Since becoming president and CEO of AMGA in October, I’ve spent as much time as possible listening to as many of our 450 members as three months will allow. You can learn a lot of valuable information and insight when your membership represents 175,000 physicians and legions of allied professionals―from nurses to pharmacists to information technology specialists―who treat 1 of every 3 Americans.
What I hear is encouraging. Healthcare organizations are finding new ways to enhance care delivery through innovative models and partnerships. For instance, many AMGA members―including Dignity Health, Intermountain Healthcare, the Permanente medical groups, Sutter Health and Christus Health, to name a few―are implementing successful community engagement strategies. These systems are partnering with their communities to address some of the key drivers of poor health, like food insecurity, transportation and substance abuse.
What I hear is providing insights into what issues will be top of mind with healthcare leaders in 2018. Thus, here’s a short list of delivery trends to watch for in the coming year:
1. Efficiency will become a top priority. Revenues are flat while expenses continue to rise for most medical providers, so medical groups and health systems must continue to make their practices more efficient. Practices will look for workflow and staffing efficiencies and ways to cut costs that don’t impact the patient experience, access or physician burnout. In addition to continued use of advanced practice providers such as medical assistants and nurse practitioners, look for growth in the use of nonlicensed, lower-cost caregivers like population health coaches or community health workers. We will also see the expanded use of enabling technology, like texting or e-coaching, which extends the reach of existing, costlier staff.
2. Physician burnout will be a strategic imperative. Addressing physician burnout will become a priority in the boardroom as leaders will demand initiatives to stem this epidemic. Many will add burnout metrics to their dashboards. Concerns about the stability of the critical primary care workforce, early retirements and productivity will drive increased attention to personnel issues including physician frustrations with their EHRs, the need for more comprehensive care redesign and the lack of adequate leadership training.
3. Competition for convenience will heat up. Patients—especially millennials—will continue to drive the demand for quicker, more accessible options to receive care. Growth in urgent care centers, pharmacy-based care, Uber-like home care delivery and virtual medicine will provide increased ways for patients to bypass hospitals and physician offices. Medical groups and health systems will find new ways to remain competitive in their markets.
4. Scope-of-practice issues will become more acute. The underutilization of many healthcare professionals―including pharmacists, nurses, physician assistants or behavioral health specialists―will lead to increased demands to expand their ability to treat patients more autonomously. This will likely lead to resistance from physicians and some medical societies when expanded scope-of-practice encroaches on turf traditionally reserved for physicians.
5. Practices will form more community partnerships. The move to value-based payment systems and the accountability for an attributed population means that healthcare systems will need to work with community partners to address some of the root causes of poor outcomes and resultant higher costs. Pre-diabetes, obesity, transportation, food insecurity, opiates and substance use disorders, and mental health are just a few of the issues that will continue to challenge healthcare systems. Look for more partnerships with community-based resources, including diabetes prevention programs, Uber-like transportation, food banks and drug treatment programs.
These are just a few of the issues that healthcare organizations will grapple with in the new year. Undoubtedly, 2018 will see unexpected changes as well as other innovations in care delivery that will lengthen this list. But, I am confident that providers will rise to these challenges and continue to further the future of medical care and provide new approaches to meeting patient and community needs. And I will keep listening, learning and supporting these efforts.
Jerry Penso, M.D., is the president and CEO of the American Medical Group Association, a trade group representing multispecialty medical groups and integrated systems of care.