Ten years ago, health systems were overwhelmingly composed of hospitals with just a handful of non-acute locations. Those non-acute sites were primarily physicians' offices located on the same campus as the hospital. Today, healthcare organizations are focused on the entire continuum of care, supporting services such as in-home care and working with long-term care facilities to reduce hospital readmissions.
The breadth of the non-acute care offerings has grown dramatically as the amount revenue health systems derive from outpatient care has increased in recent years. In November, at Becker's 8th Annual CEO & CFO Roundtable in Chicago, McKesson hosted an Executive Leadership Forum to explore how non-acute care services are evolving and what healthcare organizations are doing to deliver more economical care across the continuum.
C-suite concerns and patient preferences are changing
Advisory Board recently interviewed 90 C-suite leaders from hospitals and health systems about their top five concerns. These included:
- Improving ambulatory access. Health systems are striving to deliver services at locations and during hours that are convenient for patients.
- Minimizing unwanted clinical variation. Work is under way to eliminate unnecessary tests and procedures that don't drive better outcomes.
- Strengthening primary care alignment. The goal is to help improve the connection between primary care and the patient experience. This means extending care from the hospital to the physician's office or vice versa.
- Redesigning health system services for population health. This incorporates initiatives related to the three areas above.
- Implementing innovative approaches to expense reduction. Healthcare systems are considering how to drive down costs while still improving the patient experience.
Part of the driving force behind these concerns are changing expectations among patients, which are largely driven by the emergence of technology that has allowed the consumer experience in other industries to become more convenient. Health system leaders must take these new expectations into consideration when creating care delivery models.
Greg Colizzi, vice president of marketing for health systems at McKesson, noted, "We have heard about the tidal wave of Boomers coming into the healthcare system. Although they are receiving the care, family members in their 40s and 50s are often the decision makers about what needs to be done and where older relatives will go. These younger family members have seen how technology has evolved."
In addition, many millennials in their 20s and 30s now have children who require care. These individuals have never known a world without the internet and came of age during the emergence of smartphones. Their expectations are very different: They want immediate care, total transparency about costs and convenience. The CEO of a state health information exchange on the East Coast said the largest health system in her market is focused on delivering patients "radical convenience" to make navigating the healthcare experience as effortless as possible.
New patient entry points must be evaluated across the care continuum
At integrated health systems, "top of the funnel" activities to attract patients are often economic loss leaders. They only work if the system provides other higher-acuity services to patients.
The senior vice president of an academic health system in the Southwest said telemedicine kiosks inside grocery stores are digital front doors for patients to engage with the organization. Many of these patients don't already have a primary care physician, so these kiosks provide a great opportunity to establish a more long-term relationship with new patients.
Academic medicine seems to have an advantage over other health systems due to vertical integration. They use this approach to deliver whole lines of service in a profitable way. Some major systems vertically integrate based on illness rather than medical practice. At organizations with specialty cardiac institutes, for example, everything related to cardiac care will be provided at that institute.
Acquiring physician practices isn't a panacea to serving patients outside the hospital setting
Many health systems focus solely on acquiring physician practices as the solution for providing care in non-acute settings. Yet, physician groups aren't always interested.
In some cases, physicians are turned off by the bureaucracy that comes with a large organization, such as online learning, credentialing and other requirements. If they don't comply with these requirements, their privileges are put on hold, which can contribute to burnout.
Joining a large health system can result in a loss of autonomy or a sense of complacency for physicians. One solution is to implement an effective governance system that provides independence, invests in the system's success and cultivates a positive culture.
Will consumerism result in retail healthcare services disintermediating traditional providers?
Patients who want quick, efficient care might be more likely to go to disrupters like CVS or Walmart than to a primary care physician's office. The CEO of a healthcare consulting firm in the South said the health systems that will be disintermediated are the organizations that aren't currently focused on engaging patients as consumers.
Content strategies are one way that health systems can position themselves as experts in their markets and attract patients. Organizations are starting to invest in marketing technology and host blogs as ways to build mindshare with patients. This is one more method to deepen relationships with patients, but it doesn't always come naturally to health systems.
The senior vice president of marketing at an academic medical center in the Midwest said the hub of healthcare is now in the palm of a person's hand and that providers need to figure out how to meet them there the same way leading technology companies do.
Health systems are exploring telemedicine to close care gaps and support patient convenience
Many health systems are using telemedicine in innovative ways. One pediatric health system based in the Southwest successfully deployed telemedicine at every school in a major metropolitan school district. Parents sign a waiver ahead of time, so children can get telemedicine consults from the school nurse's office. Prescriptions are sent to the local pharmacy, so parents can pick up medications after getting their child from school.
This same health system is working to develop a home health solution that incorporates gaming and artificial intelligence to enable kids to do physical therapy at home. The health system's chair of anesthesiology said the system enables kids to complete physical therapy at home in a that is fun and engaging. The program also sends data back to a clinician who can monitor the patient's progress.
In one rural area in the South, a health system is using tele-neurology to diagnose patients onsite, rather than sending them on a $60,000 helicopter ride to another hospital.
Although some physicians have become weary of new technologies, telemedicine may be more appealing. The COO of a health system on the East Coast convinced an older practitioner to try telehealth and he loved it. The technology improved his quality of life because he can practice in the way he prefers, and his patients love him more. Before deploying telemedicine, it can be helpful, however, to identify one or two physician champions.
Conclusion
Health systems can no longer expect to attract and retain patients by simply existing. These organizations must earn patients' business. This means taking a consumer-centric approach and redesigning the system from the outside in.
As one participant noted, "It's incumbent on healthcare organizations to understand the patient and to have a relationship so they can understand what patients want before they want it."