“We do not have a health care crisis in this country – we have a health crisis with a health care system incapable of dealing with it.” ~ Mike Huckabee, Former Governor of Arkansas “We have to move from illness to wellness. Businesses will have to invest in wellness. There is no choice. It’s not philanthropy. It’s enlightened self-interest.” ~ Shrinivas M. Shanbhag, Medical Adviser, Reliance Industries, India “Our vision should be to have the healthiest people, not just the best health care, in the world. With prevention and wellness as the cornerstone of our health policy, we can be number one in both.” ~ Newt Gingrich “ Shifts taking place
The healthcare industry is approaching an exciting model shift in patient engagement as we move away from being a mostly provider driven industry to a consumer driven one. Much like the financial, music, and publishing industries in the past, healthcare is becoming a mobile, consumer -driven industry. In this consumer driven model, patients drive healthcare industry spending and can receive and transmit health-related data in real-time. The main causes for this shift are the Affordable Care Act (ACA) and changing health insurance coverage. These changes have allowed for greater access to, and demand for, health information through smartphones and patient portals. The use of mobile medical devices and technology also empowers patients to take on and share responsibility for recording and transmitting their own health-related data.
Under the Affordable Care Act, health insurance exchanges now give patients the option to shop and compare plans in order to determine which has the best value for their individual needs. Being able to compare plans metrics such as premiums, copays, and direct payments side-by-side creates greater cost transparency than ever before in healthcare. These cost transparency and the ability to ultimately determine which coverage is right for them gives patients the power to become active healthcare consumers, rather than passive participants in the current system. As healthcare consumers, they expect to have the best quality of care and value the customer experience above all else. Under this new model, patients are empowered to closely monitor their healthcare spending and their own health, interact with the healthcare system outside the hospital walls, and employ the use of technology to improve their conditions. Current and potential challenges
Americans have seen a raise in health care expenses during the 1980s, the results were extensive; managed care were assumed by employer-sponsored health plans. To a certain extent, managed care methodologies were implemented for some Medicaid and Medicare enrollees. During the 1990s, new Medicare reimbursement policies and the well-known acceptance of managed care plans had noticeably reduced the growth rate of health care expensive. All available studies show that Health Maintenance Organizations (HMOs) and other managed care plans have provided health care of equal or better medical quality to out-of-date covered insurance plans at a lower cost. While the country’s economy grow stronger during the late 1990s, anxieties about overall health care costs diminished, “and the public became less willing to accept restrictions on the enrollee’s choice of physician and the physician’s treatment choices” (Luke, 2001). Health care recipient’s outlook “turned against the concept of managed care as a result of backlash from both physicians and consumers.” (Luke, 2001) How health care is handling challenges. Many of the challenges Academic Medical Centers (AMCs) face in the current environment are well understood and widely recognized even if the solutions are not.
Faster provider consolidation, both horizontally and vertically, over the past several years is reshaping the competitive landscape. Community-based providers are gaining the size and strength to drive market dynamics and negotiate on equal or better footing with payers. Competitors are also gaining new competencies, keeping and caring for more patients themselves. This has begun to impact AMCs’ referral streams and their ability to maintain market share. There are already a growing number of markets across the country where AMCs are experiencing flat-to-declining inpatient volume growth and losing their dominant market position to large, evolving systems. Government and commercial payers are aggressively advancing value-based payment methodologies and steering patients to lower cost providers. AMCs which tend to have higher costs-to-serve than their community-based counterparts will face difficulty competing for services others also provide at acceptable levels. AMCs looking to thrive in this environment need to find ways to coordinate with other types of providers across the continuum to reorient the site of care to more cost effective settings and control quality, variation and outcomes. AMCs also need partners along the continuum to position themselves as primary contracting entities under population health or risk becoming “commodity” providers in their markets. AMCs must contend with unprecedented financial pressures as healthcare reform rolls out over the next several years. Conclusion
Today, health care costs are on the rise. The US spends considerably more on each person for health care than are other developed countries, there are no obvious progress in the healthcare outcomes. Assessments show that in the next 30 years, health care costs will again rise at a rate faster than that of the economy. The impact of an aging population will further reflect the rising cost of health care, by the year 2030, more than 20 percent of individuals 65 years or older. At that time we will be headed for another crisis. “However, the environment has changed: As a result of the experience of the last 10 years, the public is now less willing to accept changes to the health care system, and the concept of managed care has negative connotations. Consequently, the crisis may potentially be even worse than that we experienced a decade ago if we are unable to find ways to control health care expenditures”.(Luke, 2001)
Khan, F. (2014). The Shift to Consumer Driven Healthcare. The future of patient engagement. Retrieved from: http://healthcare-executive-insight.advanceweb.com Luke, R. T. (2001). Health care in the United States: current and future challenges. Retrieved
Peterson, H. (2014). Becker’s Hospital Review. Challenging Healthcare
Landscape Fertile Ground for Academic Medical Centers. Retrieved from: http://www.beckershospital review.com/strategic-planning