The Evolution of Healthcare
Risk Requires Fundamental Change — Many Systems Won’t Survive
The incentive to help patients live healthy lives is virtuous. But, it turns the business of healthcare upside down. It requires new core competencies. The fee-for-service model was driven by recruiting chronically/acutely ill patients and treating them in high cost facilities. In contrast, the risk-based model will be premised on serving large populations of patients at all levels of the pyramid and keeping them healthy enough to stay out of high cost facilities.
To succeed, health systems will need to establish a trusted adviser role with each patient that transcends the provider encounter. This requires an ongoing, customized dialogue about the patient’s health that is coordinated across channels and through time.
Other consumer services industries have been through analogous evolutions. The path to success is difficult but clear. If other industries are informative, most health systems will not succeed. The winners will be those that start early and think different.
Different Patients, Different Engagement Models
Engaging the Healthy
Risk-based models require a critical mass of healthy members to succeed. Providers competing to serve the needs of the healthy is new, but competition will no doubt accelerate quickly. Health systems that don’t get their unfair share of the healthy will be financially hampered.
Because the “chronically healthy” don’t visit providers often, dialogue with this group will be driven by proactive outreach. Loyalty will be a function of the value of those reach outs to members. Health systems will need sophisticated CRM and analytics platforms to drive the coordination, personalization and continuous improvement of this dialogue. This is too critical and too dynamic to rely on an EMR that was built for another purpose.
Influencing the At-Risk
The reduction in health spending generated by preventing a pre-diabetic from becoming diabetic can amount to upwards of $20,000 annually. More importantly, that patient enjoys a healthier, happier life. With opportunities available across numerous diseases and millions of patients, the only challenge is removing the provider encounter as a bottleneck to engaging patients and influencing behavior.
Health systems now have all the incentive in the world to aggressively reach out to the at risk population. Become the trusted guide on their health journey. This is not easy, but it is also not rocket science. Other consumer service industries have been delivering against similar challenges for years.
Managing the Poly-chronic
Most health systems today are already hyper-focused on patients at the tip of the pyramid. Working to take care of them has been at the core of healthcare for decades. But risk will change the definition of success. Financial incentives for health systems are finally aligning with the health goals of their patients. Namely, stay as healthy as possible and stay away from the hospital if possible. This will require health systems to engage patients where they live — home.
While many systems have made progress on their ability to reach out, they have not been successful in coordinating their outreaches. A discharged patient can receive 10-50 calls, letters, emails and text messages in the first 60 days after a discharge. Provider follow-ups, readmission reduction programs and surveys add to the pile. This communication assault is typical in the early stages of any consumer service industry, but success requires that it gets resolved quickly.