Patient orientation has become an important priority in the US healthcare industry, today. A major industry shift has happened toward value-based healthcare with a new patient-centric approach. High life expectancy in the 21st century has led to a growing population of seniors and, as a result, an increasing number of people with multiple chronic conditions. This has caused some problems in the healthcare industry, such as higher expenditures on healthcare and the need to search for ways on how to slow down spending and improve care quality at the same time. A new concept of population health management (PHM) brought together a new approach to public health, with a greater focus on care delivery and patient engagement. It’s becoming clear that the industry is moving away from a fee-for-service model towards preventive care and well-being of the nation.
Instead of seeing a patient as an individual with an illness, clinicians are now collecting social and economic data to detect the disparities and care gaps among various population groups. Social determinants impact care access, mortality, life expectancy, and other vital areas. In 2016, 22% percent of Hispanics did not visit doctors for needed care because of cost; with 13% White and 10% Asian Americans, respectively. There is also a well-documented link between poverty and a higher risk of infections.
Current trends in the healthcare industry require new data storage models and data managing systems. There is also a need to enable data encryption, as well as, a need for a decentralized platform and coordination between engaged parties.
What Are the Greatest Challenges Facing the Healthcare Industry?
The healthcare landscape has been defined by challenges and uncertainties over the past several years. Healthcare leaders want to keep their organizations above water and to stay ahead of the competition. The competition has only intensified with non-traditional private companies entering the market. The margin pressure on maintaining profit margins is still one of the biggest healthcare industry challenges for providers. This is largely due to lower reimbursement rates and increased competition in attracting new patients or even retaining existing ones. Increased patient expectations and the need for constant innovations place a burden on care providers. 74% of surveyed physicians report burnout, while 46% consider changing careers.
The rise of consumerism is also one of the greatest challenges facing the healthcare industry today. On the one hand, growing consumerism leads to better care quality and a patient-centric approach. However, not every health system is ready to compete in this new environment. According to the 2019 Healthcare Consumerism Report, providers are not meeting consumers’ priorities. For example, 81% of consumers place customer experience among their top priorities, while only 11% of providers reported having superb capabilities. Other areas are even worse. For example, less than 4% of providers admitted having enough capabilities to provide consumers with digital tools for their engagement, price transparency, outpatient pricing strategy, or virtual access.
Additionally, there is an intensifying conflict over the roles and responsibilities between providers and payers. New reimbursement rules and payment models have blurred the historically clear borders between those who pay and those who manage patients. More providers now offer their own insurance products or manage the total costs of an employee population, directly. The outcomes of this struggle depend on collaborative working relationships between payers and providers.
New healthcare industry issues are forcing hospitals to change their traditional “own and control” thinking to improve relationships with practitioners on clinical and financial levels through joint ventures, CINs, and co-management models.
How Technology Has Affected the Evolution of the Healthcare Industry
In 2020, digital connectivity has become essential, with the providers feeling pressured to meet growing expectations of consumers. It would be difficult to fully illustrate how technology has affected the evolution of the healthcare industry. Competition drives health systems’ investments into facility expansions and advanced technology offerings. Those who lack modern infrastructure and sufficient sophistication will most likely become candidates for consolidation. Health system managers are consistently exploring opportunities on how to improve their efficiency via new technologies. However, there is a pitfall. The adoption of new technology requires better data security and the right balance between planning further system sophistication while remaining competitive.
The integration of new technologies is also challenging because of high implementation cost and integration difficulties; such as the problems with transportability and the likelihood of clinical workflow disruption. For these reasons, easily integrated solutions addressing several problems, fitting both patients and practitioners, and ensuring superb data encryption, have gained popularity. Solve.Care is one of the most prominent examples of this one-fits-all solution.
Commenting on the healthcare industry trends, Dr. David Hanekom, former CEO officer of Arizona Care Network, the President for North America and Chief Medical Officer of Solve.Care, said, “By creating a comprehensive ecosystem to address the needs of people in healthcare systems across the globe, Solve.Care is innovating the archaic administration and coordination systems of healthcare, using distributed ledger technology, and redirecting those resources to deliver higher quality care at lower costs, with greater satisfaction for patients and clinicians.”
Changes in the Healthcare Industry
New reimbursement rules, the Affordable Care Act, and an uncertain political environment drives changes in the healthcare industry. The most noticeable change is the transformation of traditional business models. The roles of payers and providers are changing, as well as the new addition of private companies. More importantly, the focus has changed in its shift to a more patient-centered approach.
To ensure affordable and high-quality patient care, a new type of healthcare entity was introduced, the Accountable Care Organizations (ACO). The ACO is a voluntary network of practitioners, providers, and suppliers who work together to share their knowledge, improve care outcomes, and lower costs. They use non-traditional payment models, such as incentives, and reduce redundant services by eliminating the billing process. The largest US ACOs, such as Texas Medical Association, Blue Cross and Blue Shield of Texas ACO, Childrens Hospital of Philadelphia (CHOP) ACO, Arizona Care Network (ACN), and others, are at the forefront of adopting new technologies in their practice. Cooperation between Solve.Care and ACN has demonstrated how technology solutions may change the administration process and coordination of care. Blockchain systems allow ACN to use digital payments ensuring a high level of data encryption. Furthermore, practitioners can utilize the Solve.Care platform for closing care gaps and proactively delivering better care.
The impact of advanced technologies and machine learning will accelerate innovations. Millions of dollars are already being invested in the creation of services that can be easily used for various applications and by various customers. Machine learning technologies and diagnosis predicting through AI are promising fields, though not yet widely used. There are still concerns about the logic AI uses to make a diagnosis. These new technologies will, however, allow clinicians to perform more sophisticated data analysis including socioeconomic determinants. Correlations between social and economic factors and behavioral and physical health, have already been detected. Data collection and analysis will enable government and healthcare leaders to address all factors that impact health.
Drug pricing and cost control in the healthcare industry continue to generate debate. With the skyrocketing prices for branded drugs, there is a drug shortage forcing the Food and Drug Administration (FDA) to search for better solutions. Reforms are still crucial for addressing prices of branded drugs and obstacles that slow down generic medication from entering the market. They have already made great steps in accelerating a review of competitors’ applications for producing shortage products.
Despite current challenges in the healthcare industry, traditional approaches will certainly lack the ability to flourish under new circumstances. The only way that health systems can survive is to constantly try new ways of care delivery without losing sight of the reason they exist. And above all, healthcare systems need to provide quality care to every patient regardless of where, when, or how patients need it.