Value-Based Purchasing, Consumerism Top Healthcare Exec Challenges

September 24, 2018 - Transitioning to value-based purchasing and responding to healthcare consumerism continue to be among the top challenges, issues, and opportunities healthcare C-suite leaders are facing in 2019, according to a new poll from the Healthcare Executive Group (HCEG).

A survey conducted during the group’s 30th Anniversary Annual Forum had executives from payer, provider, and technology partner organizations select the top ten challenges and opportunities their organizations are seeing in the new year.

Implementing value-based purchasing ranked within the top half of the list again this year. Respondents ranked value-based payments as their fourth greatest challenge and opportunity in 2019.

However, value-based purchasing moved down a spot on HCEG’s Top 10 list. Executives thought transitioning away from fee-for-service payments was their third largest issue and opportunity in 2018 and participants in the 2017 HCEG Top 10 survey ranked value-based payments as the top issue.

Value-based purchasing is here to stay, industry experts agree. But the healthcare industry is reaching a crossroads with their journey to value.

READ MORE: Best Practices for Value-Based Purchasing Implementation

“Over the course of 2017, the policy uncertainty issuing from Washington left many healthcare administrators paralyzed about what to do next,” Michael Abrams, Co-Founder and Managing Partner at Numerof & Associates, recently told RevCycleIntelligence.com. “In particular, the cancellation of several mandatory bundled pricing programs in favor of voluntary versions raised questions about the future of value-based care, just as many administrators were beginning to accept value-based care as inevitable.”

As a result, Numerof’s annual State of Population Health study found that healthcare organizations are slowly moving to value.

As the value-based transition continues at a slow and steady pace, other issues like data analytics and healthcare consumerism may be jumping to the top of healthcare executive priority lists.

Using data and data analytics topped the list of issues and opportunities for healthcare executives in 2019. The respondents reported that they intend to leverage data, particularly from the clinical space, to help manage health and influence individual, provider, and payer decision-making.

Responding to the healthcare consumerism trend was the second greatest challenge and opportunity for the C-suite level participants. Executives stated that they plan to improve the overall medical, social, financial, and environmental well-being of their patient and member populations.

READ MORE: Good Data, Better Value-Based Care Can Boost Population Health

Providers are increasingly finding their patients engaging in healthcare consumerism behaviors.

“Healthcare customers now have more skin in the game,” David Betts, a Principal at Deloitte, told RevCycleIntelligence.com in 2017. “They are paying more out-of-pocket and as result, they are behaving as customers are want to do. They shop for their healthcare just like you shop for anything that you buy, like a car or any other major purchase.”

Healthcare organizations are quickly prioritizing their responses to healthcare consumerism as patient financial responsibility recently increased 11 percent, according to a recent TransUnion Healthcare survey. Improving total consumer health rose from fifth place in the 2018 HCEF Top 10 list to number two in the most recent poll.

Rounding out the top three challenges, issues, and opportunities for healthcare executives in 2019 was population health services. C-suite leaders are looking to operationalize their community-based health and chronic care management strategies to drive clinical integration and address social determinants of health.

Social determinants of health not only drive up healthcare costs, but also threaten a healthcare organization’s success under value-based purchasing models. Seriocomic factors account for about 40 percent of patient’s health and failing to address the factors lead to worse clinical and financial outcomes.

READ MORE: Understanding the Value-Based Reimbursement Model Landscape

Developing population health management services that factor in a patient’s or member’s housing, food, and other socioeconomic circumstances will help healthcare organizations drive down their costs while improving the overall health of their populations.

Other challenges, issues, and opportunities topping healthcare executive priority lists in 2019 include:

• Digital healthcare: implementing portals, patient literacy initiatives, cost transparency, digital payments, wearables, health monitoring, and other health IT tools
• Rising pharmacy costs: developing strategies to curb prescription drug spending
• External market disruption: responding to new players in the healthcare space, such as Amazon, Apple, Chase, Walmart, and Google
• Operational effectiveness: creating strategies to implement lean quality programs, process efficiency models, robotics automation, revenue cycle management, and real-time/near-time point-of-sales transactions
• Opioid management: establishing methods for identifying and supporting individuals and populations with substance abuse and addiction disorders and those at risk of addiction
• Cybersecurity: improving the privacy and security of consumer information

While HCEG leaders agreed that the 2019 Top 10 list contained key challenges and opportunities, the group’s Executive Director was surprised that specific concerns did not make the list for the coming year.

“Selecting and ranking healthcare issues is always a challenge as we are in a very critical and dynamic stage in healthcare,” stated Ferris W. Taylor. “Everything seems important. Particularly issue #11 Healthcare Policy Reform and issue #12 Precision/Personalized Medicine.”

“More than a handful of HCEG members were surprised that these topics did not make the Top 10.” Taylor continued. “HCEG plans to further explore the reasoning through facilitated discussions at upcoming events and within the HCEG digital community. It’s a compliment to the HCEG members that we reached an agreement on these 10 critical and actionable issues.”