The changes taking place in today’s healthcare ecosystem do not allow providers the luxury of continuing business as usual. The scope and speed of these changes demand that organizations implement their own changes—often significant ones—both internally and in the ways they interact with the larger ecosystem.
The formidable challenges of recent years include clinician shortages and burnout, soaring costs, evolving consumer expectations, the ongoing shift toward value-based care (VBC), and increased disruption by retailers expanding their presence in the healthcare market. It’s no wonder that a central theme of next month’s Becker’s Healthcare conference is the constant disruption and innovation in healthcare. Even in an industry that’s always in flux, no one could have predicted just how much change we’d face in the last few years.
Responsive and proactive changes that providers must make to succeed in this environment may involve organizational culture, operations, processes, technology and infrastructure, resource and budget allocations, and other areas. Here are four broad goals for provider organizations to pursue in their change management efforts:
- Improve the quality, delivery and breadth of care.
- Create more operational efficiencies.
- Remain financially healthy.
- Create strategic partnerships.
Let’s take a look at each of these areas, including strategies for addressing them.
Improve the Quality, Delivery and Breadth of Care
Care must naturally be the top priority, and its parameters continue to change. Consumers’ expectations have evolved, driven partly by their favorable experiences with other industries, such as travel and retail. Healthcare consumers are now demanding convenience and accessibility, pricing transparency and other qualities as part of a seamless, frictionless experience.
Delivering an exceptional patient experience requires providers, more than ever, to treat the whole person, addressing physical and emotional well-being along with the social determinants of health (SDOH) that affect one’s overall well-being. To do this effectively, they must be able to:
- Harness and analyze data to identify care gaps, comorbidities and other issues
- Build collaborative care teams that span settings and transcend silos
- Partner with community organizations to provide crucial resources such as housing, transportation, employment, food and nutrition, and even technology
- Leverage technology to connect providers, payers and community organizations
- Involve and engage individuals as well as their caregivers and support system
- Measure the impact of their efforts with key performance indicators such as health outcomes, utilization, and adherence to medication and treatment plans
Interventions targeting at-risk patients and those who are on the verge of being at risk can help to avert lengthy hospitalizations, readmissions and unnecessary visits to the emergency room. For example, providers can partner with community organizations to ensure that patients living in food deserts are able to obtain fresh fruits and vegetables, or that patients who don’t have a vehicle or access to public transportation are able to get their medications from the pharmacy.
Care management software such as Medecision’s Aerial™ solution can connect care teams; provide a 360-degree view of patient health; and deliver data and insights that drive patient engagement, inform utilization management and reduce costs.
Digital engagement is an important factor in the equation. A growing number of patients of all ages depend on smartphones, tablets and other digital tools to stay connected with the world around them, and healthcare should be no exception. The ability to communicate through one’s preferred channel facilitates access to personal healthcare information, scheduling and more. Access to technologies, and the ability to use them, can no longer be viewed as luxuries; because such tools are necessary for effective patient engagement, technological access and know-how could well be considered an SDOH.
COVID-19, which has not disappeared but rather continued to morph, served as a catalyst for innovation while highlighting the importance and viability of holistic, virtual and community-based care. These developments have added to the momentum driving healthcare’s shift to VBC payment models from traditional fee-for-service models
Create More Operational Efficiencies
Shortages of physicians, nurses and other clinicians, and the stress and burnout that have exacerbated these shortages, have heightened the need for operational efficiencies. Automation is one way to improve such efficiencies.
Automation can expedite prior authorization, an often inefficient and time-consuming process integral to utilization management, which aims to ensure quality and manage risk while cutting costs. Automation can also streamline workflows—lessening the burden on staff, freeing them to expend their energies on higher-value tasks, and creating room for larger profit margins.
Virtual nurses are one way that some healthcare systems are addressing nurse shortages and improving efficiencies, as Becker’s Hospital Review recently reported. This innovation is one of the latest forms of virtual care, which can help providers address healthcare disparities, expand access to care and keep patients engaged—without putting undue strain on organizational resources.
Remain Financially Healthy
To maintain their own financial health, providers must find ways to create larger profit margins, optimizing the use of scarce resources, particularly the human ones. Controlling costs is one of the primary mechanisms for achieving this goal.
In addition to utilization management, strategies for improving healthcare outcomes while reducing costs include care management, chronic disease management and other programs that target high-risk individuals and populations. The use of clinical data is essential to the identification of those who are eligible for such a program, as are ongoing education and outreach.
Alternative sites of care can also be useful in caring for individuals whose treatment does not require that they be hospitalized and who can instead receive the care they need in a lower-cost setting such as at home or virtually.
Develop Strategic Partnerships
Collaboration across the care continuum has become increasingly vital as the focus on holistic health has grown. We have discussed the role that community-based organizations can play in addressing SDOH, for example, and touched on comorbidities, which often require care from multiple providers.
The timely sharing of relevant and actionable healthcare information among provider organizations does not necessarily entail a partnership. In today’s marketplace, however, partnerships often make sense, and providers should stay alert to potential opportunities.
One trend we previously mentioned is the expanding presence of major retailers in the healthcare marketplace. A February 17 report from the American Hospital Association took a look at seven such companies: Amazon, CVS Health, UnitedHealth Group, Walgreens, Walmart, Apple and Google. While results have been mixed, these companies may bring value to the table, particularly when it comes to the data they possess.
The bottom line is this: Today’s providers must be diligent in pursuing opportunities that will allow them to successfully manage change so that they can provide better care at a lower cost.
The change management experts at Aveus can help.
Next Steps for Healthcare Providers
- Access your copy of our white paper “Addressing Social Determinants of Health: A Practical Road Map.”
- Contact a Medecision expert to learn about solutions that support providers’ efforts to deliver better care and introduce operational efficiencies.
- Contact Aveus, the healthcare consulting division of Medecision, to get expert help for improving your organization’s ability to manage change.
- Subscribe to the Medecision blog for more healthcare trends and strategies like this.
About The Author: Medecision
Medecision® is a digital care management company whose solutions and services are used by leading health plans and care delivery organizations to support more than 42 million people nationwide. Aerial™, a HITRUST CSF®-certified, SaaS solution from Medecision, seamlessly connects the healthcare ecosystem to powerful data and insights that drive meaningful consumer engagement while creating efficiencies to reduce costs and support effective care, case and utilization management. Aveus, our professional services division, helps business leaders solve complex challenges and drive better performance, leaving organizations more capable.
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