How Healthcare Will Evolve Over the Next Three Years

Within the next three years, clinical, operational and financial dimensions of care delivery will evolve substantially with bottom-line financial implications.

Here are a few of my predictions:

Clinical Evolution

Medicine will become more computer-assisted. Clinical Decision Support Systems (CDSS) embedded in hospital and physician practices will increasingly help physicians and non-physician caregivers with diagnosis and treatment decisions. Diagnosis and treatment algorithms will also be more quickly up- dated because of greater IT penetration.

A transition to ICD-10 coding will yield more granular data about diagnoses and disease management, allowing providers, policy makers and payers to emphasize quality care with incentives, rewards and penalties.

Operational Evolution

Primary care practices will drive care delivery as Accountable Care Organizations (ACOs) reshape the landscape. While maintaining quality standards, ACOs will curb utilization and share in savings once a thresh- old of cost reduction is met. Consequently, ACOs will coordinate care across the continuum of physicians, hospitals, non-acute and post-acute settings.

IT will improve care coordination and reduce testing utilization as patients’ records are consolidated and routinely updated. More speedy diagnosis and treatment continuation will shorten care pathways and non-acute care delivery with the benefit of telemedicine and remote patient monitoring.

Administrative tasks will be automated.  Quality re-porting and disease management data and billing will be facilitated by ICD-10 and health IT. Pervasive IT system expansion and process automation will reduce the number of clerical tasks performed.

Financial Evolution

Physicians will endure some level of cuts in Medicare reimbursements, and they will be paid for their per- formance based on the Physician Quality Reporting Initiative (PQRI) and other mechanisms.

Hospitals will endure persistent reimbursement cuts as disproportionate share (DSH) payments disappear, market basket updates are adjusted downward and increases in reimbursement are increasingly contingent upon quality and cost performance.

All non-critical access hospitals will be paid based on their quality performance, receive reimbursement cuts for avoidable readmissions and hospital-acquired conditions, and be paid bonuses if they qualify among the lowest spending per Medicare enrollee.

In 2015 physicians and hospitals will be preparing to share reimbursement for inpatient care under a bundled payment reimbursement system. Increasingly, individual procedures will lose direct reimbursement and be paid in bundles corresponding with episodes of care—a so-called episode-based payment.

Payment policies will change quickly as more granular clinical outcomes, cost and utilization data are analyzed by payers and payment advisory groups.  Evidence-based medicine and comparative effectiveness data will affect reimbursement in multiple categories including pharmaceuticals.

Many of these changes are cogently summarized by the Kaiser Foundation (visit www.kff.org/health reform/8061.cfm), but these changes will affect the member/GPO relationship.

Question: If utilization must go down, how can GPOs create increasing value?

– Gunter Wessels

Image Courtesy of gwire