Along with Ron Kuerbitz’s perspectives, the 2019 Healthcare Predictions includes commentaries from Bruce Leff, MD, Director for The Center for Transformative Geriatric Research at Johns Hopkins, Don McDaniel, Canton & Company CEO, David Nash, MD, Dean of the Jefferson College of Population Health, and Jon Zimmerman, President of Virence Health Technologies.
Here is what Ron had to share.
1. What is your outlook for healthcare in 2019? What will change or not?
Overall, I am tremendously bullish for the industry’s abilities to deliver on the quadruple aim, and I expect the current tailwinds to continue. We see pockets of significant innovation across the landscape, the current administration appears to be introducing the right constructs and policies to reward quality and efficiency, and leading practices have shown that investments in coordinating care and identifying and managing outlier populations can effectively bend the cost curve.
On the other hand, we should closely monitor the hardships endured by the majority of physicians who still today practice in smaller independent practices. Many find it difficult to make the necessary investments to make a sustainable transition to managing total cost and quality of care. I especially worry that physician burnout and frustration with the transition to risk will increase for most of these providers.
2. Why will these trends continue?
We continue to closely watch the policymaking coming out of Washington. We applaud the administration’s support for the growth of Medicare Advantage and for the continued enablement of providers to assume more risk for the traditional Medicare population. Those trends will continue to support investment into integrated payment and care delivery that are critical to the sustainability of our healthcare system. Our physician partners and health plan collaborators recognize that we are at an important inflection point, and both are committed to working together to create an innovative, yet efficient, delivery system.
I believe, however, the most significant risk we have to fulfilling our mission of achieving the highest-quality value-based care at national scale is the leap required to fully integrate healthcare financing with the provision of care.
I consistently see practices and health systems struggle to operationalize a gradual glide path to risk. I don’t think that’s possible. I believe that practices must be positioned to make significant upfront investments in infrastructure and physician incentives, and without that, are likely to experience a growing sense of burnout and frustration in managing risk. These providers – caught with one leg on the fee-for-service dock and one in the value-based care boat – are doing a lot of work, but they’re not seeing a lot of improvement in their quality of life at work or sustainability in the investments they’ve had to make to support this kind of transition.
This is especially prevalent in primary care. Recent studies report up to 65% of family practice physicians are experiencing burnout. Think about the systems in place today; they aren’t designed for physicians to be optimally effective.
Physicians are managing patients in different lines of business, across numerous payers, in various reimbursement arrangements. The multiplicity of processes, the impossibility of making the right investment, and the inability to change these circumstances is overwhelming and a catalyst for burnout.
3. What impact will this have?
As I said earlier, I’m extremely bullish for the practices and health systems that have taken the leap and made the necessary investments to be successful in true value-based care. I see that physicians have more time to spend with the right patients at the right time. As a result, these physicians are being rewarded for their mastery and sense of purpose and have the capability to make the right investments to sustain their practice and improve their engagement with patients.
However, today these successful practices are still among the minority. The vast majority of others are seemingly caught in a vicious cycle of too little time and insufficient resources to make the leap to risk. They are inclined to become disenchanted with new team-based care models and protocols and might regress back to a focus on pure fee-for-service economics and paradigms.
4. What advice do you have for industry stakeholders who want to prepare for the forecast you’ve outlined today?
For industry veterans like myself, we’ve never seen a time where there are such significant tailwinds for improving our healthcare delivery system. Our technologies, policies, capabilities, and economics are highly aligned around quality and efficiency. But we need to take advantage of it, and as such, we need to embrace a mindset change. We’re going to have to become collaborators with one another and build better partnerships to take advantage of the opportunities before us. We need to get physicians constructively engaged in the transition from fee-for-service to risk. We have to think about providing support to get them into organized systems on terms that make sense to them.
It’s akin to when the Detroit automotive manufacturers embraced vendors in the supply chain. They realized collaboration needed to happen for quality and value to improve. Vendors started attending design sessions and really participating as partners with the manufacturers. The result was quality cars built at lower prices that better met consumer needs. They understood that simply squeezing your counterparts doesn’t create value.
Healthcare stakeholders can partake in that kind of thinking – it’s the fundamental change that needs to happen.