The healthcare of tomorrow will move away from hospitals
The US News & World Report's Healthcare of Tomorrow conference discussed the future of healthcare, narrowing down the trends into four main areas: a move towards home-based care; a greater focus on value-based care; greater awareness of the social determinants of health; and the growing need for bipartisan input. The first trend, home care provision for patients, offers more comprehensive, cost-effective services in a more convenient location for patients using technology. Telemedicine can offer rural patients increased access, and is likely to be more common as a general health care channel once it is more widely used as a “regular” care path. Growing consumerism in healthcare has led to a greater focus on keeping health care at home for convenience. The change to a more value-based care system, however, has taken some time to implement. The CMS has finalized the Quality Payment Program regulation for next year, but this exempts a significant number of doctors. Private healthcare companies are partnering to offer technology and data-driven, value-based care options. Medical companies find it difficult to innovate, as the system presents as a value-based one, while still functioning as fee-for-service in terms of business income. However, the general opinion within health management organizations is that care delivery will be revolutionized within the next five to ten years through virtualized and technology-based services, offered through platforms, apps and services. Remote care delivery models could also disrupt the present system. Value-based insurance is also an area where patients can be incentivized, moving them away from lower-value care. Social determinants are an increasingly important area of focus, as evidence grows that issues such as food security, affordable housing and more affect the changes in good health outcomes. Payers should be considering how social determinants affect health as it could help to prevent issues before they arise, creating savings for ER departments and other emergency healthcare points. The final trend is the increasing call on forming bipartisan agreements for healthcare. The difficulties that recently arose with the “repeal and replace” agenda of the present administration, as well as the ongoing budget issues, create uncertainty that leads to an unstable healthcare environment. Major social programs require the support of all political groups to succeed, with healthcare advocates calling for Congress to abandon the idea of reforming the Affordable Care Act and to actively work across parties to improve it.

The question of what the healthcare of tomorrow will look like prompts a broad, compelling thought experiment. As healthcare professionals of all stripes gathered in downtown Washington, D.C., last week to discuss that very question, a few key ideas emerged.

Here are the most interesting ideas Healthcare Dive found at U.S. News & World Report's Healthcare of Tomorrow conference.

Care is moving back into the patient’s home

Health systems that embrace the patient movement toward consumerism are on the right track, according to several speakers at the conference. Locating services in a patient’s home or somewhere close by and easily accessible is more convenient for patients, but also produces more comprehensive and effective care.

Aetna CEO Mark Bertolini (who, despite some clever questioning from the moderator, declined to comment on “market speculation or rumor” that the payer could be acquired by CVS) said the home is the least expensive and most convenient setting for care. If it can’t be in the home, it should be at a retail clinic only a few miles away, he said.

“If you have to go to the hospital, we have failed you. What if that were the way the system was designed?” he said.

One key way the home can become a primary setting for healthcare is through telemedicine. This is particularly true in rural areas, where a patient may have to drive hours to get to their doctor’s office. And it will become more and more common as telemedicine becomes more widely adopted and stops being perceived as a separate category from “regular” care.

“The novelty of telehealth has fallen by the wayside,” said Christopher Northam, vice president for telehealth at HCA. “There used to be a lot more focus on the technology. Now the focus is on clinical measurement.”

Younger people are a big part of the drive toward consumerism in healthcare, and they want to receive care at their homes, Northam said. “That will shut down hospitals,” he added.

Dr. David Tsay, associate CIO at the New York-Presbyterian Innovation Center, agreed and said a lot of changes will take place in the next 10 years. “I think hospitals will look very, very different,” he said. “Hospitals will primarily be ICUs and ORs, and the rest of care will be done in the convenience of the home.”

Bertolini said ultimately it will come down to what patients demand as consumers, so creating a compelling and enjoyable experience will be key. “Us as customers — as consumers — disrupt the industry. Because we say we no longer want that, we want this.”

Conversion to value-based care continues — but at a glacial pace

HHS under President Donald Trump has walked back some of the previous administration’s payment reform efforts. Although CMS is vocal that it wants to continue the shift from volume to value, the recently finalized Quality Payment Program rule for 2018 indicates otherwise considering the large amount of physicians the administration is exempting from the regulation. Still, albeit slowly, the industry continues to embrace this shift toward value-based care.

The openness to change has resulted in olive branches being extended across the industry as incumbents look to figure out business in the shifting environment. The result is a mix of strategic partnerships and alliances as the lines between traditional healthcare companies begin to blur.

Biotech company Amgen partnered with Humana for an outcomes-based research project that will identify high-risk patients using technology and real-world data, Dr. Jason Spangler, executive director of value, quality and medical policy at Amgen, shared at a keynote panel. “We believe these types of partnerships are where we need to be moving to provide value to patients.”

Providers may be slower to adapt to value-based care. Lori Evans Bernstein, co-founder and COO at HealthReveal, said potential customers are discussing value but also want the ability “to find the good stuff" like reimbursable procedures under a fee-for-service model.

Tom X. Lee, executive chairman at One Medical, said innovating from within the system is challenging. “We operate as if we’re in a value-based world today though the vast majority of our income is still fee-for-service,” Lee said. One Medical, a group of primary care offices that offers 24/7 connectivity with patients through video and chat services, engages with the industry at the primary care layer. This allows it to operate a little outside the system somewhat. He said organizations operating further downstream have a harder time finding such opportunities.

Julie Bietsch, VP of population health management at Dignity Health, told Healthcare Dive the industry is at a tipping point for value-based efforts. About 10% of Dignity’s revenue is accrued from population health or value-based arrangements. “I think that those not investing in population health are going to be the ones left behind,” she said, adding providers need to take the first step toward population health. “If you don’t, you won’t know what happens when it’s mandated.”

Lee believes more changes are coming in the next five to 10 years in care delivery. While the market has spent a lot of time building platforms, apps and services, he sees more changes over improving the virtualized and service experiences coming into healthcare. In addition, he sees more remote care delivery models as an oncoming disruptive force.

“Those are going to be care systems of the future … I don’t think anyone denies that vision,” Lee told Healthcare Dive. “The question is, who’s going to execute it best? Easier said than done.”

Spangler said he believes the industry could benefit from more care delivery and payment innovations. “One area I think we need to move toward is value-based insurance design,” he said during a keynote panel. “We should pay and incentivize patients toward high value care and disincentivize them against low value care.”

In healthcare, there are no shortage of opinions, and discussions around value-base care will continue. Expect them to get more vocal.

Social determinants of health — a trend that needs direction

“Everyone’s talking about social determinants but no one’s talking about how to do it,” Bietsch told Healthcare Dive.

Social determinants have been a popular topic as evidence mounts that food security and affordable housing help create good health outcomes. However, there isn’t a centralized assessment of the issue, Bietsch said. For example, if an individual tells seven people that they need a home but no one helps, then the process is inefficient.

Social determinants of health and "understanding about how they drive our health" are currently buzzword concepts in the industry, she said. “But the success of it is not there.”

Bertolini is a proponent of thinking about social determinants at every level of healthcare. He noted that a person’s ZIP code is often a bigger indication of life expectancy than their genetic code, and ignoring that reality results in an incomplete approach.

He said it makes sense for payers to be thinking about social determinants of health because that’s how diseases can be prevented and savings can be realized. “Paying for a ramp, an Uber ride, food, fuel assistance is cheaper than one ER visit,” he said.

Progress requires bipartisanship

Calling for bipartisan agreement in D.C. is nothing new and hardly controversial, but at Healthcare of Tomorrow, it was an urgent demand. Budget deals are far from clear, the Children’s Health Insurance Program has still not been reauthorized and rumblings of “repeal and replace” continue despite the unlikeliness that any such legislation could gain traction. This environment breeds more and more uncertainty, which is toxic to the healthcare environment.

Bertolini said major social programs need broad support to be successful, and Congress should shift from the idea of abandoning the ACA and work together to improve upon it. “We can fix it. The list is short,” he said. “We just need a group of people with level heads in the room to fix it.”

Legislation of the magnitude and scope of the ACA isn’t going to be perfect right out of the gate, and the problem even proponents recognize will only get worse with inattention, he said. “If you were to leave Medicare alone for six years, seven years, it would fall apart just like this is,” he said.

Virginia Gov. Terry McAuliffe had a similar message. “We’ve just got to shake up the system and we’ve got to do it together,” he said. McAuliffe said CHIP reauthorization is the most pressing issue today, and lamented that “moms and dads are going to bed tonight scared to death” their children won’t have healthcare coverage.

He also criticized the White House’s decision to stop CSR payments, and said he personally talked to the Anthem CEO to convince the payer to cover nearly 60 counties in Virginia that would have otherwise not had any plan options.

“The middle is gone,” he said, “and I come from a business background, and the middle is where you get stuff done.”

Tom Daschle, former senator and the founder and CEO of The Daschle Group, said healthcare professionals need to make their voices heard in Congress by calling their legislators. “If you don’t know the name of ... their health legislation assistant, you’re not engaged,” he said.

Blair Childs, senior vice president for public affairs at Premier, said providers in particular need to lead change and tell lawmakers what is happening now in the market and where it needs to go. “Anyone thinks the healthcare system is going to be fixed by the government or by payers is crazy,” he said. “It’s only the providers who will innovate the system.”