Consulo Indicium – The Top 10 for 2021
Information for your Consideration…
Over the last decade, as I’ve finished the year, I’ve tried to put forward my top considerations for the health care industry as we move into the new year. I’m a day or two late for my personal deadline but, here are my thoughts. For starters, we should assume that the global pandemic or COVID-19 has “changed everything” – or, perhaps more accurately – “accelerated everything”. If you think I’m off base, let me know…
#1: The Move Toward Value-based Care Accelerates – I did some research the other day on the 2021 federal budget and the amount of money our society spends on various components of the budget. If you take just Social Security, Medicare, and Medicaid, you will have identified 51.6% of the entire federal budget. That’s a lot of dollars going to just a very few sectors of society in an era where the demand in other areas is expanding appreciably. For example, do we really think that we’ll be able to get by with only $92B spend on Homeland Security and $33B on the State Department when we have the SolarWinds hacking of our government IT systems by the Russians? There is clearly a need for beefing up both the technology and the liaison sides of our relationships throughout the world. But, even if you disagree with the ideas I outlined above – as I look at the total federal spend outlined above for 2021, the biggest target of the bunch is Health and Human Services with Medicare and Medicaid taking the prize as the biggest share of the pie. Hmmmm…if I were in Congress and looking for ways to manage the budget, I would likely take at look at the biggest cost areas to see if there were any efficiencies that could be extracted.
TOTAL $7,815 100%
A review of the above points and the data brings me full circle to the opening point! The US will need to (must?) move away from the traditional fee-for-service driven health care economy that encourages health care providers to “do” something in order to gain a payment toward a health care economy that is driven by value-care delivery or the “outcomes” from services delivered. Upwards of 20 – 30% savings have been projected through such an initiative. If you apply that to the Care/Caid sector alone ($1,382T) you come up with $276 – 414B in revenue that could be applied to other areas. Now couple that with the fact the deficit is growing by the trillions (no longer the billions) on an annual basis. It’s called “focus on the low hanging fruit” and, health care is part of that equation.
#2: Cybersecurity Moves from Problem to Reality – In the old days, the focus of health care cybersecurity was what happened inside the walls of the hospital, clinic, or whatever institutional base you led. Now, cybersecurity is part of a network of organizations, devices and people with varying capabilities working asynchronously to deliver health services. The complexity of cybersecurity has intensified substantially to the point where the “network” needs to be stabilized. Such an effort will require collaboration, the use of standards, and mutual required capabilities among the participants to the network. The game has changed. It will also require a much more intensive focus than simply a bunch of cyberfolks sitting in the basement. It will require the attention of leadership on a continuous basis.
#3: Health Care Demands Open Interoperability – Seamless data exchange across multiple devices and across institutions will absolutely rise to the top of the agenda for health care systems preparing for a new day. Without it, delivering the right care at the right time in the right place will simply be inoperable! Health care systems will be required to move from passive recipients of stipulations instituted by vendors who build blockades to their IT systems for purposes of control to active advocates for interoperability. In fact, I anticipate that the health care systems will be much more forthcoming on the need for interoperability as the pandemic begins to sunset as the number one priority in care delivery.
#4 – Social and Geographic Equity Become Major Concerns – The global pandemic has exposed the clear inequities that exist in our care delivery capabilities across the nation. While the social inequities have received much of the attention over the last year – and deservedly so – the geographic inequities are looming in the background. Rural hospitals are closing at a far more rapid rate than in urban areas. It is anticipated that 25 -30+% of rural primary care providers will be retiring, become disabled or dying over the next five years with no replacement providers in the pipeline!
#5: Total Experience Becomes a Priority – The focus of the last decade has been around technology deployment and clinical enhancement. While these are laudable, as we move toward a value-based care delivery model, the need for a focus on the total experience of customers becomes an important consideration on how, where and who they select for services. This will require an internal, system focus on the people delivering the care, the experience of the people receiving the care, and the technologies deployed for supporting the care delivery. This “total experience” focus will become a requisite!
#6: Technology Moves from Intelligence and Support to Management and Manipulation as it Moves from the Showroom to the Living Room – When I first saw the video from Boston Dynamics a couple of days ago, my first reaction was that it was fake! But, it’s real. Robots have actually been trained to dance. So, robots are not only making medication drops at the nurse station anymore, they are able to dance! That gets our attention. Even more exciting is that fact that there are robots out there for helping people to get out of bed, to walk to the bathroom, to engage in a whole array of “support” activities for those needing service at home or even in institutions. We are very quickly moving toward the integration of robotic care as a component of human care. Beyond the “support” component there is also a shift in the artificial intelligence/machine learning areas towards “augmented intelligence”. In other words, what can we do to support clinicians so they do a better job? I’ll point to DocBot – an AI/ML colonoscopy capability that in initial studies improves the detection of primary care providers and nurse practitioners but also experts in colonoscopy!! Everyone gets better outcomes. That’s augmented intelligence – and, most importantly, it is where we will get the greatest value from AI/ML initiatives. And, if we shift to the “management” and “manipulation” side of technology – there are any number of examples there as well. The successful outcome of Project Warp Speed was due in large part to the methodology used in creating the vaccines by Pfizer, Moderna and their partners. The Messenger RNA is only at the formative stages of development as a technology for rapidly re-engineering a whole array of problems. The use (and potential abuse) of the human genome will be moving to center stage. While it may seem that robots and genomic manipulation are vastly different capabilities, they are derived from the same basic route of technology investment. Beginning in the 1940s and 50s – and, extending over the following decades – we saw the massive impact of medication technology on infectious diseases and core treatment capabilities. The same is now happening on the technology front. Technology as a core capability is invading all things human! Whether it is driving cares, doing surgical procedures, or replicating genes – technology and all of its interfaces are moving to the forefront. Health care will experience some of the most dramatic and rapid changes due to our reliance upon human resources in traditional care delivery. The changes are beginning now. Take note!
#7: Telehealth Shifts from Disconnected Slices of Care to Comprehensive Coordinated Care – Telehealth in its initial offerings has been focused on slices of care (e.g., strokes, cardiac, diabetes, pick-your-favorite problem). The need for moving toward a more “comprehensive coordinated care (C3)” model is required because people do not have slices of medical problems in isolation (NOTE: For more information on the C3 model, send a note to Dr. Fickenscher). A comprehensive approach integrates the face-to-face component, the social determinants, the economic considerations, the provider capabilities, the learnings over time into a common care delivery bucket. We are only at the formative stage of such thinking, but it will become an imperative as we use tools more and find that simply having tools that create isolated value in a disconnected way is not the best approach toward value-based care delivery.
#8: Infrastructure Requirements Will Move to the Forefront – We’ve all heard about the difficulties of maintaining a connection on the Internet. But, if you live in Boston, or Cleveland or Denver – your problems are miniscule compared to the folks living in the vast swath of rural areas across the country. As a young sapling physician I worked in the “rural health” area and while we were able to make some positive changes, one of the areas that was left behind was quality technical infrastructure. As a result, there is a need for a program similar to the Rural Electrification Administration (REA) or Interstate Highway System related to information technology infrastructure. This will not only be a requirement for health care but it will also be the pathway for economic development and education as well as health care delivery. It will need to be an open system that is usable by all these sectors and the demand will accelerate throughout 2021.
#9: Consolidation Accelerates – There has already been a high degree of consolidation in the health care market. Health care systems are evolving over large geographic areas. Economics will be the primary driver along with maintaining technical capabilities in a rapidly changing environment. Those systems that create internal “innovation hubs” for driving new ideas and capabilities will be the leaders over the coming decade with the global pandemic driving much of the initial consolidation.
#10 – Relearning Leadership and Management in a Disconnected and Virtual World – Our health care leaders – I believe – are ill-prepared for “managing” and “leading” in the new virtual world we have entered. The approach for maintaining connection around culture and focus will be challenged in the new era. Rethinking how, where and who leads will move to the forefront if health care is to be successful in making the turn towards value-based care delivery. So, circle back to #1 and review again…