As the pace of change across healthcare—both in the United States and everywhere, but particularly in the U.S.—accelerates, things really are changing quickly now on multiple fronts, from the policy and regulatory arena, through reimbursement change, and into the business and operational, clinical, and technological spheres. There’s no segment of the healthcare industry that is not significantly changing. But more importantly, the signposts seem to be getting clearer and more closely spaced apart these days—and that is significant.
Sure, there are plenty of “Debbie Downers” and “Negative Nancys” out there (and my apologies to anyone named Debbie or Nancy). There may even be more Debbie Downers and Negative Nancys than in recent years; after all, the pace of change is putting increasing pressure on everyone in healthcare; and the pace of change is accelerating precisely because the costs and challenges of healthcare, particularly in the U.S., are forcing change. As we reported this summer, actuaries at the Centers for Medicare and Medicaid Services (CMS) announced in mid-July that total U.S. healthcare expenditures would grow from 17.5 percent in 2014 to 20.1 percent in 2025, with total spending rising from $3.3013 trillion in 2014 to $5.631 trillion in 2025. And as I’ve stated in several blogs since then, that anticipated 70-percent increase in total U.S. healthcare costs is concentrating everyone’s attention, as the reality that we in the United States are going over a healthcare cost curve, is becoming more and more apparent.
But while hospitals, physician groups, and all types of healthcare providers are under pressure as never before to curb costs and improve outcomes and experiences, some of that very pressure is stimulating tremendously creative responses. As the hoary adage notes, necessity is the mother of invention; and in the case of the U.S. healthcare system, necessity is a very large and high-pressured mom indeed.
But things really are moving forward in many areas. And below are a small number of examples from across the constellation of our coverage this year at Healthcare Informatics, as well as a few other sources, that paint a portrait of a healthcare industry replete with pioneers who really, genuinely, are moving the needle on healthcare system transformation.
Pioneering physician groups: stepping up to risk and population health management
Yes, we all know of physicians and medical groups who are either panicking at all the changes taking place in policy, regulations, reimbursement, and the business of healthcare these days, but there are also lots of physician leaders who are taking the reins of the merging new healthcare, and doing it with confidence. Probably one of the most self-confident of physician group leaders I talked to this year was Jeffrey LeBenger, M.D., a head and neck surgeon who is chairman and CEO of the 650-provider Summit Medical Group, based in Berkeley Heights, and serving patients across a swath of northeastern New Jersey, via 36 different clinic sites. I interviewed Dr. LeBenger for our September cover story on physicians and risk, and he had absolutely no lack of confidence about his group’s ability to manage financial going forward. “We spent millions developing our care management program, with hospitalists and with extensivists. And now we have four high-acuity urgent care centers. That’s the model. With chest pain, belly pain, our patients go there. And our admission rate is only 2-3 percent from our urgent care centers, whereas at the average hospital, they’re admitting over 20 percent of those patients.”
Importantly, LeBenger and his fellow executives at Summit Medical Group are compensating their physician colleagues based on quality metrics, with the result that they’ve achieved success in patient outcomes, on a per-member per-month average cost of $60, “whereas the benchmark in New Jersey is over $110,” as he told me. And if you read that cover story, you’ll see that physician leaders like Dr. LeBenger and his colleagues at Summit, are indeed “cracking the code” on how to engage their physician colleagues forward to truly manage care as well as costs, in the medical group setting—a critical success factor for accountable care and population health going forward.
Innovators push the envelope on multiple fronts
Speaking of innovation, our annual Healthcare Informatics Innovator Awards program netted four amazing winning teams of innovators, and eight wonderful semi-finalist teams. To those who complain that the leaders of U.S. patient care organizations simply aren’t moving fast enough to keep up with the demands facing them, we offer the stories of these twelve teams as proof that there are plenty of pioneers pushing the proverbial envelope across every area of endeavor open to patient care organizations.