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Leading Through Times of Change
The SHSMD Team
As the nation’s medical system goes through a period of high uncertainty and disruption,
brings together insightful experts and thought leaders to prepare hospitals and health systems for key trends that are shaping the future of health care. Following are highlights from the publication.
Michael Botticelli, director of the White House Office of National Drug Control Policy under the Obama administration,is currently executive director of the Grayken Center for Addiction at Boston Medical Center.
In his article, Botticelli writes that “the nation’s opioid epidemic is one of the defining crises of our time and
requires a forceful response from every sector. For hospitals and health systems, the epidemic forces an even stronger sense of urgency given the magnitude of the problem and its intersection with hospital services.”
He says some hospitals are successfully responding to the challenge through efforts such as:
Embracing nonopioid pain management practices.
Enhancing the identification and treatment of patients with substance use disorders (SUDs).
Incorporating SUD issues into payment and service delivery reform efforts.
Botticelli notes that “addressing the opioid crisis in the United States must be part of larger health care reform strategies, particularly those focused on containing costs, improving medical outcomes, enhancing population health and addressing social determinants of health.”
Health care futurists Matthew Holt and Indu Subaiya, M.D., focus on emerging trends in digital health. Holt is the founder and publisher of The Health Care Blog, cofounder of the Health 2.0 conference and a founding principal of Health 2.0 Advisors. Subaiya is currently executive vice president of Health 2.0 and co-founder of Health 2.0: User Generated Healthcare.
They write, “The easy availability of cloud- and mobile-based computing systems has revolutionized the business sector, putting power and access into the hands of employees and customers and creating huge shifts in how transactions are done.” Holt and Subaiya observe that health care organizations were
“latecomers to the enterprise technology game” and are now playing catch-up.
As technological advances accelerate, they urge leaders to be prepared for the next wave of change and its applications to hospitals and health systems, including blockchain, artificial intelligence (AI), virtual reality and augmented reality.
Their article also takes us through the likely focus of technology giants such as Amazon, Apple and Alphabet/Google as they grow their presence and impact in the field. Traditionally, the U.S. medical
system has centered around care platforms, in that order. The authors invite us to “imagine inverting this triple-layer stack and starting with technology platforms.”
In this scenario, trackers and AI systems would monitor and even suggest next steps to clinicians and patients to improve the quality of care. Holt and Subaiya stress that it is vital for health care leaders to understand these technologies and trends through learning and pilots and by engaging with clinical leaders in their organizations.
Chad Bouton is director of the Center for Bioelectronic Medicine at the Feinstein Institute for Medical Research at Northwell Health and a renowned researcher and developer of advanced biomedical
technology. Bouton explains in his article how this exciting new field combines neuroscience, molecular biology and bioengineering to tap into the nervous system to treat conditions involving inflammation, such as Crohn’s disease, lupus, rheumatoid arthritis and paralysis.
He observes that while many of the advances in bioelectronic medicine are related to implantable devices, innovations in wearable technology will also play a major role in creating new therapies and treatments. And he says discoveries made in the lab are being made possible by investors from industry who recognize bioelectronics as a growing sector that will present alternatives to the biochemical therapies traditionally offered by Big Pharma to treat many diseases and conditions.
In the future, Bouton believes this branch of technology will continue to expand, and we can expect rapid growth in the field that could greatly improve how we deliver care.
As part of their America’s Most Valuable Care study, David S. P. Hopkins, Ph.D., Melora Simon, Thomas Wang, Ph.D., and Arnold Milstein, M.D., of the Clinical Excellence Research Center at Stanford University have concentrated on identifying hospitals that consistently provide high-value care—excellent quality at a low cost.
Their article highlights the results of the research, which revealed three sets of care delivery attributes that distinguish top-performing hospitals from their peers: (1) thinking beyond the hospital stay, (2) cutting waste, not safety and (3) engaging the frontline team in improving the cost-effectiveness of needed care.
The study found that hospitals are rapidly adopting these attributes in areas where they have the greatest economic incentive, such as readmissions and episodes of care. Stronger payer incentives will likely be necessary to increase adoption of attributes that reduce hospital occupancy.
The authors conclude, “As payers gradually increase rewards for yearlong excellence in care delivery, hospital and health system leaders will benefit from implementing best practices and bright spots in value-driven performance that meet the needs of patients and health insurers alike.”
Amir Dan Rubin, president and CEO of One Medical, begins his article on building physician networks through partnerships by emphasizing the rapid pace at which health care organizations are aligning with physicians.
He points out that in the latest
national survey of hospital and health system leaders, 76 percent of respondents say they are already growing their networks by more than 25 percent or are likely to do so in the next five years. He says the survey also indicates that three-quarters of respondents are
operating their network at a loss or are willing to do so to achieve broader strategic objectives.
According to Rubin, health systems are pursuing these investments to attract more covered lives to their networks; to deliver higher levels of service, access and value; and to prevent physicians and their patient bases from becoming aligned with competing networks. One of the best ways to accomplish these goals, he says, is through partnerships, including affiliations, joint ventures, clinically integrated networks, lease arrangements, management services offerings, cost-plus contracts, fee-for-service billing and capitated or accountable care organization-like arrangements. Many providers, he adds, find that these options can reduce capital burdens and business risks because all partnering organizations commit resources and
management energy to the initiatives.
James E. Orlikoff, president of Orlikoff & Associates Inc. and a renowned expert on governance and the emerging health care environment, begins his article by stating that the traditional governance model “can no longer be taken for granted” in “the rapidly changing and radically challenging health care landscape.”
He says hospital and health system boards are getting older: Since 2005, the percentage of board members under the age of 50 has declined. Furthermore, time demands on board members are
growing and are an increasing cause of complaint. Looking ahead, Orlikoff predicts leaders can expect the following:
Recruiting and retaining qualified board members will become more difficult.
Effectively integrating members of the millennial generation and Generation X into current governance models will be a growing problem
Leaders will experiment with new approaches to governance, with mixed results.
As the traditional model of governance nears the end of its useful life, Orlikoff says, “We must begin to conceptualize and then to experiment with new models that are relevant to a radically different future.”
Policy and Regulation
Erin C. Fuse Brown, J.D., an associate professor of law and a faculty member of the Center for Law, Health and Society at the Georgia State University College of Law, provides an insightful perspective on the growing importance of the states’ role in establishing health care policies and regulations.
Fuse Brown says that nearly a decade after the passage of the Affordable Care Act, political gridlock has made it difficult for the federal government to move forward with national reforms, while a renewed emphasis on state flexibility means states are stepping into the vacuum to take action on a variety of health care concerns. She notes that the stakes are high because rising medical expenses translate
to increasing budgetary pressure for states, squeezing out other public priorities such as education and infrastructure.
In response, states are focusing on three key issues:
Rising costs from consolidation.
Drug price increases.
Affordability for health care consumers.
Fuse Brown concludes that the growing role of states will mean more state-by-state variation. Hospitals and health systems will need to concentrate not just on health care policies at the federal level but also on a proliferation of state regulations that will affect their facilities, finances and delivery models.
Susan Salka, president and CEO of AMN Healthcare, leads the country’s largest health care staffing and recruitment company. In her article, Salka describes the industry’s unprecedented workforce shortages across the country as one of the most critical issues facing hospitals and health systems now and in the future.
She points out that the growing deficit of qualified physicians, nurses and many other medical professionals is driving problems related to hiring, retention, turnover, unit staffing and scheduling, morale, quality of care and overtime costs. According to Salka, health care employment continues to
boom but still cannot keep pace with demand because of two leading drivers:
An aging population that is consuming more health care services.
The wave of retirements among baby boomer practitioners.
To help resolve the crisis, she calls for investment in modernizing the field’s human resources sector. Salka says providers that use innovative best practices in recruitment and retention, coupled with hiring outside health care staffing experts when needed, is a formula for success in the escalating race for clinical talent.
once again identifies key issues and emerging trends that demand an informed and planned response by health care leaders. The articles by this year’s panel of experts provide evidence-based insights designed to help hospitals and health systems prepare for a range of strategic, market, policy,
social, economic and competitive challenges and to guide them in taking the actions required to be successful in the ever-changing health care landscape.
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