The Transition of Healthcare as an Industry

By: Sean M. Weiss, CMPM, CPMA, CPC, CPC-P, CCP-P, ACS-EM
Vice President and Chief Compliance Officer

As a healthcare professional working for one of the premiere full-scale medical consultancies servicing the needs of hundreds of medical practices, hospitals, hospice facilities, and urgent care centers, and thousands of healthcare professionals, it is my job to provide clients with the latest information and trends impacting the industry, not just from a compliance standpoint but from an operations standpoint. Lately I have found myself more and more interested in data and analytics as I believe that as practices merge or become acquired by other practices or groups, they become more complex and require evidence based information to make critical decisions rather than making decisions based on speculation.

While I have never been a math-wiz, I have found myself lately relying on advanced mathematics, statistics, predictive modeling, and analytics to influence the recommendations and implementation strategies I provide my clients. However, equally as important is paying attention to trends as these tend to dictate our future. As the years go by we will have no choice but to become more analytical as healthcare professionals to allow us to keep pace with the markets and how they are trending.

Here are some interesting pieces of information: In 2012, more than 45M Americans did not have health insurance. Spending for major healthcare programs will be nearly 5 percent of GDP [gross domestic product] in 2013, and such spending is projected to grow rapidly when provisions of [Obamacare] are fully implemented by middecade, reaching 6.2 percent of GDP in 2023. Improvements in healthcare quality and safety can yield up to $400 million in healthcare savings. Healthcare costs attributable to cardiovascular disease, cancer, diabetes, obesity, and poor lifestyle choices approach $1 trillion. The question is: How would you use this information to influence decision for your group/practice? What impact, if any, would the following information have on expanding your operations or adding more services into your provider mix? The point I am making is: You have to follow the trends and stay on top of what is happening in the industry to ensure you're making decisions based on facts and not speculation.

I recently read a great article about the 7 Major Mega Trends in HealthCare by Arundhati Parmar (What are the 7 mega-trends that will redefine the healthcare industry in 2013?). The author spends time citing the key aspects to watch for according to Paul Keckley of the Deloitte Center for Health Solutions. The author states, "that business as usual won't do - and present a "new normal." It goes without saying that simply recognizing the mega-trends won't do. Accepting them and changing is key. In other words, the dictum -using another well-worn cliché-is "change or die."

Below are the 7 Mega Trends as outlined by the author:

  1. Demanding demographics: The U.S. population is changing - it's more diverse and older than it used to be. There are also large income disparities within that population. The ability to access insurance and the desire to have more healthful lifestyles are creating a unique set of demographics that is engaging with their healthcare and demanding more from the healthcare industry than previously.
  2. Strategic globalization: U.S. companies involved in healthcare are looking to expand overseas. Not only is there inherent demand from the local population but medical tourism is on the rise: 25 percent of consumers report that they are willing to travel for a medical procedure. It's important to look beyond U.S. borders for growth given projections like the U.S. share of global drug sales will drop 31 percent by 2015. And it's not just pharma or device companies that need to look for growth in foreign soil, but insurance companies, providers, information technology companies as well.
  3. Unconstrained connectivity: Smartphones and mobile devices have heralded an era of unconstrained connectivity, and consumers now can access personal health records and electronic medical records online. But users want "control over their technologies that deliver information they want and need." The healthcare industry will be forever changed by this "unconstrained connectivity" through the leveraging of technology.
  4. Constrained resources: Alongside unconstrained connectivity stands the challenge of constrained resources in healthcare. Like other industries, healthcare industry suffers from a shortage in talent and faces difficulty in accessing capital. But sometimes the bill for healthcare services gets passed on to others, so sometimes the constraint is not immediately felt.
  5. Accelerated consolidation: Functioning under constrained resources requires the need for a bigger platform especially to achieve sustainability and scalability are important. In healthcare, a fragmented system-with more than 400 insurance operators, 5,800 hospitals, long-term care, and home care industrieswill see a heightened focus on consolidation.
  6. Big data: Massive amounts of data are being generated, but in healthcare what has changed is the availability of tools to translate that data into relevant information. What is also new in healthcare is how much demand there is from consumers to access that data. Big data is what will separate winners from losers in healthcare.
  7. Consumer discontent: Six out of 10 consumers are satisfied with the cost they pay for healthcare. More people view healthcare and its underperformance as a result of its waste and inefficiency. And as we move forward, people will talk less of patients and clinical trial subjects and more of consumers.

Bart Foster who is the Founder and CEO of SoloHealth also wrote an article in December of 2012 addressing the trends in healthcare for 2013 based on the upholding of the laws by the Supreme Court as well as with the advancements in technology.

Mr. Foster lists 10 trends to pay attention to in 2013 and these are provided below:

  1. Technology Paves the Way: No doubt that technology will continue to pave the way for a better overall healthcare system, providing a more efficient and effective experience between consumers, healthcare providers, insurers, and healthcare and wellness businesses. Of course technology will enable our antiquated processes to be better but technology will also propel consumers to have more engaged and interactive experiences with not only their doctors and providers but healthcare brands. As the consumerization of technology continues, look for mobile, digital, and cloud technologies to rise in importance.
  2. Industry Adapts to New Healthcare Bill: The nine-member Supreme Court made Obamacare official this past June, sending practically everyone involved in healthcare and wellness scrambling to understand and adjust to the coming changes. The bill's primary goalto provide more Americans affordable healthcare and reduce overall costsis a noble effort. But there are a lot of changes in that 2,400-page bill that will have many ripple effects across the industry. Look for businesses to continue to focus on how it will impact their daily business, customers, and bottom line. Healthcare businesses must continue to focus on how it will impact them and be proactive in connecting, engaging, and informing their consumers of any changes, how it impacts them, and how they can benefit.
  3. Awareness & Prevention Continues its Focus: The simple principles of awareness and prevention will continue to be at the forefront, as chronic diseases account for many of our healthcare issues and costs. According to CNN's Fareed Zakaria, just 5% of the U.S. population account for more than 50% of costs. Businesses and organizations from employers to insurers to retailers will institute health and wellness programs to encourage better health and prevention. It's a tried and true formula. Awareness and prevention are probably the best frontline defense against poor health and cutting unnecessary costs across the board.
  4. Renewed Focus on the Empowered Consumer: There's a fundamental shift in consumer behavior to a "do-it-myself" empowerment mentality, propelled by today's innovative technologies. And this cultural change will get a boost as healthcare providers and businesses look to shift more responsibility to employees to help offset rising costs and put a focus on shared responsibility. As a Wall Street Journal article recently noted, look for "definitely less paternalism in healthcare offerings." As consumers increasingly turn to self-service technologies and channels, the entire healthcare industry has a tremendous opportunity to reach, engage, and interact with today's empowered consumer.
  5. CMS Star Ratings Rise in Importance: Healthcare insurance providers stand to make billions in bonus payments if they meet a certain rating in the government's Centers for Medicare & Medicaid Services (CMS) Star Ratings program. The program essentially rates providers based on 53 performance measures-many of which are tied to screening services and managing chronic issuesand can receive bonuses for meeting four or more stars. Look for providers to extend services to consumers to help better manage chronic issues through self-service offerings and solutions, as well as other programs.
  6. Retail Plays an Increased Role: From pharmacies to in-store clinics and healthcare kiosks, retail establishments from Walgreens to Walmart to Safeway will play vital roles to connect with consumers for better healthcare access, awareness, and treatments. Consumers are still frequenting brick-n-mortar stores; connecting with them while they are there offers great opportunities for healthcare providers, advertisers, and the retail locations. Reach consumers where they are... in retail.
  7. Mobile, Mobile & Mobile: Despite the rise of retail, consumers are becoming dependent on smartphones. Gartner predicts that by 2013, mobile phones will overtake PCs as the most common device to access the web. If mobile isn't a top priority at your company, it better be real quickly. Increasingly, consumers, healthcare providers, and health and wellness businesses are turning to mobile and digital communities to connect, learn, and engage. There is great opportunity for healthcare professionals, retailers, and advertisers to develop innovative strategies to reach and engage with consumers when they are on the go. This opens tremendous opportunities for the entire health ecosystem.
  8. Consumer's Online & Offline Worlds Merge: Despite having a separate mobile and retail section in this list, the need for creating a holistic consumer experience will be a necessity moving forward. Yes, mobile is increasingly becoming part of consumer's lives. But they are still frequenting retail stores, using their laptops, social networking, and moving constantly between their offline and online worlds. So businesses need to be thinking about the complete consumer experience across all touch points. Take for instance, CEO of National Retail Federation Matt Shay's comment in last week's USA Today: "What we're going to see is that the two (online/offline) become further and further indistinguishable from one another. Everyone is playing everywhere now."
  9. Personalization& Relevancy Drives Consumer Experience: The rise of digital, social, and mobile-along with the empowerment of consumers-is directly tied to the growing trend of consumers wanting personalized and relevant communications from brands. No more cookie-cutter approach. Consumers know you have a wealth of data about them and they expect you to use it to customize to their preferences and needs. And relevancy and context are frequently mistaken for targeting and personalization, but they are not the same thing. Take for instance, our SoloHealth Station consumer kiosk. It's contextually relevant because we reach, target, and personalize to consumers when they are thinking about their healthcare. They are engaged for more than four minutes per session because it matters!
  10. Traditional "Lines" of Business Continues to Blur: The merger and partnership of insurers and hospital operators crosses a traditional healthcare divide. But look for this trend to continue as the industry restructures and overhauls healthcare operations to cut costs and make way for better efficiencies. Business will collaborate and share data and processes. What once seemed like strange bedfellows now looks like smart, streamlined business.
    How will your group or practice use the above trends to help guide decisions? How will you attract the right people for the new normal that we have entered? Where and how will you gather the relevant data needed in this new world we are venturing into? What tools are available to you and where will you go to get them? These are questions that professional organizations are struggling to grasp and how to guide their clients down this new road. DoctorsManagement has been guiding physician groups, hospitals, and other medical providers through the new trends to hit our market since 1956 with great success.

While my job when writing for BC Advantage is to provide implementation guidance and analysis to the things health care professionals require to be effective and efficient, I cannot help but to share with you, our loyal reader, the fact that for 18 years, my team and the professional consultants at DoctorsManagement have been the trend setters. 

Sean M. Weiss is Vice President and Chief Compliance Officer for DoctorsManagement, LLC, a full-scale medical consultancy. As a practice management consultant, Sean specializes in the formation of medical practices, merger and acquisitions, divestitures, exit strategy planning, strategic planning (S.W.O.T.), and workflow analysis.  Sean is used by clients across the country as a turn-around expert based on his proven track record of success in the industry during the past 18 years. Sean has a significant background and heavy concentration in audit and appeal representation for large and small healthcare practices that have been targeted by federal (Medicare), state (Medicaid), and commercial insurance payors. Sean delivers measurable financial results for healthcare facilities and helps physicians deliver quality care without sacrificing government compliance. You can contact Sean at or 800-635-4040.