Put Me in Coach: Mandatory bundled payments will force many provider organizations off of the value-based care sidelines and into the game in 2016. Some will win, most will struggle and many will fail—forcing providers to put into place a true value-based care strategy built upon network scale and scope and the clinical and IT infrastructure to successfully manage value-based programs.
Penny Wise, Population Health Foolish: Health system–employed primary care medical groups become the norm—and will continue to drain health system resources—whereas achieving real value under population health models remains elusive for many as health systems struggle to manage chronic patient populations and transitions into (and from) post-acute environments. Network development across the continuum as well as specialist integration will be seen as equally critical, if not more so, as primary care.
Get with the In-Crowd: Successful health systems with regional strength will turn the tables on payers and set the terms for narrow networks and direct-to-employer contracts to secure and grow share, manage appropriate utilization, and take more risk—and share—of the premium dollar.
There’s an App for That: In population centers, health systems that embrace retail, digital and telemedicine platforms will realize big gains in brand value and set the stage for essentiality to shift from physical assets to service and results.
I’ll Sit This Dance Out: Population health is not for everyone or for every organization. The road to value-based care does not require everyone to do the “Hustle” when a simple “Waltz” will do. Listen to the music that is relevant in your market, and pick your dance partners wisely.
Back to the Future: Provider merger and acquisition activity will continue to be strong in 2016 as providers continue to partner in an effort to achieve scale, especially in response to the market transition to value-based care. Federal and payer challenges to hospital asset and even virtual mergers will force many health systems to revisit vertical (payer and medical group) integration as an alternative foundation of their strategy.
Child’s Play: Downward financial pressure means community hospitals will face the closure of their NICUs and smaller pediatric programs, and children’s hospitals will step in to either manage these units or create new capacity on their own campuses. Simultaneously, integrated health systems holding on to their pediatric platforms will look to freestanding children’s and academic medical centers for subspecialty support. Partnerships across key pediatric programs—and across state lines—will broaden research populations, and further advances in pediatric research will require a push for even greater collaboration in the future.
May–December Romance: Hospitals will develop lasting, meaningful relationships with post-acute care providers, though the match-making will require kissing many frogs along the way.
Do the Math: Health systems, newly rich with access to clinical data through investments in EHRs and HIEs, will increasingly invest in data aggregation and predictive analytics—and be soundly disappointed with their efforts. Unleashing the power of big data is not core to most organizations, will be hugely expensive and will require years of effort. It is one thing to do the math, and entirely another to act upon the results.