At the Becker's Hospital Review Annual Meeting in Chicago May 10, CEO Michael Tarwater of Charlotte, N.C.-based Carolinas HealthCare System summarized healthcare's new trajectory as providers place a new emphasis on value and population health.
"[Americans' take on healthcare] used to be 'We want the best, we want it now, we don't want to travel far and we don't want to know what it costs,'" Mr. Tarwater said. "Now, we want it to cost less. And we're going to need a lot more of it."
The U.S. healthcare system is the best in the world at rescuing patients, he said, but with our aging population, epidemics in obesity and other chronic diseases, and an unsustainable economic outlook for the rising cost of healthcare, American providers have a new imperative to better manage populations outside hospitals' four walls. He credited efforts from New York City Mayor Michael Bloomberg to improve New Yorkers' health, such as banning trans fats and smoking in restaurants.
Mr. Tarwater summarized the changes the healthcare industry will see in the advent of health reform.
1. Reimbursements. Private insurance payments won't escalate as they once did, in part because of larger insured populations and declining government funding rates to hospitals. There is promise in new models of care delivery in ambulatory and medical home settings, but payment issues remain in these contexts as well, Mr. Tarwater said.
2. Consumerism. Patients, especially the newly insured and those who have seen their benefits improve, are expected to be more engaged in their healthcare and to utilize more services than before. Health insurance exchanges and new health insurance regulations mean consumers are likely to be more informed than ever before about their care, coverage and overall health, especially because they will be paying more out of pocket for their care in some populations.
3. Demographics. Baby boomers still operate with a sense of entitlement, Mr. Tarwater said. Every day for the next 12 years, 10,000 people per day will turn 65 and become eligible for Medicare under the current eligibility criteria for the program. That has an enormous impact on the healthcare industry and the types of care delivery providers must supply in order to meet increased demand.
4. Communication. The "communication revolution" brought on by mobile and Web technology has enabled the public to research from tomes of easily accessible information that they can now use to drive their care decisions. Some of this information may be confusing, however, and it's important for physicians and medical professionals to help guide patients to good information sources. Patient experience also has a new and hugely significant medium through social media, such that their experiences with a provider, good or bad, can be broadcast to others who put a lot of trust in their opinion. That's important for providers to consider as they think about patient satisfaction. "Don't believe it?" he asked. "Ask Bank of America or Yahoo."
5. Telemedicine. With the new premium being placed on value-based healthcare reimbursement models, telemedicine shows a lot of promise to do a lot with a little, Mr. Tarwater said. It's gotten a slow start, largely because payors hadn't built incentives into this model, but it has the potential to be a game-changer.
Carolinas recently launched a pilot telemedicine program for seven of its hospitals that didn't have the resources to fully monitor their critical care centers. Now, using direct video and audio links, a physician can monitor patients remotely and give instructions to staff at patients' bedsides. The pilot virtual critical care center, named the EICU, can accommodate up to 500 beds at 30 hospitals, which would be the largest endeavor of its kind in the country.
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"[Americans' take on healthcare] used to be 'We want the best, we want it now, we don't want to travel far and we don't want to know what it costs,'" Mr. Tarwater said. "Now, we want it to cost less. And we're going to need a lot more of it."
The U.S. healthcare system is the best in the world at rescuing patients, he said, but with our aging population, epidemics in obesity and other chronic diseases, and an unsustainable economic outlook for the rising cost of healthcare, American providers have a new imperative to better manage populations outside hospitals' four walls. He credited efforts from New York City Mayor Michael Bloomberg to improve New Yorkers' health, such as banning trans fats and smoking in restaurants.
Mr. Tarwater summarized the changes the healthcare industry will see in the advent of health reform.
1. Reimbursements. Private insurance payments won't escalate as they once did, in part because of larger insured populations and declining government funding rates to hospitals. There is promise in new models of care delivery in ambulatory and medical home settings, but payment issues remain in these contexts as well, Mr. Tarwater said.
2. Consumerism. Patients, especially the newly insured and those who have seen their benefits improve, are expected to be more engaged in their healthcare and to utilize more services than before. Health insurance exchanges and new health insurance regulations mean consumers are likely to be more informed than ever before about their care, coverage and overall health, especially because they will be paying more out of pocket for their care in some populations.
3. Demographics. Baby boomers still operate with a sense of entitlement, Mr. Tarwater said. Every day for the next 12 years, 10,000 people per day will turn 65 and become eligible for Medicare under the current eligibility criteria for the program. That has an enormous impact on the healthcare industry and the types of care delivery providers must supply in order to meet increased demand.
4. Communication. The "communication revolution" brought on by mobile and Web technology has enabled the public to research from tomes of easily accessible information that they can now use to drive their care decisions. Some of this information may be confusing, however, and it's important for physicians and medical professionals to help guide patients to good information sources. Patient experience also has a new and hugely significant medium through social media, such that their experiences with a provider, good or bad, can be broadcast to others who put a lot of trust in their opinion. That's important for providers to consider as they think about patient satisfaction. "Don't believe it?" he asked. "Ask Bank of America or Yahoo."
5. Telemedicine. With the new premium being placed on value-based healthcare reimbursement models, telemedicine shows a lot of promise to do a lot with a little, Mr. Tarwater said. It's gotten a slow start, largely because payors hadn't built incentives into this model, but it has the potential to be a game-changer.
Carolinas recently launched a pilot telemedicine program for seven of its hospitals that didn't have the resources to fully monitor their critical care centers. Now, using direct video and audio links, a physician can monitor patients remotely and give instructions to staff at patients' bedsides. The pilot virtual critical care center, named the EICU, can accommodate up to 500 beds at 30 hospitals, which would be the largest endeavor of its kind in the country.
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