changes in a healthcare organization
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Changes in a healthcare organization cvs health insuranve

Changes in a healthcare organization

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Expect to see large organizations making big investments to better leverage and monetize the use of data to improve productivity, enhance patient care and drive additional funding for key programs.

Expect to see more large health systems as organizations try to monetize large investments and drive synergies from scale. With COVID throwing historical utilization rates on their head and making projections nearly impossible to calculate, employers, providers and payers are forced to consider utilization, rates and risk as they model the coming year.

Please note that the views of authors do not always reflect the views of AHA. Emerging Issues Top 10 Emerging Trends in Health Care for The New Normal Continued disruption will require health care boards to adapt their governance models By Geoffrey Martin In these unprecedented times, what priorities should hospital and health care system boards focus on to prepare for and beyond?

Collaborative Ecosystem COVID has exposed vulnerability at health care organizations across the globe on critical issues, including safety, equipment, data availability, and infrastructure.

Among the topics for boards to consider: Increasing storage and self-distribution. We see a trend toward more self-distribution models instead of just-in-time delivery from distributors. This allows organizations to buy in bulk, control distribution and minimize their reliance on items at risk of being depleted. Organizations do not have a limitless supply of capital so this is not a one-size-fits-all procurement strategy, but it may make sense for certain items in the supply chain.

Deeper relationships and back-up suppliers. The value of vendor-of-choice relationships became apparent as many hospitals scrambled for pandemic-related supplies. The key is striking a strategic balance between price, performance and trust. Neither is overreliance on one vendor without having plans B, C and D in place. We see many organizations developing connections with tiers of back-up suppliers — often smaller and geographically closer than their primary vendors — to gain flexibility, speed and as much certainty as possible that critical items will be on hand when needed.

New supply chain models for new care settings. Health care futurists believe that by , most care will be delivered at home, in outpatient settings or virtually.

Adapting to this new way of care — in terms of supplies and delivery methods — will require relationships with different types of vendors, such as retailers, contract employees and technology providers. This is an exciting but huge challenge: how to reimagine supply chains to deliver non-hospital-based care in a safe, cost-effective and high-quality way at scale. Smarter, faster, predictive information. Expect to see more automation software and artificial intelligence AI in health care supply chains.

In addition to freeing personnel from repetitive tasks, these technologies can assist decision-makers in identifying trends and providing resources to workers. For example, predictive analytics focused on population health within an organization or system could alert managers to trending disease states and their associated supply needs.

Supply chain managers could use AI tools to master the new transportation logistics of getting supplies to widely dispersed home care settings and so on. Offload financially draining services. Organizations like CVS and Walmart now offer basic primary care, simple diagnostic services and chronic disease management — services that health systems have struggled to provide and do so profitably.

Identifying opportunities to partner with retail organizations to fill this gap can help simplify organizational services, increase access and provide better patient care at a lower cost. Expand the market while improving community health. New entrants can be a force multiplier and increase the overall market for health services. Look for opportunities where your services could have a significant impact on community health and partner intentionally.

For example, about half of women age 40 and older do not get screening mammograms. If mammography services provided by a large retailer were successful in motivating this population, the majority of women receiving in-store mammograms would not need follow-up care. However, many would require referrals for follow-up diagnostic exams and, possibly, treatment. Establishing a two-way relationship with that new entrant — sharing data and providing easy access to hospitals or health systems — could open the door to a potentially significant flow of new referrals.

Think outside your ZIP code. With the emergence of virtual services and virtual workforces, the talent pool is expanding and new entrants are emerging that can offer services at a lower cost and often at a higher quality than is possible for some organizations. Trustee Discussion Topics: Does our organization have a progressive supply chain strategy that includes risk mitigation, reliable suppliers, alignment with care delivery changes and a technology plan that is utilizing rapid advancements consistent with other fields?

Are we evolving our business model quickly enough to provide the right mix of services to match our mission, enable market differentiation and improve our financials? Have we considered how to use the competition and new models to exit financially draining services, expand the market and leverage resources outside of ZIP codes we operate in?

Patient and Workforce Engagement 3 Patient Consumerization Today we can receive goods the same day we order them, and track them minute by minute from order placement to delivery. Other top issues include: Inclusion and diversity.

The momentum around improving inclusion and diversity within health care teams is encouraging. There is strong evidence that diverse teams and inclusive cultures drive better outcomes especially among diverse patient populations , more effective problem-solving, greater engagement and higher employee retention.

Large organizations are using their scale to invest in IT tools and programs that give employees greater flexibility to work remotely. The virtualization and gig economy has already begun and will be in full effect in health care over the next several years.

Physical and mental health. The issue of employee safety was amplified by COVID as organizations redesigned care delivery spaces and protocols on the fly to protect health care workers and patients.

These efforts will broaden as health systems ramp up testing of patients and employees, remote working and virtual care services. Organizations need to keep a pulse on staff burnout, continually looking for ways to make their jobs more sustainable and expanding access to mental health services. Trustee Discussion Topics: Are we measuring the patient experience compared to other health care providers, or are we striving to exceed an experience provided by high-performing organizations in other sectors, such as retail?

Have we provided the resources and skills to our teams beyond clinical knowledge to drive the level of experience our patients are demanding? Do we have the right leadership, and are we on a cultural journey as an organization that is going to drive measurable change in both the short term and over time? In May , the Trump administration and justice department, which is historically responsible for defending a federal act or statute in the courts, chose to support the repeal of the ACA.

Of course, no change will be enacted until when the Supreme Court hears the case. However, if the Supreme Court votes to repeal the ACA, the effects will be far-reaching for patients and health systems, as 21 million Americans will lose insurance coverage. With an unsuccessful attempt to repeal the ACA, a gridlock in Congress, and the absence of constructive legislative action, the Trump administration still made big waves that deeply impacted health organizations, payers, and patients through executive orders:.

Medicaid expansion was a hot topic for debate in and will continue to be well into Although Medicaid expansion legislation was passed in and took effect in , referendums and legislation are still pending in many places throughout the United States:.

The Medicaid expansion legislation intensely affects healthcare organizations and patients because Medicaid expansion means more people have access to healthcare than before. Health systems need to be prepared to care for this new influx of patients without compromising quality and also ensuring they meet CMS standards of care in order to receive reimbursements. Medicaid expansion allowed people in remote communities, such as throughout the Mountain West, to access care that was previously unavailable.

As a result, critical care hospitals and smaller healthcare organizations started merging and contracting specialty services with other organizations. For example, small hospitals throughout southern Utah, southeast Idaho, and southern Wyoming with University of Utah Health and Intermountain Healthcare to provide specialty care to patients within their communities. As prescription drug prices skyrocket, and pharmaceutical companies and politicians continue to debate who should pay, a new bipartisan bill appears to offer at least some of the answers.

With increased information available to consumers, payers and providers are incentivized to improve quality and cost, driving down healthcare prices without compromising the level of care.

With pending legislation, health systems must prepare for the changes to come in As price transparency increases and consumers—and CMS—demand quality care for less, healthcare organizations need new ways to succeed within the VBC landscape.

Alternative payment methods—including ACOs, shared savings, shared risk and bundled payments, and population-based at-risk contracts—are just some examples of new payment models that link cost and reimbursements to quality as the fee-for-service model continues to diminish.

Another aspect of the new consumerism approach to healthcare is mergers and acquisitions. Another part of a consumer-driven healthcare landscape is access through virtual healthcare, or telehealth. Healthcare organizations should offer, or consider offering, easily-accessible healthcare consultations—like virtual healthcare and telehealth—that also emphasize quality care with convenience and easy scheduling.

As the push for virtual healthcare continues, so does the pressure for health systems to develop these programs, which requires a major overhaul for some organizations. Health systems need have the following capabilities:. While there have been many notable mergers in the past few years—for example, the merger of HCA Healthcare and Mission Health, and Mercy Medical Center joining Cleveland Clinic , to name a few—it is unclear how these newly created companies will impact the future of health systems and insurance companies.

Private sector companies are also playing a part in healthcare on an unprecedented level. For example, both companies now offer virtual clinical and home visits for their employees. Google is hiring physicians from and to develop new healthcare solutions that could possibly threaten current healthcare organizations by taking patients away from traditional hospitals and clinics.

Employers also had to deal with the new 1. These add more cost burdens for employers and healthcare organizations as they strive to provide care for this increasing population with limited financial resources. As the business of providing healthcare becomes more complex, so does the process of treating individual patients. Instead of looking through a myopic lens that only allows a provider to see a patient with an illness, clinicians and their multidisciplinary teams are now collecting socioeconomic information as part of the care process.

Where a patient resides, employment, family situation, etc. Social determinants of health SDoH impact mortality, morbidity, life expectancy, healthcare expenditures, and health status and functional wellbeing, to name a few.

They also cause major disparities in health and healthcare. The data clinics, health plans, and hospitals are collecting today is far richer than it used to be and can highlight inequality. Data shows, for example, a stark disparity when it comes to healthcare cost being a deterrent to getting care. Anywhere from 10 percent to 22 percent, depending on race and ethnicity, did not see a doctor because of the cost, and anywhere between 19 percent and 35 percent delayed needed medical care because of the cost Figure 3.

These disparities lead to situations where patients is prevented from following medical advice due to cost. For example, a diabetic patient will stop taking insulin or use less insulin than they need to survive because of the high cost of this prescription drug. The percentage of patients with a usual source of care ranges from 75 to 87, depending on ethnicity.

Those who have seen a doctor in the past 12 months or had a healthcare visit in past 12 months ranges from 75 percent to 85 percent, again, depending on ethnicity. Lastly, this disparity also appears among those who have seen a dentist in the last 12 months; between 54 percent and 68 percent Figure 4. With source of care and health visit data clearly illustrating the need for better access, health systems have the insight to improve care across underserved race and ethnicity categories.

The benefits of this legislation will continue throughout Another promising development to help combat the opioid epidemic is the additional number of codes for on opioid use disorder and the telemedicine parity law, passed in 36 states and District of Columbia. Telehealth allows people who live in hard-to-reach places to access the same opioid addiction recovery services that are offered in an urban area.

The new telemedicine parity law requires private insurance companies to cover telehealth the same way they cover in-person visits, making opioid disorder support services more affordable. Health systems should adjust to the changes and also prepare for by considering key questions:. The time to prepare for change in healthcare legislation, healthcare access and delivery, and payment methods is now—health systems need a clear goal and a strategic plan, based on their current knowledge, that will help them get there.

As health organizations continue to evolve in an everchanging landscape, digital health, alternative payment models, and better data, including social determinants of health, are key pieces to the puzzle. Health systems have opportunities to improve like never before; new types of organizations are entering the healthcare industry with new ideas, technology is changing the method of delivery, and patients are demanding price transparency.

The only way for health systems to remain successful, and flexible, is to be willing to try new ways of healthcare delivery and to never lose sight of the reason the organization exists—to provide the care to each patient, when, where, and how they need it.

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