Since the Affordable Care Act was signed into law in 2010, the environment for healthcare has changed dramatically. Now, it could change even more with the possibility of an ACA repeal. But over the past six years, I have learned a few tips on how to navigate difficult times and transitions through experience, education, and collaboration with colleagues and governmental leaders. Here’s a review of some major industry trends and how healthcare organizations can adapt:
- A changed financial model. The ACA has helped more people obtain health insurance, which means hospitals need greater coverage capabilities to deal with higher volume in both the inpatient and outpatient arenas. A robust outpatient department with extended hours is more important than ever to meet the increasing demands of the communities you serve.
- Attend governmental meetings, join local boards and listen to the voices of those you serve. What are they saying? What do they need? Provide community outreach to those who otherwise would not have used your services. Competition is tough—find a way to drive the business back to your front door.
- Increasingly complex hospital systems. Many hospitals are becoming more specialized and are part of a greater healthcare system—whether it’s for-profit, nonprofit, or government-related. Compliance and consolidation have become key words in healthcare today.
- Boost compliance: Compliance has become such an ever-growing component of quality that incorporating quality into compliance must be an exercise undertaken at every organization. Hospitals must deal with broad and unprecedented regulatory changes, and therefore they must have a deep understanding of the quality initiatives throughout the organization. The biggest challenge of ACA compliance is the intensity of the regulatory expectations, and how these need to be implemented across the system.
- More and more healthcare entities are becoming High Reliability Organizations (HRO). An HRO is an organization that has succeeded in avoiding catastrophes in an environment in which normal accidents can be expected due to risk factors and complexity. I highly recommend you undertake this journey.
- Consolidate resources: Deciding how to consolidate resources and service lines should be part of your daily discussions in the C-suite. Creating standardization across the system is extremely important. Staff, physicians, patients and visitors must feel they are part of “one family.”
- Boost compliance: Compliance has become such an ever-growing component of quality that incorporating quality into compliance must be an exercise undertaken at every organization. Hospitals must deal with broad and unprecedented regulatory changes, and therefore they must have a deep understanding of the quality initiatives throughout the organization. The biggest challenge of ACA compliance is the intensity of the regulatory expectations, and how these need to be implemented across the system.
- Competition from urgent care centers and emergency centers. It is vitally important for hospitals and healthcare systems to develop relationships with these centers. For example, providing laboratory services to these centers will not only provide a vehicle to market your organization in the community, but will also help drive revenue to your bottom line.
To cope with this avalanche of changes, your organization should develop a 5-10-15 year plan with specific target dates and the associated revenue required to achieve it, and review it monthly without fail. Update and revise as you encounter barriers and challenges. It must be a fluid-working document, as the healthcare environment is not stagnant. It is critical to practice what is often called “scenario planning” or “creating an envisioned future.”
- Ask yourself:
- What changes can we expect in the healthcare industry over the next 5 to 15 years?
- Where is regulation headed?
- How is the practice of medicine evolving?
- What treatments, research and operations will be changing?
- Develop your organizational goals:
- Perform a market analysis of the population(s) you serve. Is it diverse? Do you need translators or healthcare professionals who speak a number of different languages? Get to know your neighborhood(s). For example, think about food markets; depending on the neighborhood, the variety and availability of food items varies depending on the community they serve.
- Does/will your current staff require a new skill set? For example, if you’re providing care to a number of different populations, those populations may have different medical needs. As communities change and evolve, you must be prepared for the types of medical problems your hospital could be faced with more frequently. Are you prepared?
- Add responsibility and accountability to your strategic plan. Executing your plan appropriately and achieving your objectives over the duration is much more difficult. Two words come to mind: responsibility and accountability. The days of the CEO owning the plan are over. It is everyone’s job (from front-line worker to the C-suite office) to ensure the strategic plan is a success. It is the responsibility of the leaders within the organization to “trust but verify” the work is being done according to the plan.
- What measures are critical for your strategic plan in order for you to make thoughtful decisions? What other things must be measured for regulatory and reporting requirements? Don’t forget about insurers—what are they measuring? What is your contractual risk? Be sure these are embedded in your plan.
- Report on the status of the strategic plan. In order to build credibility within and outside your organization, you need to demonstrate transparency (good and bad) and that you are living by the strategic plan you’ve created.
Darlene A. Cunha, MMHC, BSN, RN, ACHE, is an accomplished senior healthcare executive who focuses on population health management and the patient-caregiver experience.