The future of healthcare, according to industry leaders

By Linnie Greene, Staff Writer at Arcadia

Posted: December 22, 2022

Healthcare Analytics Value-Based Care The Schema

From value-based care payment models to SDoH innovations, here’s what healthcare experts expect in 2023 and beyond

If anyone has a finger on the healthcare industry’s pulse, it’s the people at the top of cutting-edge organizations taking on risk-based contracts, value-based care, and population health challenges.

In this article, gather insights from medical organizations’ top innovators, from KLAS VP of Value-Based Care and Core Solutions Bradley Hunter — an expert on changing trends and regulations — to Becky Trotter, CareAllies’ Director of Population Health Solutions.

With a variety of different backgrounds and roles, these healthcare leaders share a common goal: improving cost and performance for healthier patients and healthy business models. Read on to learn more about their predictions for the future, and how you can translate this wisdom into action today.

Value-based care payment models & whole-person health

Value-based care encompasses several payment models, but in the end, it translates to whole-person care. Think: screenings, preventive care, and early interventions that keep more expensive (and detrimental) problems from cropping up down the line. As Will Daines points out: what’s not to love? But as Meghan Tortora mentions, it’s a challenge best undertaken with evidence and data to point the way forward.

“The foundation of data that we have within Arcadia allows a more empathetic approach for the providers, a more holistic view of patients … For my team, and the work that we do, we constantly bring it back to that patient experience, that patient-level. Somebody’s grandmother is on the other end of those 1’s and 0’s, that BP and A1C.” — Meghan Tortora, Beth Israel Lahey Health

“I think we have to start from the position that improving healthcare, driving towards better outcomes at a lower cost — that sounds unimpeachable, right? It sounds like the obvious thing we would want to do, and it's not challenging because we're trying to talk people into a model of care that is worse for patients or higher cost — it's hard to do because even though the objectives are unimpeachable, how you get there is really complicated.” — Will Daines, Castell

The importance of a tailored regional approach

Fine-tuning your approach to the regions you serve is critical, whether you’re an ACO or working strictly under fee-for-service. As Becky Trotter points out, the best approach is often bespoke — tailored to each group’s unique needs, and not a universal checklist.

“The biggest thing we see is not just how contracts or payers are structuring their plans, but the disease prevalence that exists in those markets. You’re going to have a different disease burden in Texas than you're going to have, maybe, in Philadelphia. I know in our Texas market, for example, diabetes really plagues our South Texas market, and it's prevalent in North Texas, but not to the degree that it is in the south. So our focus becomes less on, “Let's check the box on 10 things,” and “Let's create this program that says, ‘Okay, we're going to focus on these disease states for this market or these disease states for this area.’” — Becky Trotter, Care Allies

Healthcare’s changing landscape

The COVID-19 pandemic shook healthcare as we know it, but change was already afoot before the first diagnosed case. Bradley Hunter and Shawn Dubravac have especially valuable perspectives, a bird’s-eye view of what’s happening industry-wide. What’s coming next? Overdue modernization, Dubravac argues, and more recognition of risk-based contracts’ potential, says Hunter.

“Fee for service, which has been the dominant model for a long time in healthcare, was really exposed for what it was — that is, a monstrous beast. There were many health systems that I talked with where, Q2 last year, they were saying, ‘Oh man, we're going to be in the red. Elective surgeries aren't happening.’ Then they would just say, ‘How many millions of dollars are we going to be in the red?’ … They looked at other health systems that were in capitated contracts and it was business as usual. They said, ‘Wait a second, how do we get involved in that? Because we've been dipping our toes in this value-based care thing, where we have, 10%, 20% of revenue type to value-based contracts, but it's really not enough for us to get shifted into this. We've really seen that shift happen where there's a lot more interest in going fully at-risk through capitated contracts.” — Bradley Hunter

“It took about 20 years to get to where we are today. I would argue the next big transformation is now upon us. As we move from digitization to datafication. That's taking all of the information that's now being captured by all these digital devices and redeploying it into the services and the experiences that we have. And it's empowering an entirely new suite of services. At the same time it's transforming all of these industries that have existed for decades that were largely performing the same services they've always been performing. You could argue that healthcare has modernized somewhat, but a lot of the services still look like they did say 50, 60, 70 years ago.” — Shawn Dubravac, NYT-bestselling author and industry expert

Automation and outreach

Automated outreach and communication accomplishes several things. First, as Michelle Francis notes, it gives organizations a better picture of their patient population. Secondly, it increases the likelihood of attendance for appointments. And third, it generates trust. When it’s done right, it’s done with the help of robust data, which gives providers and care managers the context they need to intervene effectively.

“It allows us to take this mass amount of information we have at our fingertips and really make it actionable, without needing, necessarily, an advanced degree in analytics … How do we identify this patient population that could potentially be appropriate for palliative care referral? In the past, we were using a process that required that manual labor, of somebody conducting an evaluation with a patient on the phone.” — Michelle Francis, Nuvance Health

“That one-to-one human experience is one of the things we think makes Castell unique, and one of the things that’s really important to us … I would say the end result, absolutely, is a phone call. But if you think about the power behind that person that is making the call? You can’t do any of this without the right data and information at your fingertips.” — David Dirks, Castell

SDoH & vulnerable populations

One major talking point in 2022? Social determinants of health, also known as SDoH. It’s high time that healthcare acknowledged the social factors impeding people’s access to care, and as Elise Kohl-Grant points out, a large part of bridging these gaps is empowering patients to own their care journey. These impacted groups can be some of the hardest to track, so up-to-date data is of utmost importance.

“I think that's what we're striving to be, is that the consumer can start to manage their own care and they feel empowered. And then they can be more involved in their care, because at the end of the day, you can't make anyone come to their appointment. But if they feel responsible to come to the appointment, the services are no longer being done to them, they're being done with them.” — Elise Kohl-Grant

“We have questions that we'll go out to community and ask them … ‘How are you? What are you missing and what can we provide to help get you there?’ We’re also working with some vendors to get — you know those old blood pressure machines in the grocery store? But more complex, that can be put it in a church or put it in a grocery store where they're going to be. Then, you try to engage with them and say, ‘Hey, you can use this once a week. You can answer some basic questions on the screen, and it will come back to us.’ It will feed into our larger data pool and we can figure out, ‘Hey, we need to do X, Y, and Z, because we identified this trend right here.’ It’s about figuring out how we collect the data.” — Anthony Del Rio, Rush Health

Risk-based contracts

The “risk” in risk-based contracts isn’t a misnomer. As Hunter states, it takes an audacious healthcare organization to take it on, but with a firm commitment (and a lot of high-quality, actionable data), it’s not as scary as it might seem.

“Some of it stems from just pure audacity. That happens, where they're like, ‘Hey, we're going to do this, because we think it's going to be the way the future.’ So, that happens. Then, there's also the way where the organization says, ‘Okay, this is what we really want to do. How can we go about doing it?’ A lot of the time it stems from, can we find a payer who's willing to go at-risk with us? CMS is always very willing to go at-risk, but often they're looking to say, can we do commercial contracts as well? Because an interesting thing that happens is you look at risk and if you're only taking on a small percentage of risk, then you're putting the rest of your fee-for-service revenue at risk. An example, if you put 5% of your revenue in value-based contracts and you just absolutely kill it, then you're going to kill your fee-for-service revenue.” — Bradley Hunter, KLAS

Population health

For administrators and providers that tend to diverse populations, this is an essential takeaway: great population health starts with empathy. It informs novel, innovative programs (like Umpqua Health’s program to distribute air filters during Oregon’s wildfires), and it helps gain support from employees at every level.

“If coding and documentation is just about box checking, you're not going to win over any physicians or advanced practice providers. If we can connect coding and documentation with better acknowledgement of their population's illnesses, better resources to take care of those illnesses, and connect those to programs that actually improve people's health, then we can create that connection for people, that population health, it's not just something we do because we've been told to do it, but it's something that directly contributes to the health of my patients and our collective patients.” — Will Daines, Castell

Want to stay up-to-date as new healthcare industry trends emerge?

These topics played a critical role in healthcare’s 2022 evolution, and they’ll continue to shape the field in 2023 and beyond. To learn more about what the experts are saying check out the latest season of The Schema, a series featuring the brightest minds in healthcare. To keep a pulse on the intersection of data and meaningful action throughout the year, subscribe to Vitals webinar series or Data Bytes newsletter.