November 1, 2019

Hey, Alexa, Where’s My Healthcare System?

Voice search for health care may be the future of health systems, becoming virtual more than physical.

For decades, we’ve worked intimately with systems to improve how they could deliver care. From HealthPartners to Avera, Mayo Clinic Health System, Essentia, and M Health Fairview, the focus has usually been on how individual sites fit into the larger picture to create a continuum of care at a scale that is sustainable and beneficial for patients and communities.

As economics have pressured organizations to streamline and create efficiencies, that growth of systems has accelerated, either through acquisition of independent hospitals and clinics or the growth of independents into a system of their own.

So, when a thought leader with the Advisory Board presented in BWBR’s offices on the future of health systems, it gave us pause when Stuart Clark talked of “systems” but did not mention traditional health organizations. As Stu pointed out, systemizing healthcare in the more traditional approach of mergers and acquisitions has evolved to a point where the major players are not necessarily organizations like Kaiser, Cleveland Clinic, or even Mayo Clinic.

Playing the role of disruptors in the healthcare industry as they have in their own respective market sectors, companies like Amazon (Amazon pays for employees to travel for cancer treatment); CVSHealth (CVS looks to make its drugstores a destination for healthcare); UnitedHealth (FTC approves UnitedHealth-DaVita deal); and Walmart (company to give employees financial incentives to use higher quality doctors) are now creating the new systems of care we’ve traditionally seen created by traditional healthcare organizations. While these companies might initially be targeting less acute care needs, efforts to enter primary care, improve the management of chronic diseases, or capture more of the healthcare spending can be seen in retail space transitioning to clinic space or utilization of established distribution platforms.

By example, as Stu noted, CVS commits almost 20% of their retail space to healthcare. With CVS’ acquisition of insurer Aetna, they now have a network and audience to manage chronic disease, steer patients away from emergency departments, engage their insured members in wellness discussions and options, and cross sell products.

If you have Amazon’s Alexa, and even better, an Amazon Prime account, finding care could be a “Hey, Alexa,” away, but the response could also be limited to the Amazon relationship with area providers or insurance companies.

More than a trend, this systemization of our healthcare beyond what we have traditionally thought of as a healthcare system is becoming a real challenge for hospitals and clinics operating in this fast-changing environment. Payer reform is challenging enough. Competition is equally challenging if not harder especially when it is with new entrants who operate by yet-to-emerge if not different rules.

In a recent blog, I spoke to a concept of “coopetition” as a way to compete. This has traditionally been in how partnerships are formed with direct competitors (i.e., provider service agreements). However, competitors need to be recognized as more than the other provider down the street. Competitors in healthcare are those who are in our homes (virtually), at the grocery store, and worn on our bodies.

In a SWOT analysis, where we place questions like, “How will this impact volumes?” “What will be the impact on current space?” or “How can we provide similar services?” will influence how we respond to these new challenges. Are they threats, or are they opportunities? There’s no simple answer. These new systems might be an opportunity to rethink and form new relationships. They could also be the inspiration for existing healthcare organizations to recognize new ways to deliver care themselves.

When asked to think about how they serve their patient populations, traditional healthcare organizations often fall back to the formal ways (or places) they serve through clinics, hospitals, ASCs, nursing homes, etc. When we change the question to be more open ended and asks, “how” can we serve populations of healthy and well, chronic, and even acute populations many of the responses are very similar to what the new healthcare systems are doing.

What will traditional healthcare systems need to do to make sure they aren’t missing in the future? Obviously, the answers are elusive.

What we do know is that the way systems have formed and grown through mergers and acquisitions in the past have not always proved successful. Stu shared roughly 59% of acquired hospitals failed to outperform their market peers two years after acquisition. Additionally, 1 in 5 hospitals went from a having positive margins to negative margins over a two-year period.

The idea that bigger is better fails to produce if the only thing that has grown bigger are the elements that are under threat. By thinking of systems beyond geographic borders, much like Amazon and Walmart are doing, organizations may be able to improve or expand services designed into their operations and space. More than far-fetched, it’s an idea embodied in services like telemedicine, which, while not new, has grown in acceptance and utilization from providers and patients, alike.

Recognizably, at some point in a person’s care there will always be a need for a place/space where hands-on care will be required, needed, and even desired. What that looks like and how it will be presented may be unknown today, but the human factor will have a place. In that SWOT analysis, that’s the strength healthcare organizations can’t ignore. It’s also the complement they need to leverage any opportunity in designing whatever this new system will be.

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