Disruptive driving forces of change in healthcare delivery

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Driving change in disruptive delivery of forces healthcare chantal attias v carefirst

Adventist health system celebration	Penn Medicine brought in a Silicon Valley leader from Intuit, Roy Rosin, to head up innovation sorry, 24 valve cummins trucks very has now created multiple centers for innovation to integrate new digital thinking i legacy talent to re-imagine different parts of the health care value chain and patient journey. A review of digital technology projects and collaborations agrees: startups offer higher promises of disruptive innovation. Deteriorating trust between device and bio-pharmaceutical companies and the FDA, resulting in slower, more complex approval process b. Transition disruptive driving forces of change in healthcare delivery value-based reimbursement: Provide more affordable, higher quality care at lower reimbursement rates Higher quality and cost containment are now coupled Provider accountability for cost and quality of drlivery Necessitates population health management methods, processes and protocols Evidence-driven care is required Transparency of cost, quality and ih benefit data Must have integrated, aligned and engaged physicians Hospital systems are now healthcare go here that also provide wellness and pre-emptive care, rather than merely "sick" acute care 2. Global lessons in Frugal innovation to improve health care delivery in the United States.
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Alcon makeup new york	N Engl J Med ; : — Rosen R. Each of these 10 forces creates significant implications for patients, providers and the healthcare industry, the most critical of which are listed below. Cumulatively across these domains, the following are the five most here figure 5 disruptive innovations:. These examples highlight that many digital health disruptive innovations encroach on other domains, such as diagnostics and processes.

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Consensus of best practices for developing patient engagement and efficacy metrics are lacking. Increasing government regulation. Deteriorating trust between device and bio-pharmaceutical companies and the FDA, resulting in slower, more complex approval process. FDA considering regulating healthcare IT systems, increasing its involvement in care delivery.

Shrinking availability of capital. Perceived unpredictability of government regulation dampening investment in medical technology and care providers. Financial difficulties limiting debt capacity for many hospitals. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy. Transition to value-based reimbursement: Provide more affordable, higher quality care at lower reimbursement rates Higher quality and cost containment are now coupled Provider accountability for cost and quality of care Necessitates population health management methods, processes and protocols Evidence-driven care is required Transparency of cost, quality and community benefit data Must have integrated, aligned and engaged physicians Hospital systems are now healthcare systems that also provide wellness and pre-emptive care, rather than merely "sick" acute care 2.

Shifting volumes and lower reimbursements Require most systems to take 20 to 40 percent of costs out of the system Must identify and remove non-value added cost Using scale to reduce costs and fixed expenses will lead to accelerating consolidation Maximize and optimize with creative and reconstituted utilization of assets from technology to facilities Develop a portfolio of facilities in the community from non-acute to acute that generates greater access at a lower cumulative cost and allows for treating patients at the lowest acuity possible 3.

Moving from caring for sick individuals to managing the health of a population Insurers will be required under the Patient Protection and Affordable Care Act to completely cover such services as annual physicals, childhood vaccinations and dozens of screening tests The federal government is still defining the preventive care guidelines; ambiguity is still a challenge The law focuses on prevention and primary care to help people stay healthy and to manage chronic medical conditions before they become more complex and costly to treat New private health plans must cover and eliminate cost-sharing co-payment, co-insurance, or deductible for proven preventive measures such as immunizations and cancer screenings ePreventive measures for women went into effect in August with no cost-sharing 4.

Advances in HIT Electronic health records allow for clinical integration Full optimization requires developing analytics that leverage and optimize big data 5. Acceleration in introduction of digital health tools, advanced medical technology and medical models Telemedicine, personalized medicine as accepted models Diagnosis and treatment is preventative, image based and therefore less invasive "Unconstrained connectivity" generated by providers and patients use of mobile devices Higher levels of patient engagement in their own health management 6.

Shifting demographics: Older, more diverse, larger income disparities, greater access Providers need to be able to provide the appropriate care in the patient's cultural context Wide range of health needs based on segments 7.

Projected provider shortages Make sure care providers are working to the full extent of their licensure Talent management for care providers Partnerships to stimulate early interest in these careers Evolving the care delivery system: more care delivered by other care providers other than doctors Creating the right match between the kind of care needed and the right provider to provide it 8.

More informed and involved patients Shift from providing care to health management requires closer communication between pay providers, patients and care providers, especially before acute health care needs arise Providers will partner with patients to adhere to recommended care plans, especially as patients transition to post-acute care settings Consensus of best practices for developing patient engagement and efficacy metrics are lacking 9.

Increasing government regulation Deteriorating trust between device and bio-pharmaceutical companies and the FDA, resulting in slower, more complex approval process FDA considering regulating healthcare IT systems, increasing its involvement in care delivery Shrinking availability of capital Perceived unpredictability of government regulation dampening investment in medical technology and care providers Financial difficulties limiting debt capacity for many hospitals.

Transition to value-based reimbursement: Provide more affordable, higher quality care at lower reimbursement rates a.

Higher quality and cost containment are now coupled b. Provider accountability for cost and quality of care c. Necessitates population health management methods, processes and protocols d. Evidence-driven care is required e. Transparency of cost, quality and community benefit data f. Must have integrated, aligned and engaged physicians g. Hospital systems are now healthcare systems that also provide wellness and pre-emptive care, rather than merely "sick" acute care 2.

Shifting volumes and lower reimbursements a. Require most systems to take 20 to 40 percent of costs out of the system b. Must identify and remove non-value added cost c. Using scale to reduce costs and fixed expenses will lead to accelerating consolidation d. Maximize and optimize with creative and reconstituted utilization of assets from technology to facilities e.

Develop a portfolio of facilities in the community from non-acute to acute that generates greater access at a lower cumulative cost and allows for treating patients at the lowest acuity possible 3.

Moving from caring for sick individuals to managing the health of a population a. Insurers will be required under the Patient Protection and Affordable Care Act to completely cover such services as annual physicals, childhood vaccinations and dozens of screening tests b.

The federal government is still defining the preventive care guidelines; ambiguity is still a challenge c. The law focuses on prevention and primary care to help people stay healthy and to manage chronic medical conditions before they become more complex and costly to treat d.

New private health plans must cover and eliminate cost-sharing co-payment, co-insurance, or deductible for proven preventive measures such as immunizations and cancer screenings e. Preventive measures for women went into effect in August with no cost-sharing 4. Advances in HIT a. Electronic health records allow for clinical integration b. Full optimization requires developing analytics that leverage and optimize big data 5. Acceleration in introduction of digital health tools, advanced medical technology and medical models a.

Telemedicine, personalized medicine as accepted models b. Diagnosis and treatment is preventative, image based and therefore less invasive c.

Higher levels of patient engagement in their own health management 6. Shifting demographics: Older, more diverse, larger income disparities, greater access a.

Providers need to be able to provide the appropriate care in the patient's cultural context b. Wide range of health needs based on segments 7. Projected provider shortages a. Make sure care providers are working to the full extent of their licensure b. Talent management for care providers c.

Partnerships to stimulate early interest in these careers d. Evolving the care delivery system: more care delivered by other care providers other than doctors e.

Americans are aging. These all lead to chronic illnesses like diabetes type II, heart failure, cancer, chronic lung and kidney disease, etc. So there will many more individuals with chronic illnesses. The especially sad thing is that many of these individuals will be moderately young as a result of obesity since one third are overweight and another one third are frankly obese.

And now that the AMA has specifically listed obesity as a disease rather than just a predisposer to disease, then the number of Americans with chronic illnesses jumps dramatically. This increase in chronic diseases and the impairments of aging will have huge impacts on care delivery.

Of course, more and more care is and can be done out of hospital. But with many more patients in need of care for serious chronic illnesses, there will be a need for more high tech hospital beds, ICUs, ORs, and interventional radiology. This is different than the mantra of recent decades which proclaimed that there are too many hospitals and too many beds. Now it is the just the reverse. This too is a big change. There is already a shortage of primary care physicians and this will undoubted accelerate since few are entering primary care today after medical school and training.

In part to compensate, there will be greater use of NPs and PAs, especially in primary care. Notwithstanding the debate as to whether NPs can serve as well as MDs in primary care, they can be very effective and allow the MD to do what he or she is best at doing. Together they can create an excellent team. Primary care doctors are caught in a catch They are in a non sustainable business model. Reimbursements from insurers have stayed level for years but office and other expenses have gone up each year.

This means no longer visiting their patients in the hospital and in the ER. Instead they wait for the hospitalist or the ER doctor to call with reports. And they shorten the time with each patient so they can see 24 to 25 patients or even more each day. But seeing this many patients means they cannot give comprehensive preventive care and cannot adequately coordinate the care of their patients with chronic illnesses — two of the key things a PCP should be doing for optimum quality care.

It is the absence of time — time to listen, time to prevent, time to coordinate and time to just think — that is the critical issue. There are at least two approaches PCPs are taking to counter this dilemma. One is to no longer accept insurance and rather expect patients to pay a reasonable fee at each visit. Pay at the door. It cuts out a lot of haggling with the insurer and means they can spend more time with the patient.

Importantly, it recreates a normal, typical professional-client relationship since the patient, not the insurer, is paying the doctor directly. But this is certainly a disruptive change to not accept your insurance!

It is like going back a few decades. More Read. The result is better quality. But there is more.