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Transformational Growth in the Care Delivery Landscape is Changing Health Systems into Systems of Health
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Healthcare providers are on the verge of reinventing their role in the care delivery process due to various external factors, such as the following:• Unsustainable growth in healthcare spending driving continuous downward pressure and declining operating margins• The emergence of alternative payment models that focus on patient outcome and reduce costs for payers• Threats from non-traditional players transforming the care delivery model through innovative business models, delivering operational efficiency and applying advanced technologies for patient-centric care• Empowered patient-consumers taking an active role in their health and demanding personalized care and effective treatment. The COVID-19 pandemic has necessitated the adoption of novel care delivery models among providers, further accelerating the payers’ plans to reduce avoidable in-patient admissions, thereby saving costs. The pandemic has exposed the vulnerabilities of the existing fee-for-service model which is highly reliant on case volumes, resulting in misalignment of incentives between payers and providers, where providers and health systems suffered huge losses due to drop in outpatient and elective surgery volumes even as payers reported significant profits. As a result, providers are ready to embrace alternative payment models (APMs) like bundled or capitated and global or population-based payments which minimize the focus on acute care by enabling the providers to manage conditions without affecting revenues. More than ever, providers are willing to explore hybrid models of care and benefit from the advances in virtual care. The change in reimbursement models that incentivize providers for generating savings is driving them to adopt new technologies that can help deliver efficient care across the continuum. To achieve cost-synergies and scale up operations, providers are building alternative sites of care and integrated delivery networks (IDNs) that help them offer care in appropriate settings to align with the principles of value-based care and retain patients who would have otherwise switched to competitors. Increasingly, providers are looking to partner with MedTech companies that can support them in building new capabilities for the value-based care models. In order to build solutions that solve the needs of key stakeholders in the current landscape, MedTech companies need to demonstrate the value of their device in achieving the goals of the providers by supporting them with operational efficiency, improving the patient experience, owning the outcome, and easing reporting and health information exchange. Providers are looking for quantifiable, data-driven metrics that create evidence on the efficacy and effectiveness of the therapy to prepare them for shared-risk models. Providers and health systems need to be prepared for the changing policies (including price transparency, anti-trust measures and provider regulation, and cost-containment through APMs) under the current federal administration in the United States, which might impact them.
Author: Srinath Venkatasubramanian
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