The soaring cost of healthcare tops the list of challenges the rapidly changing industry confronts, but it is hardly the only issue traditional companies and new entrants need help addressing. And while the ongoing move to value-based care is often portrayed as the primary lever
for addressing rising costs, Huron Executive Vice President, Chief
Operating Officer and Healthcare Industry Leader Mark Hussey
notes that a number of other steps are needed to deliver substantial improvements to access, affordability and quality. Hussey
recently discussed some of those additional steps along with other
high-level industry insights via email:
Consulting: What are the biggest disruptions
to traditional healthcare right now?
Hussey: The healthcare industry continues to be impacted by
several factors: rising costs, evolving payment models, industry
consolidations, consumers taking control of their own medical
decisions, a focus on transparency and regulatory uncertainty.
While these challenges are apparent, they also give healthcare
providers an opportunity to shape their organization’s future.
Consulting: What are the biggest challenges
and opportunities for healthcare providers?
Hussey: As the healthcare industry continues to face disruption,
providers are feeling pressure from both internal and external
factors. Internally, healthcare leaders must contend with burnt
out physicians and rising expectations around compensation
and benefits, as well as the implementation of new technology
to better run their business. Externally, healthcare leaders must
meet the needs of consumers who want improved access and
higher value care while also keeping an eye on rapid escalation of
competition. Leaders must make hard choices. Decisions focused
on long-term financial and strategic sustainability involve big
changes and significant risk. It comes down to balancing delivery
of the best possible care with increased financial pressures,
skyrocketing costs and declining revenue. Fortunately, challenges
allow for opportunities. Organizations must look outside the box
to make the most of their core business while finding growth in
other ways. That includes looking outside of
the industry at others’ best practices and
investing in technology that creates a
more consumer-centric experience.
Consulting: What are the
biggest challenges and
opportunities for insurers?
Hussey: One of the biggest challenges facing
insurers in the United States is the inefficient healthcare
delivery system, focused on treating high utilizers. According to
The Centers for Medicare and Medicaid Services (CMS), the US
ranks near the bottom in healthcare efficiency and spends more
per person to get a worse outcome than nearly every other
country. Focusing on value-based care is just an incremental step
in the existing healthcare delivery business model. It won’t deliver
the impact or changes we need to see in access, affordability
and quality. Alternatively, as structured today, our healthcare
delivery system impacts only 10 percent of an individual’s health
- individual behavior (40 percent), genetics ( 30 percent) and
social and environmental factors ( 20 percent) are the primary
factors. The greatest opportunity for insurers is to disrupt the way
we see healthcare by looking at new models, new processes and
new services that impact all the factors of an individual’s health,
delivering more value to the consumer at a lower cost.
Consulting: How do you expect the industry to
evolve during the next five years?
Hussey: Over the next five years, there will be a growing
trend of cross-industry collaboration and organizations
looking outside the healthcare industry to find innovations
to improve their business models. As care continues to move
outside the four walls of the hospital, the rise of telehealth will
impact the nature of care delivery and you will experience an
increase in the use of a consumer-centric approach to the way
healthcare is delivered. The use of precision medicine and
using data analytics to make a more customized consumer
experience will also grow in popularity. —E.K.
Q&A with Huron’s Mark Hussey