by Nancy Gahles, DC, CCH, RSHom(NA), OIM

Nothing endures but change. There is nothing permanent except change. All is flux, nothing stays still. —Heraclitus

Healthcare is on the precipice of a dynamic shift right now. The lines between industries has blurred significantly over the past year, and made way to some exciting opportunities for integrative practitioners. From the shifting roles of insurance companies to new methods for conducting business, health and patient care is likely to see some dramatic changes over the next twelve months.

Here are three ways you can expect to see the greater healthcare industry shift, as well as potential new roles for practitioners in the integrative space.

1. A New Playing Field

In early December, CVS announced plans to buy insurance company, Aetna. With hospital-insurer negotiations heating up, the field was poised for a new play.

Closing out the year, Becker’s Hospital Review noted mergers between retail, healthcare, and insurers are giving the industry pause to consider these threats to their long-held, tightly controlled business models. Molly Gamble, author of the above article, said, a number of mergers illustrate the blurring line between healthcare and other industries, noting other such mergers as Optum and DaVita Medical Group. As for for what’s coming down the pipeline, Gamble said Apple and Amazon have shown interest in expanding into healthcare, with talks of Amazon moving into the electronic health record (EHR) space. 

The complexity and management of EHRs and the toll it exacts on the physician has long been known as a factor in doctor and nurse burnout. Removing this space from hospital administrators and medical personnel at the bedside and putting it into the hands of competent technology professionals may be  the ticket to unburden the system and free both physicians and nurses up to deliver quality care.

According to a December 5 Washington Post article, author  Carolyn Johnson, said the reasoning behind the emergence of a new paying field is “partially because siloed industries, such as the stand-alone company that wrings rebates on drug prices, don’t make as much sense in a healthcare system where companies are increasingly trying to put as many functions as possible under one roof-whether it’s seeing doctors, surgery or prescriptions.”

UnitedHealth Group has already begun this endeavor as its own pharmacy benefits manager and is building this out into a new business model that includes acquiring networks of clinics and surgical care centers. 

The big idea here is that pharmacy benefit management is taking on the role of negotiating drug prices in-house and obfuscating the need for the previously dominant player, medical health insurance.  What this will ultimately mean for patients and providers is anyone’s guess. 

Michael Munger, president of the American Academy of Family Physicians, told Young that, “The powerful alliance is unsettling to some doctors, who worry their roles could be usurped by a company eager to manage care in a cheaper setting.”

Munger said his organization isn’t opposed to the merger but has concerns—for example, that the merger could push Aetna patients into MinuteCinics instead of appointments with primary care doctors.

As an observer of the growing trend for drug stores to offer free flu shots and pneumonia vaccinations, the writing has been on the wall for years. The business model of the clinic scenario hasn’t taken off well. This new idea may give legs for the harried, too busy consumer to avail themselves of a one-stop shopping experience.

2. A New Workforce  

The new business plan seems to be providing easy access to consumers by managing their healthcare in one accessible place, whether it be a CVS, network clinic, or surgical center. But, as a result, what will become of the primary care physician? 

The necessity for primary care docs are on the decrease, which has been the case for years. Medical students are opting for the higher salaried positions in more specialty medicine. The up-and-coming profession of coaching has created personnel that can replace the time spent by an MD with a patient who needs simple advice, screening, or education about their condition and the medications prescribed. Health coaches are becoming certified and gaining status in hospitals, clinics, and private practices. Nurses are now becoming certified health coaches and will likely fill positions in these retail health clinics.

This trend for a new workforce follows the failed value-based care strategy of previous years. Value-based care payments were made on “bundled payments”. However, in November, the Centers for Medicare and Medicaid Services (CMS) issued a final rule officially cancelling one strategic bundled pay program, the hip fracture and cardiac bundled pay program. They also rolled back some mandatory requirements in the Comprehensive Care for Joint Replacement Model. The mandatory nature of the original model required hospitals to invest in the value-based care models. Now that this ruling has been issued, it effectively devalues the value-based plan and sets the stage for the emergence of the new class of healthcare workers—and their consumers.

It appears that there is quite a bit of confusion as to what value means in healthcare, but with confusion comes opportunity to redefine.

A December 2017 survey commissioned by University of Utah Health found that among 5,031 patients, 687 physicians, and 538 employers there was a wide disparity about what value means. For patients, the top value statement was, “My out-of-pocket cost is affordable.”  Following that were timely appointments with reasonable wait time. For physicians, quality and service measures meant value.

According to the survey, “it was notable that only 32 percent of patients chose “My health improves” as a top priority—a startling statistic for physicians who are trained to prioritize clinical outcomes as a key measure of value. This finding suggests that providers will have to better address access, convenience service and cost when determining value.”  

And if health improvement isn’t a factor for consumers, entities like CVS might just be the disruptive innovator of new healthcare in 2018.

3. The New Leadership

With a new playing field and new players, it stands to reason that new leadership will emerge with new cultural values. Enter the Millennials. The millennial generation consists of those born between 1980 and 2000. In healthcare, millennials in their thirties are ascending to senior executive roles as well as CEO positions at independent hospitals and smaller organizations.

The Becker Review noted a trend to facilitate this new leadership. The trend is not only to lay off highly paid administrators but to eliminate their roles completely. In June, MD Anderson Center eliminated executive vice president roles and gave senior VP’s more responsibility. Others quickly followed suit. In December, San Diego-based Scripps Health shared plans to eliminate the CEO position in its four hospitals in favor of a regional CEO model. The need to lower costs is at the heart of this shift.

Witt/Kiefer, a leading executive recruiter firm, issued a survey of more than 100 emerging healthcare leaders, those age 40 and under, in positions at the director level and above. “Salary, benefits, and job security considerations that entice healthcare leaders to remain in their current positions or leave for new organizations do not seem to hold as much sway for millennials as with previous generations,” they said.

Growth opportunities and work culture (51 percent and 25 percent, respectively) were far more significant than salary.

One millennial executive summed it up this way: “Culture is paramount.”  This group of executives differs from previous generations. The millennial leaders embrace innovative approaches to the business of healthcare and the holistic development of their executives. They value organization-wide support systems that ensure their personal growth along with enough autonomy and flexibility to ensure a healthy work-life balance. Further, 51 percent of millennials surveyed are concerned about burnout in their current position as well as during their overall career in healthcare management, and 55% said that the amount of paid time-off was a critical factor.

The new leadership wants to feel mentored. One respondent to the survey said, “ If I do not feel mentored, I will move to another organization ASAP.” And 50 percent of participants indicated they will likely seek a new employment opportunity within the next six months.

Stability, continuity in an organization, is often borne of time served to develop the culture. What might be of a concern to the healthcare industry as a whole is the nomadic quality of the millennial executives. Results of the survey showed that an overwhelming majority (77 percent) would consider taking a job in a field other than healthcare. One participant intentionally kept all options open, stating:”I chose my master’s degree to be non-healthcare specific in the event I need to leave healthcare entirely.”

Despite the apparent Wild West feel of the industry as it shifts, the survey’s conclusion is hopeful.

“Healthcare is undergoing massive change at a unique time, when millennials are ascending to top roles and baby boomers are retiring.  Generational turnover is natural and inevitable, and yet the transitions currently taking place at the top echelons of healthcare organizations may have an indelible impact on the industry. “I can’t think of a more exciting time to be involved,” one respondent said. “There will be difficulties but there is a great opportunity for innovation.”  

Such is the state of life: none are happy but by the anticipation of change: change itself is nothing: when we have made it, the next wish is to change again.  The world is not exhausted; let me see something tomorrow which I have never seen before. Samuel Johnson