CRITICAL THInKInG AT THE CRITICAL TIME
™TRANSFORMING HEALTHCARE
FROM REACTIVE TREATMENT TO
PROACTIVE HEALTH MANAGEMENT
1 Looking Forward — Transforming Healthcare from Reactive Treatment to Proactive Health Management
3 The State of
Healthcare Reform — Slow but sure progress, or failure to deliver?
6 The FTI Consulting View
7 Making the Case for Change
8 Partner with FTI Consulting
Looking Forward —
Transforming Healthcare from Reactive Treatment to Proactive Health Management
where we are —
in transition from medical treatment to health management.
Long before the passage of the Patient Protection Affordable Care Act (PPACA) in 2010, healthcare reform was critically needed. Healthcare expenditures as a percentage of U.S. GDP, for example, were escalating at an unsustainable rate, and similar trends were evident in most of the developed world.
The drivers of this trend were clear – populations were aging, making them more susceptible to chronic diseases including diabetes, cardiovascular disease, COPD, cancer and chronic diseases that are expensive to treat.
Costs of treatment were also being pushed higher by the proliferation of more expensive drugs to treat specific conditions, medical device technologies that were expensive to develop and deploy, and insurance costs that had to increase to keep pace.
In response, Accountable Care Organizations (ACOs) – organizations comprised of payers, physicians, hospitals or other healthcare providers
who work collaboratively – and other integrated care organizations have emerged as major new organizational structures in an effort to reduce the cost of healthcare by providing efficient, high- quality, coordinated care to assigned populations of patients.
These healthcare entities are designed to lower healthcare costs, improve quality outcomes and the quality of the care experience by transforming healthcare from its traditional reactive role of providing immediate medical services to proactive healthcare management conducted over time. By aligning the activities and incentives of providers, insurers and patients around improved outcomes, the total cost of care can be reduced in comparison to the traditional approach of waiting until patients actually have chronic diseases that require intense and sustained treatment.
in short, putting downward pressure
on healthcare costs requires
controlling the total long run
cost of care.
Experts disagree on the
progress of healthcare reform
and its ability to deliver the
needed results.
Some experts believe that reform efforts are progressing well and that, over time, improvements in cost, access and quality of care will be achieved to the benefit of patients and communities.
Other experts believe progress is not sufficiently transformational, and that a new direction is needed.
Everyone agrees, however, that the fundamental realignments needed have occurred too slowly, and that success will require significant and sustained coordination and alignment amongst key players.
There also seems to be a general consensus that factors, such as demographics, socio-economic status, mental health and social behavior must be part of the mix, even though there has been limited forward progress to date in reflecting their influences.
In this environment, health systems have the opportunity to engage as a go-to resource for education, preventive medicine, and post-acute care. Serving as the patient’s advocate for long-term health and the patient’s resource for chronic illness and disease management are fundamental prerequisites for transformational success.
The state of
Healthcare reform — Slow but sure progress, or failure to deliver?
Experts disagree about the success of the
transition to controlling the total long term cost
of healthcare.
Fundamental to a transformational approach to healthcare is a community perspective on healthcare, in which ACOs and other healthcare participants think strategically about comparative advantages in a broader healthcare, landscape: what services does the organization perform well and what are its weaknesses; which service lines
should be provided, and what others should be added or need to be dropped;
what services make a positive contribution to its financials and which do not; what services does it consider to be “core”; and what healthcare responsibilities can best be undertaken jointly, as part of a broader healthcare community.
Tobacco Use Diet & Exercise Alcohol & Substance Abuse
Sexual Activity Quality of Care Access to Care Education Employment
Income Family & Social Support
Community Safety Air & Water Quality Housing & Living Conditions
Transportation Length of Life
Quality of Life
HEALTH BEHAvIORS
CLInICAL CARE
SOCIAL &
ECOnOMIC FACTORS
PHySICAL EnvIROnMEnT HEALTH
OUTCOMES
HEALTH FACTORS
POLICIES AnD PROGRAMS
Taking a community Perspective on Healthcare
Source: Adapted from County Health Rankings, 2014
Some experts believe progress in transforming healthcare to deliver improvements in cost, access, and
quality of care has not been suffi ciently
transformational.
FTI Consulting believes that a successful transition from traditional delivery of medical services to proactively promoting the maintenance and optimization of long-term healthcare starts with an objective assessment of the community being served:
- What does the community look like currently?
- How is it likely to change going forward?
- What does that imply about community patient needs today and over the long run?
- What are the levers (and associated incentive structures) that can be used to reduce the demand over time for healthcare services by the patient community;
- What are the options to supply healthcare resources to the patient community more effi ciently; and
- What are the potential eff ects of exogenous changes that might realistically occur in the marketplace (such as Medicaid reform).
The FTI Consulting view
Armed with this information, health systems – in collaboration with the broader community in which it operates – can now make intelligent tactical decisions that will move them meaningfully toward that goal:
• narrow the organization’s focus to focus on areas in which it has a comparative advantage
• expand or realign the organization’s footprint to address all aspects of healthcare in these areas of focus
• Think beyond acute and post-acute
care by focusing on preventable
healthcare management, in
collaboration with other healthcare
players in the community
As a fi rst step in this transition, FTI Consulting recommends a Transformational Demand Assessment.
This assessment looks at more than just past hospital history. It also identifi es demographic, socio-economic, mental health and social behavior factors;
predicts future disease patterns that are likely to occur in a community if left unaddressed; and provides a stratifi ed health profi le of the population to
determine the specifi c healthcare resources that will be needed, based on empirical and statistical analysis.
Using this Transformational
Demand Assessment, FTI Consulting helps communities and providers design integrated care systems that better meet the needs of their diverse patient populations today, and well into the future.
Making the Case for Change
Urgent care / mini-
clinics Physician
office
Hospice
Acute care hospital
Community care facilities
Skilled nursing facilities CARE COORDINATOR
Behavioral Medical Wellness
Mental
• Preventative
• Incentive-based
• Chronic disease
• Acute disease
• Emergent
• Urgent
• Obesity
• Smoking cessation
• Alcohol/drug abuse
• Medically-related
• Incident-related
• Depression
PATIEnT nEEDS CARE nEEDS CARE SETTInG
Source: Center for Healthcare Economics and Policy, 2015
Chronic Care High Risk Disease Management
Highly Complex
Case Management
Health Promotion Preventive Care
Primary Care Specialized Care
Chronic Care Long-term Care Sub-Acute Care Acute Care Rehabilitative Care
End-of-Life Care
Partner with FTi consulting
• Clinicians and hospital executives who have been in every executive position from chief nursing officer, chief medical officer, COO, CFO, CEO, who understand the practical difficulties and day-to-day needs and demands in the healthcare environment.
• Economists and modelers with expertise in healthcare transformation and analytical tools that are relevant, and data that is both pertinent and predictive.
• Unparalleled data analytics,
benchmarking and core metrics, best practices, micro/macro simulation and predictive modeling algorithms to change the healthcare equation.
• Strong track record of assisting each of our clients – hospital executives, physicians, employers, payers, state and regional
governments, or ACOs – to achieve a clear vision of the role they can most effectively play in this new health care environment, and the tactical steps they can take now that will move them meaningfully toward that goal.
• Deep supporting experience in related business specialties.
- real estate and construction - corporate finance
- forensic litigation - strategic communications
our healthcare clients agree…
FTI Consulting experts seamlessly combine
deep and broad relevant experience.
Susan Manning Senior Managing Director +1 202 589 3458
[email protected]Meg Guerin-Calvert Senior Managing Director +1 202 589 3451
Michael Biggs
Senior Managing Director +1 404 460 6238
[email protected]Jonathan Guppy Senior Managing Director +44 (0)20 3727 1729
[email protected]About FTI Consulting
FTI Consulting, Inc. is a global business advisory firm dedicated to helping organizations protect and
