans. Community health plans allow employers to directly connect with primary care providers and promote employee wellness. "There will be a resurgence of interest in community-based health plans, but the ones who survive will be regional in coverage and share control and overhead with a management services organization-like structure they own," he says. "The smart money is on those who link community hospitals and lots of primary care with university hospitals and then a CCRC."
Overall the changes will be massive and early adopters will have the most options while those who wait until it is safe will see their inpatient revenue fall, be locked out of good contracts and loose valuable physician and patient relationships. Accountable care is a differentiator in a marketplace that is becoming commoditized.