Healthcare

2015 was a tumultuous year in many ways. Mergers and acquisitions changed the landscape for both healthcare providers and the insurance industry, and legal challenges to the ACA provided uncertainty. Healthcare organizations continued to move from volume to value as they restructured and addressed costs and service delivery. Improving population health moved from discussion to action in many organizations.

It amazes me how seemingly disparate ideas, when considered together, can create new ways of seeing the world. Bear with me for a minute, and I’ll share an insight I’ve received lately based on two seemingly unrelated ideas.

Here’s the first idea: NY Times bestselling author Bruce Feiler gave a TED talk a couple of years ago about how to apply the concept of agile programming to families. He said that when using an agile programming model, teams meet once a week to answer three questions:

I’ve been thinking about the implications of UnitedHealth Group’s recent announcement to reduce its exposure on the healthcare exchanges.

The company’s CEO Stephen Hemsley said UnitedHealth had sustained heavy losses this year from policies on the exchanges, and as a result, will stop marketing efforts for 2016 plans and will cut commissions to brokers in efforts to limit the number of enrollees in exchange plans next year. He also indicated that the company is considering complete withdrawal from the marketplace in 2017.

We’ve been publishing blogs about healthcare for more than a year, and we hoped we’ve provided some good information about where the industry is and where it might be going. Sometimes we write about trends in the industry, sometimes we write about what we’ve learned, and sometimes we write about what might be possible in the future. We hope you’ve enjoyed our blogs and have taken something from each one to help you do your job better.

Medicare turns 50 this week with a number of substantial challenges in its future, and its overall success may be one of the largest contributing factors. When Medicare was created in 1965, nearly half of all seniors in the United States were uninsured. The program covers 55 million people today, providing medical care to one in every six Americans.

Bold and provocative keynote speaker Ezekiel J. Emanuel presented top trends in healthcare to more than 1,400 members on day one of the AHLA Annual Meeting in Washington, D.C. Of the mega trends Emanuel predicted, we anticipate the following three trends will impact the healthcare industry sooner rather than later.

As you know by now, the U.S. Supreme Court issued an opinion yesterday allowing subsidies in states using the federal healthcare exchange. In other words, the decision was a big win for the ACA. Details of the opinion in King v. Burwell are available from many sources, so I won’t rehash them here. I plan to discuss the effects of this ruling in greater detail in a later blog. Today, I would like to offer three brief observations from yesterday’s decision.

I was offered the opportunity recently to observe a medical examination of a child in Guatemala, and I was able to accept because I didn’t have to leave home. The U.S.-based doctor examined the patient with the help of medical personnel in Guatemala, special instruments designed to transmit high-resolution images, and a high-speed internet connection.

Of course, I had heard about advances in telehealth, but until I saw the clarity of the images on the screen and heard the detail in the sound transmission, I really had no idea how much the field had progressed. We could see inside the child’s ear with detail that rivaled an in-person exam. Her heartbeat was loud and distinct. It was as if we were sitting in her local doctor’s office, conferring with a specialist – which, in a way, we were.

In the past several months, I’ve had the opportunity to discuss trends in the healthcare industry with some of the best minds in the business, and one topic keeps coming up – population health. What has surprised me is that everyone I talked to places a different emphasis on aspects of the larger concept. It’s as if there isn’t a universal agreement on the definition of population health.

I think it’s safe to say that the focus of population health is to improve chronic disease management, reduce risk factors and improve gaps in care, but there are a number of strategies available to reach those goals.

It’s a sign of the times – Dr. Phil McGraw attended this year’s Consumer Electronics Show to pitch his new app “Doctor on Demand.” His app allows a patient with a smart phone or tablet to access a board-certified doctor or psychologist for about the cost of an office visit co-pay. DOD has 1,400 physicians and 300 psychologists in its network.

I had the honor of participating in the American Health Lawyers Association’s inaugural Women’s Leadership Institute today. Our keynote speaker was Dr. Antonia Novello, former Surgeon General of the United States. Dr. Novello was the first woman and first Hispanic to serve as Surgeon General, and her talk set the tone for a great day of sharing and learning for those of us committed to inclusion in the workplace.

Her presentation provided practical advice on how women can open doors to opportunity. As I reflect on her words, I realize her 10 key points can help anyone – men, women, black, white, Hispanic – improve their personal brands, and be more effective in their professional and personal relationships.

Healthcare’s Triple Aim – providing better care for individuals, better health for populations and lower costs overall – is closely related to the benefits of clinical integration. In a successfully integrated organization, patients have increased satisfaction, providers benefit from higher reimbursements, and payers recognize lower costs of care. But is integration effective and can it be achieved?

Clinical integration has been part of our discussions since the 1980s. Thirty years ago, the primary aim of integration was to provide the means for hospitals to control costs and improve negotiations with payers. We witnessed a move toward larger organizations in the 1990s as hospitals initiated a record number of institutional mergers and practice buyouts. Merely merging or expanding, however, has not necessarily proved effective.