Once physical proximity is no longer a prerequisite to deliver clinical expertise and a personalized patient experience, the game changes, says Safavi. An organization known nationally as a leader in cardiology could then have a presence in regions where it doesn't have physical locations. "You can't ignore [telehealth], because competitors who don't build bricks and mortar may be able to compete in your area," he says. "On the other hand, the opportunity for your organizational reach goes up too."
A lot of organizations are looking to adopt telehealth services a la carte, says Erickson. "Our vision is that it should be an e-care suite of services, because if you have a stroke patient, you really need all of the pieces," he says. "It needs to be interdependent and work together rather than siloed in six different areas."
Skin in the game: Pay for performance has come a long way in a few years. It used to be a negative buzz phrase for many in the hospital industry, as commercial insurers rolled out incentives that were intended to pay hospitals better (or less poorly) for better outcomes. Now, many CEOs are finding ways to pay their own employees for better performance, including Frank Perez, CEO of Kettering Health Network in Dayton, OH.
"For years we have structured pay for performance for our executives all the way down to managers based in part on their performance against a quality scorecard," he says. "It's part of their lives."
Participation in Medicare ACE demonstration projects: Many CEOs expect CMS to develop new acute care episode demonstration projects that might support integrated (sometimes called bundled) care in the vein of its ongoing cardiac and orthopedic demonstration projects. Gaining acceptance into any such program is difficult, but learning what successful previous applicants have done can equip your hospital or health system with tools that are successful outside the demonstration.
Value-based physician recruiting/employment: Faye Deich, chief operating officer at 390-bed Sacred Heart Hospital in Eau Claire, WI, focuses on creating and growing value. "This means that we provide the best quality care that we can while doing so in the most efficient and effective manner," she says of a hospital that resides in the top 10% in quality care measures nationally. "That means . . . removing waste and reducing redundancy while engaging our colleagues on the front lines to accomplish this. Aligning with our physicians is critically important in accomplishing all of this."
Noninvasive surgeries: Minimally invasive surgeries have already won over patients by reducing pain and recovery times, and the procedural approaches are going to get even less invasive. Natural orifice surgery may eliminate scars altogether.
Nonphysician providers: While physician assistants and nurse practitioners can't replace physicians, they can collaborate with physicians to share and prioritize the workload and make the practice more efficient.
Expansion in individual health insurance: Employer-based coverage continues to drop, so insurers will need to find other ways to get new members. That's why insurers are devoting more resources to the area of individual health insurance. But with that new focus comes issues not found in the employer-based market, such as the need for better marketing, consumer outreach, and Web site design to help prospective members decide which plan is best for them and for current members to understand the often complicated world of health insurance.
Managed Medicaid plans: More states have been expanding public insurance options through managed Medicaid programs, which put health insurers in charge of offering Medicaid coverage. This added focus will mean the insurers that are already dealing with that needy population will have an advantage over those that have stayed out of needy populations as states relax Medicaid salary restrictions.
Translation services: As an increasing number of non-English-speaking patients seek care, and given the increasing complexity of health information, it's important that translators or interpreters not only have the right linguistic qualifications, but that they also have appropriate cultural sensitivities. The growth of remote-based translation services continues to grow, as well, offering additional options.
Public quality measures: Hospital leaders should recognize that patients are becoming increasingly educated in the use of online tools that allow them to compare not only the price of certain elective surgeries, but other quality measures, such as the number of C-section deliveries or the mortality rate for heart bypass operations. In addition to the need to develop or refine a systemwide plan for presenting such information, there are opportunities to utilize such data market development.
Medical robotics: The next generation of surgeons and a need to stay competitive are two factors fueling the growth of medical robotic technology. Advances in the types and quantity of surgical applications that can be performed with the assistance of computers and robotics will help make this market a key growth opportunity for hospitals in the years ahead.
Wireless and mobile devices: Healthcare information will need to be extremely mobile because that is what patients and providers will demand. There are probably physicians already asking their CIO when the PACS system will be accessible on their iPhones.
Electronic health records. The roughly $19 billion in funding for health information technology included in the American Recovery and Reinvestment Act pretty much ensures that the adoption of EHRs will increase substantially in the coming years. Well, that and the penalties providers will incur by not being meaningful users of EHRs by 2015.