Futurescan
Healthcare Trends and Implications
2013–2018
Futurescan
Co-sponsored by:
• Society for Healthcare Strategy and Market
Development of the American Hospital Association
• American College of Healthcare Executives
• With Support From VHA Inc.
2
American College of Healthcare Executives
• Professional society of more than 40,000 healthcare
executives—Leaders Who Care
• Board certification in healthcare management as ACHE
Fellows (FACHE®)
• Foremost continuing educator for the field
• Leading healthcare management publications:
– Health Administration Press books
– Journal of Healthcare Management, Frontiers of Health
Services Management and Healthcare Executive
• Fulfilling our vision to be the premier professional society for
healthcare executives dedicated to improving healthcare
delivery
3
Society for Healthcare Strategy and Market
Development
• Personal membership group of the American Hospital
Association
• Serves more than 4,000 healthcare planning, marketing
and public relations/communications professionals
• Committed to helping members meet the future with
more knowledge and opportunity as their organizations
work to improve health status and quality of life in their
communities
4
Futurescan 2013–2018
• Insurer-Provider Integration: Insurers and Providers
Integrating Toward a Common Cause
• Value-Based Payment: The Calculated Risk of Payment
Reform
• Nursing: Transitions in Nursing Present Challenges and
Opportunities for Hospitals
• Palliative Care: Better Care for the Seriously Ill, Better
Value for the Healthcare System
Please note that the views expressed by the conference speakers do not necessarily reflect the
views of the Center for Healthcare Governance and the American Hospital Association.
5
Futurescan 2013–2018
• Information Technology: Health Information
Exchanges—Helping Hospitals Harness the Power of IT
• Mobile Healthcare: mHealth and the Future of
Healthcare
• Governance: A Transforming Healthcare Sector
Requires Boards to Step Up Their Game
• Striving for Excellence: The Future of Baldrige-Based
Performance Excellence
Please note that the views expressed by the conference speakers do not necessarily reflect the
views of the Center for Healthcare Governance and the American Hospital Association.
6
“The hospital—altogether the most
complex human organization ever
devised …”
Peter Drucker
Drucker, Peter F. (2002). Managing in the Next Society. New York, New York: St. Martin’s Griffin.
7
Actions We Should
Start, Stop and/or Continue
We should start.....
We should continue.....
We should stop.....
8
FutureScanning
Trend
Implications of this Trend?
Implications of this Trend?
Implications of this Trend?
Implications of this Trend?
Implications of this Trend?
At least 1 positive, and 1 negative.
Implications of this Trend?
9
Insurer-Provider Integration
Insurers and Providers Integrating
Toward a Common Cause
Scott P. Serota
10
Insurer-Provider Integration: Aligned
Incentives Mean Better Results
Integration of providers and insurers can
align incentives to better control costs.
• Learn from past missteps but recognize that today’s
environment has changed.
• Closely monitor the development of new federal and
other aligned payment strategies.
• Be aware that physicians may need assistance in
adjusting to new payment mechanisms.
11
Insurer-Provider Integration:
Collaborative Strategies
Hospitals and insurance companies will form joint
ventures to create new insurance products.
• Take steps to learn more about the insurance industry
culture, values and operations.
• Design products and strategies that serve consumers
who are demanding more involvement in their health
and medical care.
• Consider products that will target high-end consumers.
• Prepare IT systems to handle more sophisticated
analytics to monitor new strategies.
12
Insurer-Provider Integration:
Aligned Practice
Health plans will share risk with providers
through patient-centered medical homes, ACOs
and other new organizational structures.
• Build capacity in primary care.
• Monitor the progress of the organizations participating
in the CMS ACO programs.
• Educate staff and board members about the benefits
and risks of aligned practices.
• Build needed IT capacity and sophistication.
13
Insurer-Provider Integration:
Paying for Value not Volume
New reimbursement strategies will better
align financial incentives between providers
and insurers.
• Make sure data systems can effectively track quality
indicators and not just volume.
• Make sure data systems can track patients through
the entire care experience and not just in the hospital.
• Keep up to date with new payment strategies being
piloted by private insurers.
• Be cognizant that consumers will be demanding
greater value.
14
Insurer-Provider Integration: Public and
Regulatory Pressures
The passage of the ACA has cast the public
spotlight on many healthcare issues that
were previously ignored.
• Be prepared to assume a broader and more visible
community role.
• Focus more attention on population health and
community benefit.
• Tighten cost structures as the shifting of costs from
public to private sources will no longer be tenable.
• Be prepared to be transparent in terms of costs and
quality.
15
Value-Based Payment
The Calculated Risk of
Payment Reform
Bruce S. Pyenson
16
Value-Based Payment: Insurers Are
Poised for Change
Forced to abandon many traditional practices (e.g.,
lifetime limits, exclusion of pre-existing conditions),
insurers will look for new models for handling risk.
• Closely monitor the insurance industry in your area so
you will be able to respond quickly to changes.
• Consider joint ventures with insurers to create new
products.
• Design programs aimed at health promotion.
• Design programs that will reduce 30-day
readmissions.
17
Value-Based Payment: Payments Will
Be Less
Inpatient admissions will decrease over the
next several years.
• Focus on outcomes, quality and access rather than
volume.
• Expect a decrease in elective procedures as cost
sharing increases.
• Develop centers of excellence to capture the more
limited volume of elective procedures.
18
Value-Based Payment: A Spectrum of
Potential Responses
Payment reform will present opportunities that
involve risk and will require new ways of evaluating
potential outcomes.
• Think beyond the status quo when evaluating new
opportunities. The status quo may be disappearing.
• Use scenario planning to evaluate opportunities
against current and future opportunities.
• Plan for costs associated with learning new strategies
and ways of operating.
19
Value-Based Payment: Focus on
Outcomes
The majority of new payor contracts will be
performance based.
• Create care management teams that will follow
patients after discharge.
• Work with the medical staff to help them transition to
the new reimbursement environment.
• Consider participating in bundled payment programs.
• Closely monitor ACO developments in your area.
20
Value-Based Payment:
Human Capital Needs
Hospitals will need a depth of financial, medical
and administrative talent to succeed at payment
reform.
• Consider hiring executive-level staff with experience
in the insurance industry.
• Develop medical leaders who can relate
administrative excellence to clinical outcomes.
• Develop finance staff who understand risk
assessment and management.
• Look for leaders with experience in alternative forms
of reimbursement.
21
Nursing:
Transitions in Nursing Present
Challenges and Opportunities
for Hospitals
John W. Rowe, MD
22
Nursing: Expanding Scope of Practice
Many states will pass legislation allowing
advanced practice nurses to practice
independently.
• Carefully monitor the situation in your state and provide
appropriate advocacy.
• Investigate ways that advanced practice nurses can
collaborate with primary care physicians in your facility.
• Look for ways that advanced practice nurses can extend
your primary care capabilities.
• Work with medical and nursing leadership to allow nurses
to practice to the full extent of their training as the law
permits.
23
Nursing: More BSNs
Hospitals will hire more BSN-prepared nurses
who are better equipped to handle the
increasingly complex care setting.
• Work with local nursing schools to develop programs
to create pathways for practicing nurses to earn the
BSN degree while employed.
• Work with local nursing schools to develop simulation
labs and clinical experiences to expand the number of
training slots.
• Provide tuition assistance for employed nurses
earning a BSN degree.
24
Nursing: Magnet Status as a Sign of
Excellence
More hospitals will pursue Magnet status as a
means of gaining market advantage.
• Assess the benefits and costs of obtaining Magnet
status at your institution.
• Work with local BSN programs to recruit their
graduates, as Magnet status emphasizes this degree.
• Work with local colleges to provide pathways for
current nurses to pursue a BSN degree while
employed.
• Use the Magnet application as a means of improving
and promoting excellent nursing care.
25
Nursing: Nurse Residency Programs
Residency programs will proliferate in order
to better prepare the nursing workforce and
improve retention.
• Work with local nursing schools to create residency
programs in your facility.
• Use residency programs as a means of recruiting and
retaining well-qualified nurses.
• Use residency programs as a way of engaging and
stimulating nursing staff.
26
Nursing: Clinical Nurse Leaders
Clinical nurse leaders will be used to direct care
teams that promote evidence-based medicine
and quality care.
• Provide mentoring and leadership opportunities for nurses
with graduate-level training.
• Provide financial incentives or scholarships for promising
BSN-level nurses to pursue advanced degrees.
• Be sure your organization’s CNO is a full participant on the
leadership team.
• Consider adding an individual with a graduate degree in
nursing to your governing board.
27
Palliative Care:
Better Care for the Seriously Ill,
Better Value for the
Healthcare System
Diane E. Meier, MD
28
Palliative Care: A Standard Service
Line
Palliative care will be a regular feature of
integrated care and will be offered by virtually all
large organizations.
• Train your workforce in palliative care competencies.
• Develop palliative care interdisciplinary teams that can
coordinate care for seriously ill patients.
• Make sure the individuals responsible for innovation or
development add palliative care to their priorities.
• Seek Joint Commission certification for your palliative care
program in anticipation of a likely future accreditation
requirement.
29
Palliative Care: Avoiding Unwanted and
Costly Care
Palliative care programs will reduce costs by
decreasing ED visits and re-hospitalizations, and by
helping patients and families make more informed
care decisions.
• Make sure staff throughout the facility are aware of the palliative
care program.
• Recruit physicians who have subspecialty certification in hospice
and palliative medicine.
• Recruit non-physician staff who have specialized training and
expertise in palliative care techniques.
• Make sure the palliative care team comprises the appropriate
mix of caregivers.
30
Palliative Care: Better Care
By providing a coordinated approach, palliative
care programs improve the quality of care given
to seriously ill patients.
• Educate the community on the value of palliative care.
• Emphasize the support patients receive in navigating the
healthcare system.
• Develop and monitor quality indicators that reflect the
value of palliative care programs.
• Develop an organizational structure that allows for the
identification of palliative care candidates throughout the
organization.
31
Palliative Care: New Skills for
Physicians
Medical school and residency training will
require that physicians demonstrate competency
in palliative care skills.
• Provide continuing education for current staff
physicians in palliative care skills and encourage
subspecialty certification.
• Make sure staff physicians understand the value
palliative care can have for patients and families.
• Recruit physicians who are certified in hospice and
palliative care.
32
Palliative Care: It Takes the Community
In the long term, palliative care programs will
be integrated with community resources
outside the acute-care setting.
• Conduct a palliative care systems capacity
assessment in concert with community agencies.
• Develop relationships with local nursing homes, home
health services, assisted living facilities and other
community agencies.
• Develop management expertise that can effectively
share resources with community partners.
33
Information Technology:
Health Information Exchanges—
Helping Hospitals Harness
the Power of IT
Carla Smith
John P. Hoyt, FACHE
Pamela Matthews, RN
34
Information Technology: More
Cost-Effective Care and Payment
Hospitals’ adoption of electronic data
interchange (EDI) standards will accelerate in
order to reduce costs.
• Make sure the IT department can capture data from a
variety of software applications.
• Make sure the strategic plan addresses EDI and its
relationship to other initiatives.
• Design systems for addressing standards that
streamline processes.
• Use funds saved from clearinghouse fees for other
strategic IT initiatives.
35
Information Technology: A Key Tool for
Delivering Care
Electronic data interchange will be a key tool in
the delivery of care and in payment models.
• Plan carefully in designing and implementing systems
for EDI.
• Tie EDI to the organization’s strategic plan.
• Understand that data is a strategic lever for
operational efficiency and providing quality care.
• Be prepared to invest the necessary resources in
these systems.
36
Information Technology: “Homegrown”
Health Information Exchanges
Many hospitals will develop their own health
information networks in order to most effectively
manage costs and coordinate care.
•
•
•
Carefully evaluate your organization’s capabilities for
designing and operating its own HIE.
Build and invest for the long term, both in terms of
intelligence systems and staff competence.
Continue to monitor public and other private HIE
efforts in the community.
37
Information Technology: Community and
State Health Information Exchanges
Local communities or states will pool their resources
to construct health information exchanges that serve
a variety of organizations and settings.
• Closely monitor all public and private HIE efforts in
your community.
• Be cognizant of the various funding sources (e.g.,
grants to participant fees) for community HIEs.
• Be prepared to devote resources to an HIE.
• Develop an IT strategic plan that addresses local,
state, federal and payor-based initiatives for the
integration of clinical and business data.
38
Information Technology: Integrating
Health Resources
Health networks and information technology will
be the mechanism to integrate care across
multiple providers and enable population health
management.
•
•
•
Carefully evaluate your organization’s current and
future IT capabilities.
Hire clinical staff with expertise in data analytics.
Build relationships and partnerships that will be key
to your organization’s future success.
39
Mobile Healthcare:
mHealth and the Future of Healthcare
Christopher L. Wasden, EdD
40
Mobile Healthcare: Inevitable and
Transformative
Mobile technology will have widespread
applications in healthcare and will transform how
care is delivered.
• Make sure you have a viable strategy for mHealth
and its applications.
• Hire staff who are expert in mobile applications.
• Focus on interoperability between applications.
• Monitor other industries in order to anticipate new
demands by patients and other stakeholders of
mHealth.
• Make free Wi-Fi available throughout your facility.
41
Mobile Healthcare: Preventing
Readmissions
Remote monitoring systems will reduce
readmissions and ED use by patients with
chronic conditions.
• Consider providing low-cost or free home monitoring
services, as they can reduce overall costs.
• Use social media to provide support and assistance
to discharged patients.
• Closely monitor the medical device industry for new
applications in mHealth.
42
Mobile Healthcare: New Dimensions in
Patient-Physician Relations
Mobile technology will transform and expand the
traditional patient-physician relationship.
• Encourage physicians to communicate with patients
via email or text.
• Help physicians create new payment models for
mobile communications.
• Take appropriate steps to safeguard the security and
confidentiality of patient information.
• Make sure physicians have easy access to wireless
technology throughout your facility.
43
Mobile Healthcare: A More Engaged
Patient and Consumer
Patients will use mobile technology to monitor
their health and engage in healthy behaviors.
• Provide access to health apps with demonstrated
effectiveness through your website and promotional
materials.
• Design apps that provide information on healthy
eating and activities that promote health.
• Provide virtual health coaching services for
individuals or groups using mobile technology.
44
Mobile Healthcare: On Demand
Medicine and Healthcare
Patients will expect to schedule appointments on
mobile devices and to access test results as soon as
they are entered into their EHR.
•
•
•
•
Develop online scheduling protocols.
Develop secure channels and the necessary security
safeguards so patients have the ability to access
their EHRs remotely.
Help physicians develop procedures for sharing
patient data via mobile devices.
Acknowledge that healthcare will become
increasingly transparent.
45
Governance:
A Transforming Healthcare Sector
Requires Boards to Step Up
Their Game
Barry S. Bader
46
Governance: Leaner, More Efficient
Structures
Economic pressures for greater operational
efficiency will lead systems to consolidate or
eliminate local subsidiary boards.
• Examine the various types of board models to determine
which best meets your needs: professional, clinical expertise
or community based.
• Choose system board members based on desired skills and
the ability to pursue the interests of the entire system.
• Find new roles for former members of local boards so their
commitment and dedication is acknowledged and extended.
• Look for new ways to connect local units or facilities with the
communities they serve.
47
Governance: Higher Expectations for
Board Performance
As hospitals transform into care systems, boards
will need to evolve to meet the more complex needs
of the future.
• Select board members based on the skills and expertise
they bring as well as their ability to be strategic and
visionary.
• Set clear standards for board members’ attendance and
participation.
• Provide the necessary continuing education to keep board
members up to date on the rapid changes in the field.
• Make sure the board engages in a regular and rigorous
self-assessment process.
48
Governance: New Ways of Operating
Boards will need to adopt leadership strategies
that will enable them to transform their
organizations in an uncertain environment.
• Employ scenario-based strategic planning to address
“what if” questions.
• Make decisions based on inquiry and empirical data
rather than advocacy.
• Use dashboards and scorecards so boards can easily
monitor performance and identify variance.
• Focus on both short-term performance and longer-term
growth and evolution.
• Use risk management techniques to assess various types
of risk—reputational to financial.
49
Governance: A Focus on Quality
Boards will elevate quality from an oversight
function to a strategic priority that is integral to
system redesign and cultural transformation.
• Devote at least 20% of meeting time to quality issues.
• Include quality objectives in the CEO’s performance
evaluation.
• Work with medical staff to set quality and patient
safety goals.
• Include at least one independent quality expert as a
board member.
50
Governance: More Public
Accountability
Boards will devote more attention to their public
accountability for community benefit,
stewardship of resources and ethical conduct.
• Advocate for clear and consistent regulatory
requirements for tax-exempt status.
• Educate board members on how to use community
health assessments in strategic planning.
• Structure boards to give high priority to community
benefit and community health improvement initiatives.
• Build capacity for collaboration with appropriate
community partners.
51
Governance: Changing Roles for
Physician Board Members
As physician-hospital integration progresses,
physician board members will face conflicts of
interests as employees or competitors.
• Use the same competency-based criteria to select
physician board members.
• Look for new ways to involve key physicians in the
operation and direction of the hospital.
• Consider developing a clinical leadership
infrastructure that can be used to channel the voice of
physicians to the governing board.
52
Striving for Excellence:
The Future of Baldrige-Based
Performance Excellence
Harry S. Hertz, PhD, HFACHE
53
Striving for Excellence: The Baldrige
National Quality Award
• Established in 1988, Baldrige is the only U.S.
public-private partnership dedicated to
improving U.S. organizations so they can
compete globally.
• The Baldrige Award program broadened in
1998 to include healthcare and education
organizations.
• There have been 16 winners in the healthcare
category since the program’s inception.
54
Baldrige Healthcare Criteria
Framework: A Systems Perspective
Source: Baldrige Performance Excellence Program
55
Striving for Excellence: Baldrige Goals
Healthcare organizations’ interest in the
Baldrige Award will remain high.
• Benchmark your organization’s capabilities and
performance against the Baldrige criteria.
• Use the criteria to achieve the type of organizational
excellence necessary for success in the current
environment.
• Participate in state-level quality award programs.
• Encourage key staff to participate in Baldrige or local
quality programs as examiners.
56
Striving for Excellence:
A Holistic Approach
Healthcare organizations will use a holistic
approach to achieve organizational excellence
and efficiency.
• Use the seven Baldrige criteria as an internal assessment
tool.
• Determine if measurements are in place to monitor
performance in all key areas.
• Make sure your information system can effectively
integrate clinical and nonclinical functions when assessing
performance.
• Use both historical and external measures to benchmark
organizational performance.
57
Striving for Excellence:
Integrated Strategies
Healthcare organizations will adopt integrated
strategies for safety, quality and cost reduction.
• Make the application of quality tools a standard part
of operations.
• Use the Baldrige framework as a means to focus
attention on each of these essential elements of care.
• Be sure your organization uses “cycles of learning” so
measurements are monitored and then used to
improve performance.
58
Striving for Excellence: Social Media as
the New Frontier
Future Baldrige criteria will acknowledge the role
of social media in organizational excellence.
• Use social media to communicate with staff and break
down traditional organizational barriers.
• Use Facebook, Twitter and other social media outlets
to communicate with consumers.
• Use social media to coordinate with suppliers,
collaborators and other external partners.
• Use data from social media exchanges to learn about
customers’ preferences and perceptions.
59
Striving for Excellence: Focus on
Business Model Innovation
Constant innovation will be necessary to achieve
performance excellence in a transformed
healthcare system.
• Expect that innovative practices will be incorporated
into future Baldrige criteria.
• Incorporate innovation and entrepreneurship into
leadership development programs.
• Use experts from outside the industry to seed ideas
for disruptive changes.
• Select board members who can offer creative
strategies beyond the traditional “hospital focus.”
60
“‘We will do everything for everybody’ has
never been a viable value proposition for
any successful business model that we
know of—and yet that’s the value
proposition … of general hospitals.”
Clayton M. Christensen,
Jerome H. Grossman, MD,
and Jason Hwang, MD
The Innovator’s Prescription: A Disruptive Solution for Health Care (2009)
61
Futurescan
This presentation was adapted by Mary Stefl, PhD,
Chair, Health Care Administration, Trinity University,
from Futurescan: Healthcare Trends and Implications
2013–2018.
Futurescan 2013 is available for purchase from Health
Administration Press. Single copies (order code 2236)
are $48. Packages of 15 copies (order code 2243) are
available for a discounted price of $430. Order online at
ache.org/HAP or call the ACHE/HAP Order Fulfillment
Center at (301) 362-6905.
62
Futurescan
Healthcare Trends and Implications
2013–2018