The top expenditure is medical equipment such as surgical robotics (selected by 27% of respondents), followed by IT/EMR investment (20%), brick-and-mortar expansion of outpatient facilities (17%), and physician acquisition/investment (17%). Another 9% plan brick-and-mortar expansion of inpatient facilities, which perhaps reflects the emphasis most healthcare organizations feel they need to make on moving care out of the more expensive areas of treatment, if possible.
In response to healthcare reform, many healthcare leaders—but not all—are experimenting with value-based contracts with payers. A quarter of CEO Exchange respondents say they are investing significantly in large-scale, active commercial contracts (for more than 5,000 lives), while another 36% say they are participating in limited pilots (with fewer than 5,000 lives). But 21% have conducted no more than initial conversations, and 18% are playing wait-and-see.
Several organizations are trying to pressure payers in their markets to work with them on sharing risk, trying to take the initiative in moving toward value based purchasing of healthcare. They're trying multiple strategies, but engaging directly with employers is one that seems promising.
Medicare Advantage programs seem to be a low-risk way to test alignment and understand what benefits the facility, the provider and the patient. In the Puget Sound area, Catholic Health Initiatives has bought two Medicare Advantage plans. Several are also active in the Medicare Shared Savings program.