NYC, Statue of Liberty with city in the background

It’s hard to forecast the future of healthcare these days, but a panel of experts gave their predictions of what it will look like in five years in New York City at a recent conference: Healthcare 2021 A Vision for New York.

Their predictions, which have implications beyond New York, included: further consolidation of health systems, more compatible electronic medical records across competing health systems, more engaged consumers, slightly lower costs, and quality improvement from value-based initiatives.

Keynote speaker George Halvorson, former chief executive officer at Kaiser Permanente, set the tone for the day by saying there is opportunity to provide care at levels beyond previous expectations.

“We need to buy care by the package, not by the piece,” Halvorson said.  “When we do that, we can re-engineer care to what the patient needs and the outcomes we want.”

He also predicted that the main sites of care in five years will be the following:

  • Hospitals and outpatient facilities that are smaller in size and provide care for a shorter time.
  • Clinics that offer multiple specialties and kiosks that provide mobile clinics.
  • Homes, which will be the site for 40 percent or more of care now provided in clinics.
  • Online, which will offer the same services as a clinical setting and will increasingly make physician office visits obsolete.

On the healthcare information technology front, Farzad Mostashari, M.D., co-founder and CEO of Aledade, said healthcare has digitized, but has not redesigned. The tools are there, but the potential of making healthcare decisions based on outcomes cannot be fully realized until electronic medical record systems are compatible and the data gathered is usable.  Right now, simple notifications to primary-care physicians, such as those indicating admission to the hospital or discharge and transfer, are not made. If the PCPs are the primary point of contact, they cannot be left out of patient care due to the EMR not talking to their system. As hospitals get acquired, this can even be a problem within health systems.

Consumers who often feel left out of the healthcare process must become engaged and educated in the next five years, said Charles Bell of Consumers Union.  So far, high-deductible plans are not changing consumer behavior in a good way. And, Bell said, with only 20 percent of medical services “shoppable” by consumers, they still don’t have any “skin in the financial game.”

Generally, everyone agrees consolidation will strengthen healthcare in New York City, but with that comes painful and expensive transformation and a reality that traditional healthcare delivery is a thing of the past.

“We’ve known for a while—probably since 2007—that the way of independent hospitals was the way of the dinosaur,” said Linda Brady, M.D., president and chief executive officer of Kingsbrook Health System in Brooklyn.

Brady hopes to save her struggling system by joining a regional health system in the next five years. She acknowledged the system will not have the same control over decision making, but said it is more important to continue serving the community.

Brady’s prediction may already be coming true. Northwell Health is talking with Gov. Andrew Cuomo’s administration about managing a new network made up of four community hospitals in Brooklyn, including Kingsbrook.

Mega systems that are common in other areas of the country have not surfaced in New York City.  The first one will likely be Northwell, the most progressive and aggressive system in the market. Jeffrey Kraut, executive vice president of strategy and analytics at Northwell Health, predicted the market will have just four or five health systems in five years. He stopped short of saying Northwell would take the plunge first, but the system’s aggressive growth strategy suggests otherwise.

The reality is not everyone will still be around in five years.

Perhaps David Sandman, president of the United Hospital Fund in New York City, said it best: “You can’t be a lightweight in healthcare today.”

Valerie Pillo is an analyst at DRG and a Quality Initiatives expert. Follow her on Twitter at @ValeriePilloDRG.

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