INDUSTRY OVERVIEW:
The numbers don’t lie: Providing 13.5 million jobs and 8 out of the 20 fastest growing occupations, health care is the country’s largest industry. Compared to other industries, the health-care industry as a whole is expected to realize a relative increase in the number of career opportunities across the spectrum of its many specialties.
People are living longer and thus demand more and higher quality preventive and long-term care. The demand for health-care workers is expected to grow faster than the average rate for all occupations between 2000 and 2010. In particular, the demand for home care aides, registered nurses, physician assistants, nurse practitioners, physical therapists, nontraditional health aides, and physicians will continue to increase at a healthy pace. This trend also applies to technical and administrative jobs, as hospitals continue to focus their energies on more efficient management and profitability.
Many people are attracted to the health-care industry for its human touch and service-oriented aspects. However, the harsh reality is that the industry as a whole is all business these days. Hospitals, nursing homes, home health care, specialized clinics-and even to some extent organizations that provide alternative medical treatments-are being run increasingly like any other major for-profit organization. Simply put, health care today is all about big business-with its focus sharpening on driving profits higher.
The health-care industry provides diagnostic, healing, rehabilitation, and preventive services. The individual physician is often the consumer’s (or patient’s) primary point of contact with the system. However, it is the health-care organization itself-that is, the hospital or health management organization (HMO)-that finances much of the industry today; it represents the preponderance of the physician’s revenues. The lion’s share of these revenues, in turn, comes from employee health insurance plans, Medicare (health insurance for Americans over the age of 65), and Medicaid (health insurance for Americans on welfare). Health-care organizations (with the exception of county hospitals) are generally run for profit. This disconnect between organizations based on the profit motive and those operating as nonprofits creates tension among doctors and other health-care professionals intent on prescribing the most cost-effective treatments and conducting diagnostic tests. Health-care organizations are increasingly driven to cut costs across the board.
ALTERNATIVE MEDICINE
A growing segment of the population is turning to a wider, more diverse set of techniques and therapies to meet health-care needs. The catchall category of alternative medicine refers to any practice outside of conventional medical treatments, including homeopathy, acupuncture, massage therapy, and chiropractic. The granddaddy of the movement is Dr. Andrew Weil, who preaches the benefits of treating a patient holistically, serving the body, mind, and spirit.
Americans are increasingly turning to herbal remedies to treat ailments, spending over 4 billion dollars a year on herbs and other botanical remedies. Health-care providers and insurance companies are beginning to recognize the legitimacy of some of these alternatives and to accept some nontraditional techniques for treating chronic health issues.
HOSPITALS
Despite the increased outsourcing (not uncommon in any industry today) of medical records, housekeeping, lab testing, and clinical services (e.g., orthopedics and radiology), hospitals remain the biggest employers in the health-care industry. The huge networks such as HCA and Tenet demand a steady supply of doctors, nurses, administrators, medical technicians, therapists, and other support staff. In areas where competition from HMOs is mounting and cost-cutting is a priority, former staff may move outside the immediate confines of a hospital. However, close and important links remain-particularly for any type of surgery or specialized treatment such as chemotherapy.
HMOS AND PPOS
Health maintenance organizations (HMOs) and preferred provider organizations (PPOs) are hybrids-basically, a cross between a hospital and an insurance company. Each type of managed care plan covers primary care visits, preventive services, and copayments for prescription drugs, whereas only PPOs allow the enrollee to choose his or her physician (HMOs maintain a list of plan-approved doctors). Some of the largest organizations have their own medical staffs and facilities where they treat patients; smaller ones may simply access networks of private providers and hospitals. Competition is fierce in this arena-M&A and internal strife often destabilize the job market. Coventry Health Care, Humana, Harvard Pilgrim Health Care, and PacifiCare Health Systems (one of the leading Medicare HMOs) are a few of the better-known players.
SPECIALTY PROVIDERS
As hospitals have attempted to cut costs, they have turned to firms that can provide specialized services at rock-bottom prices. These include everything from nursing homes (Beverly Enterprises) to home infusion therapy providers (Apria Healthcare) to diabetes treatment providers (American Healthways). Clinics that focus on special treatments such as chemotherapy, MRI and other scanning techniques, and physical therapy are also proliferating. Most are small and locally run; however, Gambro and Fresenius Medical Care are two enormous service companies that focus on this type of care; others will undoubtedly emerge as their popularity increases.
HOME CARE
Advances in technology have done much to improve efficiency and reduce costs for both patients and home care staff. Today, home care nurses and aides can administer complex treatments previously available only in hospitals and clinics to the elderly and severely disabled in their own homes. And because almost all hospitals and HMOs now release patients before they are self-sufficient, home care is often the most cost-effective choice. Most jobs in this sector don’t require much training (they are closely supervised by RNs, NPs, or physicians)-just deep reserves of patience and kindness. The pay is low-often less than $10 an hour-and the work is arduous. The rewards? In addition to extremely flexible hours and plenty of personal contact with patients, there is the satisfaction of helping people when they are most in need.
The various health-care positions require varying levels of education and training. Registered nurses (RNs) are trained at the undergraduate level, whereas nurse practitioners (NPs) have received master’s degrees in their specialties. Physician assistants (PAs) are licensed to practice medicine under the supervision of a physician. Doctors of osteopathy and medical doctors both complete 4 years of postgraduate work to earn the titles of DO and MD, enabling them to prescribe medicine and perform surgery. To qualify for some positions (including doctor, nurse, tech), technical training is required-and to actually land a job, you often need a strong network in a given area and practical experience in the industry.
RNs, pharmacists, and radiological technicians are currently in very high demand and will continue to be in the decade ahead. Why? The Baby Boomer population is maturing into retirement, the elderly population in the United States is growing, and health-care spending is being cut wherever possible-which means that today, whenever a nurse can do something a doctor used to be responsible for, that’s exactly what’s going to happen. Employers are looking to attract people to these in-demand professions by offering signing bonuses, tuition reimbursement or loan repayment, flexible scheduling, and incentives for voluntary overtime shifts.
The good news doesn’t end there: Opportunities will also grow at a healthy clip for just about every other health-care function, including doctors, optometrists, occupational therapists, audiologists, medical record technologists, medical transcriptionists, and speech pathologists. The highest demand will be for physician assistants, physical therapists, lab clinicians, dental hygienists, respiratory technicians, substance abuse counselors, and especially home health-care workers.
Hospitals and HMOs offer jobs in management in addition to medicine-particularly if you have a background in information technology (IT) and data system development. As a job seeker, you should be aware that HMOs have been the catalysts for many of the efficient business practices adopted throughout the health-care industry in recent years. Technical and administrative support positions are in high demand as the industry evolves in an intensely competitive market. Health-care IT is a steadily growing sector; although the industry has been a late adopter of IT, it is catching up now. There will be lots of opportunity in this area for the tech-savvy.
As the US health care industry moves toward a financial model that is based on value rather than volume, keeping people healthy and out of the hospital will be key. In a fee-for-service (FSS) model, health systems generate more revenue when patient volume increases. But under a value-based model, a person who shows up at an emergency room or a doctor’s office becomes an expense rather than a source of revenue. Rather than seeing people as patients, health systems should treat them more like members. This shift can help strengthen customer loyalty, build brand and reputation, and even improve the health of our nation.
Companies in this industry provide a wide range of health care and social services through hospitals, doctors’ offices, nursing homes, outpatient surgery centers, and other facilities. Major companies include Ascension Health, HCA Healthcare, Kaiser Permanente, and Tenet Healthcare (all based in the US), as well as Fresenius (Germany), National Hospital Organization (Japan), and Ramsay Health Care (Australia).
Worldwide, health care expenditures reached about $9 trillion in 2021 according HIS Market. Health spending in the US is expected to reach about $1,500 to $2,000 per person by 2050, according to Statista.
The US health care sector includes about 890,000 establishments (single-location companies and units of multi-location companies) with combined annual revenue of about $2.5 trillion.
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An aging workforce, rising demand for health care services, and moral and well-being concerns are driving shortages of skilled health care staff. But there are a number of dimensions shaping the future of work, including automation, telehealth, and new staffing models.
Health care providers should proactively seek opportunities for augmentation in clinical workflows, which will allow clinicians and patients to benefit from an aligned financial reimbursement system, new technologies, innovative talent models, and extended locations for care delivery.
Engaging with consumers and improving the patient experience
Health care leaders need to maintain the talent continuum that offers resources for redefined roles of the health care practitioners. Providers should proactively seek opportunities for augmentation and automation in clinical workflows, which will allow clinicians and patients to benefit from an aligned financial reimbursement system, new technologies, innovative talent models, and extended locations where care is delivered.
Wages in the health care sector vary widely by job function and training requirements, from nurses and aides and orderlies at one end to surgeons and other medical specialists at the other. Overall, average wages for the sector in the US are slightly higher than the national average.
Injury rates in the US health care sector are significantly higher than the national average. Common injuries include back strains and sprains from moving patients or from falls.
The adage, “What goes up, must come down,” isn’t likely to apply to the global health care sector in 2019. Aging and growing populations, greater prevalence of chronic diseases, exponential advances in innovative, but costly, digital technologies—these and other developments continue to increase health care demand and expenditures. Health care stakeholders—providers, governments, payers, consumers, and other companies/organizations—struggling to manage clinical, operational, and financial challenges envision a future in which new business and care delivery models, aided by digital technologies, may help to solve today’s problems and to build a sustainable foundation for affordable, accessible, high-quality health care. This vision may have a greater probability of becoming a reality if all stakeholders actively participate in shaping the future— by way of shifting focus away from a system of sick care in which we treat patients after they fall ill, to one of health care which supports well-being, prevention, and early intervention.
As the industry continues to move toward this value-based system, here are a few trends US health care organizations should watch in 2019:
Collaboration between health systems and health plans
The shift to wellness rather than illness
How technology can help put patients at the center
Increased adoption of virtual care options
Greater focus on population health
Hear more about these trends from Deloitte’s US Health Care Leader, Steve Burrill.
Shaping tomorrow’s health care industry
The global health care industry doesn’t show any signs of slowing down in 2019. Aging and growing populations, greater prevalence of chronic diseases, and exponential advances in innovative, but costly, digital technologies continue to increase health care demand and expenditures.
Health care stakeholders struggling to manage clinical, operational, and financial challenges envision an industry in which new business and care delivery models, aided by digital technologies, may help to solve today’s problems and to build a sustainable foundation for affordable, accessible, high-quality health care. This vision may have greater probability of becoming a reality if all stakeholders actively participate in shaping the future—by shifting focus away from a system of sick care to one of health care that supports well-being, prevention, and early intervention.
Regional & International Issues
Worldwide, health care expenditures reached about $9 trillion in 2021 according HIS Market. Health spending in the US is expected to reach about $1,500 to $2,000 per person by 2050, according to Statista. Leading global health care firms include Fresenius (Germany), HCA (US), National Hospital Organization (Japan), and Ramsay Health Care (Australia).
Developed countries around the globe face pressure to reconfigure their health care systems in order to?rein in costs?and deliver care more efficiently. Major expenses include?inpatient hospital stays,?outpatient care, pharmaceuticals, and long-term care. Health spending in industrialized countries has shown consistent growth in recent decades, other than a slowdown following the late-2000s economic crisis. Doctor per capita ratios are highest in Austria, Norway, Spain, Lithuania, and Germany, according to the Organization for Economic Co-operation and Development (OECD).
In countries around the globe, aging populations are putting a strain on health care delivery. As citizens get older, they are more prone to expensive chronic illnesses such as diabetes and heart disease. Not only high-income nations such as France and Japan but also emerging economies with improving health systems such as Brazil, China, and India are experiencing demographic shifts as life expectancies increase. By 2050, 80% of older people will live in low- and middle-income countries, according to the World Health Organization (WHO).
Developing countries are vulnerable to public health woes such as high infant and maternal mortality, undernourishment of children, and high rates of HIV/AIDS. Low-income countries’ health spending is typically financed by more than 40% out-of-pocket spending and about 30% external aid, according to the World Health Organization. Poor public health has an impact on a country’s wealth; for example, AIDS strikes adults who would normally be in the workforce. For these countries, the goal of reducing or alleviating these and other public health issues is complicated by lack of money and resources such as doctors, clinics, and medicines.
Globally, health spending has doubled over the past 20 years, reaching about $8.5 trillion in 2019. High income countries still dominated the overall spending for about 80% of global spending on health.
Doctors around the world are making use of electronic health records (EHRs), which can help a physician track a patient’s health, check for potential harmful drug interactions, and provide medical decision support. The use of EHRs among health providers is highest in countries that have a unifying government health IT organization, such as Denmark, Finland, and Sweden, where use of EHRs is nearly universal.
Major states with the highest number of health care establishments include?California,?Texas,?Florida, and?New York.
The US has an average of about 2.4 hospital beds per 1,000 people, according to the Kaiser Family Foundation. South Dakota has the highest number of hospital beds per 1,000 population, followed by the District of Columbia, and North Dakota. Oregon and Washington had the lowest average.
States with high Hispanic populations, such as California and Texas, often require doctors and staff to speak basic Spanish. Signs, disclosures, and forms are often printed in both English and Spanish.
Strategically moving from volume to value
As patients’ role and influence in their health care increase, providers and payers must likely shift accordingly and take advantage of emerging opportunities to establish more direct, personal relationships with the consumer. Digital technologies can improve engagement, enable convenience-driven access to care, and nurture a two-way relationship for the long term. Organizations that understand and act on how consumers would like to use digital health, telehealth, wearable monitoring and fitness devices, online resources, social media, and other technologies will likely be well-positioned to develop patient engagement strategies that help individuals make informed health care decisions.
Investing in digital innovation and transformation
Digital technologies are supporting health systems’ efforts to transition to new models of patient-centered care and helping them develop “smart health” approaches to increase access and affordability, improve quality, and lower costs.
Blockchain, artificial intelligence, and virtual reality are just some of the technologies disrupting health care. These technologies are helping with diagnosis and treatment; helping with speed, quality, and accuracy; and improving the patient experience.
Responding to health policy and complex regulations
Key takeaway
Investment in digitization can lead to better usage of health data in research supporting personalized health care. Interoperability issues and risks around connected devices, disparate systems and processes, and pilot models that need scale to facilitate system-wide adoption are some of the challenges on this road to innovation. Digital innovation is supporting and augmenting workers but not replacing them though. It is allowing highly trained resources to focus on more valuable, patient-facing activities.
Maintaining regulatory compliance and cyber security
As data becomes the new health care currency, protecting it will be key. Clinical innovations, connected medical devices, and market complexity have amplified the continued need for evolving government policies, regulatory oversight, and risk management.
And while government policies and regulations seek to strengthen health care security and safety at a micro level, health care organizations should focus on compliance, ethics, and risk, driving awareness throughout the enterprise.
Investing in exponential technologies to reduce costs, increase access, and improve care
Click the image to view the infographic
Key takeaway
While government policies and regulations seek to strengthen health care security and safety at a macro level, health care organizations should focus on compliance, ethics, and risk, and drive awareness throughout the enterprise. Organizations need to invest in crisis management capabilities that make their cyber-diligence stronger and better.
Major services include patient care which accounts for about 85% of the industry’s revenue. This is followed by assisted daily living (ADL) which accounts for more than 5%. Other revenue sources also include dental non-surgical intervention; medical and diagnostic testing; appropriations from government; and government contributions. Leading health care entities in the US include a number of for-profit entities, an exception to the global norm of nationalized medicine. However, among the community hospitals in the US hospitals, around 60% are not-for-profit, according to Becker’s Hospital Review. Most doctor’s offices and ambulatory care centers are run as for-profit enterprises.
Hospitals can be operated by the government, charitable organizations, or for-profit corporations. Hospitals typically have between 50-1,000 beds and provide both inpatient and outpatient services, with larger facilities providing more complex care. Many hospitals are part of multi-facility health systems. Majority of hospitals are general medical and surgical hospitals, with only a quarter of hospitals provide psychiatric and other specialized services.
Federal and state governments are heavily involved in the US health care sector as direct-care providers (such as the Department of Veterans Affairs); operators of health insurance programs (Medicare for the elderly, Medicaid for the low-income and disabled); and as providers of various social services programs.
About 92% of Americans are covered by some form of private or government health insurance, according to Statista. Many are covered by combinations of private and government policies. More than half of Americans are covered by employer-sponsored health insurance, the most common type; others are covered by Medicare, Medicaid, direct-purchase, and military plans. The 2010 Affordable Care Act (ACA) has reduced the uninsured rate by extending health care coverage to more Americans through state health exchanges, subsidy programs, and expanded Medicaid programs. The combination of employer-sponsored plans, individual insurance, subsidized insurance, and the uninsured creates a complex web of payers (private insurance companies, the government, and self-payers), known in the industry as a multi-payer system.
Some providers enter managed care contracts with payers that encourage plan members to use certain facilities. Government and commercial health plans use tax dollars and premiums collected from individuals and businesses to reimburse providers for taking care of insured patients at pre-negotiated rates. Some companies and organizations are switching to self-funded insurance plans, where claims are paid for directly by the business, in order to reduce expenses. Beyond contributing to premiums, individuals also pay additional direct or out-of-pocket expenses to providers for health care services.
In total, US government expenditures grew by $111 billion in 2021 as compared to the prior year, according to Health System Tracker.
Technology
Growth in the industry is heavily dependent on scientific advances, medical research, and the development of health care information technology. Many of these advances are led by research hospitals that maintain a staff of PhDs specializing in research and discovery. Molecular biology, largely federally funded, has advanced understanding of the cellular processes involved in disease, largely by identifying defective proteins and gene mutations. New treatments, often developed in partnership with pharmaceutical and medical device firms, counter the effects of these abnormalities. Advances in computer technology have produced new diagnostic imaging systems like ultrasound, MRI, CAT, and PET that can detect abnormalities in their earliest stages, as well as minimally invasive surgical systems that reduce patient recovery times. The R&D that drives these discoveries is costly.
In response to health care reform mandates aimed at improving efficiencies, health care providers are implementing health information technology (HIT) systems. Electronic health records (EHRs) are used to share information and coordinate patient care among doctors at multiple facilities. More than 95% of US hospitals had adopted certified EHRs (systems that meet federal meaningful use criteria). Many US hospitals and doctors have received incentive payments from the Centers for Medicare and Medicaid Services (CMS) for demonstrating meaningful use of EHRs; eligible providers face Medicare reimbursement reductions for not demonstrating meaningful use. The US Office of the National Coordinator for HIT is working with technology firms to standardize system structures, data security methods, and services, including through open and accessible application programming interfaces (APIs). Protecting patient data is also a major concern.
Some physician practices are adopting personal health record (PHR) systems, where consumers can contact health professionals and access certain parts of their EHR, as a method of reducing repetitive in-person patient encounters. Other HIT systems include medical coding, claims filing, billing, inventory, and prescription management software. Some hospitals have adopted wireless technologies to give doctors and nurses access to records at bedside. Telemedicine and remote patient monitoring systems are also growing in popularity.
Competitive Landscape
Health care reform efforts in the US and other developed countries are changing how providers are reimbursed for care. More attention is being focused on rewarding or penalizing institutions based on efficiency standards and the quality of care delivered. As pay-for-performance reimbursements are implemented, health companies are consolidating to better compete and negotiate with suppliers and insurers. Slim operating margins and a minimal ability to raise prices makes eliminating wasteful processes essential. Obtaining grants and federal funds is key to profitability in the case of many nonprofit health care providers.
Hospitals, surgery centers, and other facilities may compete for physicians, seeking to attract doctors with state-of-the-art equipment and quality work environments. Hospitals and ambulatory surgery centers also compete for procedure volumes, as health care shifts toward outpatient settings. Physician practices and ambulatory clinics in cities generally have several direct competitors in the immediate geographic area, but those serving in remote regions may have little to no competition for patients. Smaller care providers can find success in offering specialized services and building a local reputation for quality care. The US health care sector is highly fragmented: the top 50 organizations generate about 20% of revenue.
Competitive Advantages:
Diverse Services Network – Health networks that provide care in a variety of settings, including hospitals, clinics, and physician practices, can benefit from the shift toward outpatient care. Hospital care is becoming more specialized, while routine procedures are increasingly performed in ambulatory facilities. Increasing bargaining power with insurers and suppliers is essential in the changing health care landscape.
Advanced Technologies – Having access to the most advanced medical care technologies and emerging fields of medical research helps boost the reputation of health care facilities. Hospitals that participate in clinical research programs can offer patients experimental treatments and cutting-edge care techniques. Having access to digital systems that help determine treatment protocols and avoid redundant processes is also beneficial.
Insurer Relationships – Companies depend on commercial insurance contracts for the majority of reimbursement revenue. In the US, government mandates aim to lower Medicare and Medicaid spending, and commercial insurers often follow the lead of Medicare and Medicaid in setting rates. Managed care organizations include hospitals in their provider networks based on quality, price, and the availability of services in the area.
Companies to Watch:
HCA Healthcare is the largest for-profit operator of hospitals in the US, with about 190 facilities in 20 states. It also runs ambulatory, surgery, and urgent care centers across the country and has operations in the UK. The diversified company is expanding its portfolio of specialized hospital services and outpatient care facilities.
Fresenius operates nearly 4,000 dialysis clinics worldwide, as well as more than 100 hospitals in Germany and Spain. The company also provides infusion equipment and hospital management services. Fresenius operates in more than 100 countries and has expanded in recent years through acquisitions.
Tenet Healthcare operates major urban medical centers and small community hospitals in about 10 US states. Like HCA, Tenet operates ambulatory health centers and has operations in the UK. It also provides patient billing and communications services to affiliates and nonaffiliates across the US through its Conifer Health Solutions subsidiary.
Adapting to changing consumer needs, demands, and expectations
Patients and caregivers, dissatisfied with poor service and lack of transparency around price, quality, and safety, are expecting health care solutions that are coordinated, convenient, customized, and accessible.
To help keep up with increasingly engaged consumers, providers and payers will have to shift accordingly and take advantage of emerging opportunities to establish more direct, personal relationships. Organizations that understand and act on how consumers would like to use digital health, telehealth, wearable devices, and other technologies will likely be well-positioned to develop patient engagement strategies to help individuals make more informed health care decisions.
Sales & Marketing
Typical customers are individuals requiring urgent medical care, routine check-ups, and long- or short-term help including nursing home care, day care, and social services.
Marketing efforts vary depending on the type of service provided. Doctors typically stick with traditional approaches like word-of-mouth, referrals, and insurance approved-provider lists. A growing number of physicians use TV, online, and print advertisements and direct mailings (including email) and have websites and even personal blogs — though doctors must avoid violating patient’s rights and privacy laws when writing about specific cases or incidences. Hospitals market to doctors, insurers, and individuals using a variety of means, including medical presentations, brochures, magazine and newspaper ads, targeted press releases, informational websites, and TV and radio ads.
Prices vary depending on the services offered, the length of the patient stay, the patient’s insurance policy, and the level of government support. For hospitals, the average length of stay is about 4.5 days; the average cost of a stay is about $12,000. Medicare (and, in many cases, supplemental state insurance policies) sets limits on reimbursable charges. In a typical scenario, a doctor visit costs around $150, but Medicare may pay less than half of that. The patient pays the rest through Medigap insurance or out of pocket. To offset these losses, doctors often limit the number of Medicare patients they accept, shorten time spent with patients, or raise prices on private payers through what’s known as cost shifting.
THE UNINSURED NATION
Currently, some 43.6 million Americans have no health insurance. The number of uninsured Americans continues to grow like an epidemic. Why? Insurance premiums continue to skyrocket as health insurers consolidate their businesses through frequent mergers and acquisitions. The result of this trend is a continued decline in competition among health insurers-and higher premiums are one of the results. Indeed, employers are facing double-digit percentage increases in health premium costs each year. The upshot: More and more of the cost of health insurance is being passed on to employees, meaning many people simply can no longer afford health-care coverage-considered a necessity (indeed even a birthright, many argue) in any industrialized nation.
RUNAWAY COSTS
Doctors and hospitals have been grappling with rising costs for a long time-and each year the problem seems to get worse. Malpractice insurance premiums, soaring prescription-drug prices, and the increasing numbers of uninsured Americans are all factors leading to ever-higher costs for caregivers. At the same time, revenues for doctors and hospitals keep falling, as insurers are doing everything in their power to lower payments for claims.
Meanwhile, insurers are not feeling the squeeze nearly as much as the caregivers. The reason: They make sure that revenue from premiums rises at a higher rate than claims payments.
Creating financial sustainability in an uncertain health economy
The emergence of personalized medicine, increased use of exponential technologies, entry of disruptive and non-traditional competitors, the demand for expanded care delivery sites, and revamped payment and public funding models are all impacting the financial performance of the health care ecosystem. Between 2017-2022, global health care spending is expected to rise 5.4 percent annually to just over $10 trillion.
Health care providers are stressing rigorous financial management, efficient operational performance, outcomes-based care, and innovative solutions to help address this rise in spending. Developing public-private partnerships, investing in prevention and well-being, and learning from industries outside of health care will also be key.
Health care providers are stressing rigorous financial management, efficient operational performance, outcomes-based care, and innovative solutions development. These could result in improved care provision, reduced costs, counter declining margins, and aligned cost structure and care models with reimbursement trends and payment models. Developing public-private partnerships, investing in prevention and well-being, and learning from industries outside of health care will also be key.
Using new care delivery models to improve access and affordability
Moving from volume to value will require building an outcomes-based financial model and data infrastructure to maximize value-based care (VBC) reimbursement pathways, which will likely be fundamental to many health systems’ sustainable growth.
Clinical innovations, patient preferences, and government program payment policies are prompting hospitals to shift certain services to alternative points of care and even to virtual environments that benefit from a cost and access perspective. It will be imperative for stakeholders across the health care ecosystem to collaborate around a whole-life approach to funding and delivering sustainable care.
Creating a positive margin in an uncertain and changing health economy
It is imperative for stakeholders across the health care ecosystem to collaborate around a whole-life approach to funding and delivering sustainable health care. Collaboration should be key. Investments in technology such as virtual health and telehealth could expand services while also helping hospitals bend the cost curve. AI powered nurses interacting with patients and intelligent virtual assistants providing personalized health care coaching are innovations that are already gaining traction.
Some hospitals have high levels of uninsured patients. As payer and service mixes change, and competitive and regulatory pressures rise, hospitals are looking to reduce wasteful processes. The ability to raise prices is limited. Hospitals, as well as ambulatory care providers, are consolidating to gain scale and are outsourcing noncore functions such as revenue cycle and environmental services.
Accounts receivable in the sector can be high, as payments from insurers may not arrive for months after a patient has been treated. Disputes with insurers are common, as insurers often deny or reduce reimbursement requests. Health care providers can lower the amount of write-offs from uncollected bills by working with insurance programs to increase the number of patients covered.
Regulation
Health care providers are subject to extensive state and federal regulations. Almost all health care providers participate in Medicare or Medicaid programs, run by the Centers for Medicare & Medicaid Services (CMS). Medicare and Medicaid participants must abide by a large number of regulations concerning their operating, accounting, and billing procedures. Medicare has a major influence on the payments hospitals receive, as many other payers use Medicare payment schedules as their benchmark.
Recent federal legislation has tried to address the rapid growth in national health care costs, especially the health care reform law of 2010 (the Affordable Care Act, or ACA), which substantially expanded health care coverage to previously uninsured Americans. Other important laws affecting the health care system include the Balanced Budget Act of 1997 (BBA); the Medicare Balanced Budget Refinement Act of 1999; the Medicare, Medicaid, and State Children’s Health Insurance Program (S-CHIP) Benefits Improvement and Protection Act of 2000; the False Claims Act; the Criminal Health Care Fraud Statute; the False Statement Statute; the Anti-Kickback Statute and Stark Law (provisions of the Social Security Act; and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH), part of the American Recovery and Reinvestment Act (ARRA), established financial incentives for Medicare providers to achieve meaningful use of electronic health records. The HITECH Act also strengthened HIPAA patient information privacy regulations.
State health and finance regulations can vary widely. Some states mandate a specific level of staffing per patient, or require a “certificate of need” before a hospital can invest in capital improvements. Most states manage a network of state health regulators to inspect health care facilities (such as hospitals, surgery centers, and clinics) to ensure safe working conditions and a low risk of infectious diseases. Physicians must pass exams and be licensed by a state medical board to practice in a particular state. State boards respond to complaints about doctors but typically don’t monitor activities or inspect offices.
Location Specific Industry Data :
COUNTRY | STATE/REGION | CITY/TOWN/LOCATION | INDUSTRY OVERVIEW | HUMAN RESOURCES | PRODUCTIVITY | MARKET | FINANCE | NOTES | ACTIONS |
---|---|---|---|---|---|---|---|---|---|
Switzerland | NA | Villarbeney | EDIT |COPY |DELETE | ||||||
Australia | NSW | Earlwood | EDIT |COPY |DELETE | ||||||
Netherlands | ZH | Rhoon | EDIT |COPY |DELETE | ||||||
Great Britain | NA | Great Haywood | EDIT |COPY |DELETE | ||||||
France | CENTRE | Dunkerque | EDIT |COPY |DELETE | ||||||
Netherlands | NB | Esbeek | EDIT |COPY |DELETE | ||||||
United States | IL | Alexander | EDIT |COPY |DELETE | ||||||
Austria | LOWER AUSTRIA | Raschau | EDIT |COPY |DELETE | ||||||
Sweden | NA | Paskallavik | EDIT |COPY |DELETE | ||||||
Austria | BURGENLAND | Hochbruck | EDIT |COPY |DELETE | ||||||
Austria | BURGENLAND | Wilfleinsdorf | EDIT |COPY |DELETE | ||||||
Germany | RP | Ditscheid | EDIT |COPY |DELETE | ||||||
Denmark | REGION SJALLAND | Kobenhavn V | EDIT |COPY |DELETE | ||||||
Great Britain | NA | Radway Green | EDIT |COPY |DELETE | ||||||
Italy | NU | Nuoro | EDIT |COPY |DELETE | ||||||
United States | VT | Brattleboro | EDIT |COPY |DELETE | ||||||
Netherlands | ZH | Naaldwijk | EDIT |COPY |DELETE | ||||||
Iceland | NA | Sau?Arkrokur | EDIT |COPY |DELETE |
March 7th, 2020 at 9:21 pm
With rising healthcare cost many hospitals are struggling to keep open. some are forced to merger or face closure.
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August 15th, 2020 at 3:36 am
The Healthcare Industry continues to evolve. There is little time spent interacting with clients because certain deadlines need to be met and time spent relating to the client is timed.It is now a business for profit, no time spent building relationships and offering comfort to the clients anymore.
HMO Health Management Organizations and PPOs Preferred Provider Organization, a cross between hospital and Insurance Companies is the order of the day. HMOs are responsible for the finances of the Industry and the determination for the continuum of Medical personnel practices is dependent on certain criteria being met.
The Industry is catching up to digitization and employment is also preferred with an IT background.
Healthcare provides 13.5 million jobs and stands as 8 out of 20 fast growing occupations. There is a threat to how many hospitals will be able to survive the present economic climate as there have been mergers and where mergers did not occur or work out, hospitals and other Health care Institutions have closed their doors. The Industry has diversified and extended itself to embrace Alternate Medicine and Home care.
Many Insurance companies are offering coverage for Alternate care because clients are utilizing herbs and moving away from conventional medicine.
People are living longer and the older people opt to remain at home and utilize Homecare Services.
Collaboration is to be considered key along with virtual health and telehealth to expand services to help the Industry survive. We hope for the best.
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