McKesson : The Business of Health Care November 2017

Value-based reimbursement is a game-changer for health care providers. Assuming the clinical and financial risk for patient care requires hospitals, doctors and other clinicians to change how they've historically run their operations. Eight new industry reports, surveys and published research articles reveal the wide range of strategies providers are deploying to successfully respond to the challenge.

Accountable Care Organizations

The number of public and private-sector ACOs passes the 900 mark

The number of public and private-sector accountable care organizations (ACOs) climbed to 923 as of March 31, 2017, up 11 percent from the 831 in operation one year earlier. That's according to a report from Leavitt Partners, the Salt Lake City-based health care consulting firm, published in Health Affairs. Some 32.4 million people were receiving health care services through an ACO by the end of the first quarter of 2017, the report said. That's an increase of 2.2 million people, or 7.3 percent, over the previous one-year period. The net gain of 92 ACOs was the result of 138 new ACOs starting operations and 46 ACOs dropping accountable care contracts, the report said. The 923 ACOs had a total of 1,366 accountable care contracts. Of those, 715, or 52.3 percent, were commercial contracts; 563, or 41.2 percent, were with Medicare; and 88, or 6.4 percent, were with Medicaid.

The accountable care solutions market will reach nearly $19 billion by 2021

That's according to a report from MarketsandMarkets, the Seattle-based business research firm. The report said the market for products and services supporting accountable care and ACOs will grow at an annual rate of 16.6 percent from 2016 to 2021 and hit $18.9 billion by 2021. The report attributed the double-digit growth to 'increasing government initiatives, implementation of initiatives to shift the burden of financial risk from payers to health care providers, [a] growing need to curb health care costs and advancing IT and big data capabilities.' The products and services supporting accountable care and ACOs include EHR systems, advanced analytics, revenue cycle management, patient engagement tools, population health management, care management, health IT integration systems, health information exchange capabilities and clinical decision support systems.

Hospitals and Health Systems

58 hospital or health system transactions were announced during the first six months of 2017

The pace of hospital and health system mergers and acquisitions is picking up. That's according to a report from Kaufman, Hall & Associates, the Skokie, Ill.-based health care financial advisory firm that tracks hospital and health system M&A activity. The report said 58 separate hospital or health system ownership transactions were announced during the first half of this year. That's up from 52 during the first six months of 2016. Thirty-one of those 58 deals were announced in the second quarter. 'The uptick in transactions among larger and like-sized organizations is likely to continue in the months ahead,' the report said. 'Leaders of many larger health systems are thinking strategically about how best to build the scale and capabilities needed to remain competitive in a rapidly changing health care environment.'

29% of hospital executives say creating economies of scale is their top strategy for containing costs

That's according to a survey of 301 hospital executives conducted by the Economist Intelligence Unit and sponsored by Prudential. Some 78 percent of the respondents cited rising costs as a critical or extremely critical concern, with 45 percent saying cost was a barrier to the successful transition to value-based care models. The top five strategies the executives said they would pursue over the next three years to tame costs were: optimizing current operational and clinical processes (38 percent); eliminating unprofitable services (35 percent); seeking lower-cost vendors for supplies (35 percent); partnering with other hospitals and health systems to create economies of scale (29 percent); and increasing their role in preventative, primary and integrated care to reduce costs under value-based and population health management contracts (29 percent).

Physician Practices

The number of physicians with active medical licenses is now nearly 1 million

The number of U.S. doctors with active medical licenses reached 953,695 in 2016, according to the Federation of State Medical Boards. The Euless, Texas-based FSMB, which represents 70 state and U.S. territory allopathic and osteopathic medical licensing boards, published its data in the Journal of Medical Regulation. The FSMB conducts a biennial census of physicians with active medical licenses using data from the 65 state boards in the U.S. The FSMB said the number of physicians with active licenses in the U.S. rose 12.2 percent to 953,695 in 2016 from 850,085 in 2010, with 103,610 newly trained doctors entering the medical profession. The number of actively licensed doctors per 100,000 people rose to 295 in 2016 from 277 in 2010. 'These censuses demonstrate a growing and more diverse physician population,' the report said. Two of the biggest shifts were in gender and age. Women represented 33.5 percent of the physicians with active licenses in 2016, up from 29.7 percent in 2010. Last year, 29.3 percent of the doctors were 60 years of age or older, compared with 25.2 percent in 2010.

Most doctors continue to work at physician-owned medical practices

That's according to a Policy Research Perspectives brief published by the American Medical Association. The AMA said 55.8 percent of doctors worked at medical practices last year that were owned by physicians. That's down one percentage point from 2014, when 56.8 percent of doctors worked at physician-owned practices. The figures are based on a survey of a representative sample of 3,500 physicians conducted by the AMA in 2014 and 2016. The association conducted a similar survey of 3,466 doctors in 2012. The brief said the percentage of doctors working in practices owned by hospitals or hospital systems, or working directly for a hospital or hospital system, was unchanged between 2014 and 2016. The percentage each year was 32.8 percent. Some 47.1 percent of the surveyed physicians had an ownership stake in their medical practice last year, down from 50.8 percent in 2014 and 53.2 percent in 2012. The percent of doctors working at their medical practice as employees rose to 47.1 percent in 2016, up from 43 percent in 2014 and 41.8 percent in 2012.

Population Health

82% of health care executives say they're moving forward with population health management plans

Despite the political uncertainty in Washington over the future of the Patient Protection and Affordable Care Act, 82 percent of 199 health care executives surveyed by Health Catalyst, the Salt Lake City-based health analytics firm, said their organizations will continue with their population health management strategies. Some 4 percent said they were accelerating their plans, while another 4 percent said they were hitting pause. Some 10 percent said they weren't sure what they were going to do. Only 13 percent of the respondents said their organizations have 30 percent or more of their patients or enrollees under population health-based risk contracts. Some 36 percent said they expect to reach that threshold in one to two years, with another 37 percent estimating that it will take three to five years. It will be six to 10 years for the rest. The biggest barriers to a successful population health management strategy were financial incentives in contracts (37 percent), access to high-quality data and analytics (17 percent) and care-model issues (16 percent).

88% of hospitals and health systems screen patients for social determinants of health

Most hospitals and health systems screen at least some patients for social determinants of health as part of the clinical care they receive. However, most don't do it on a systematic or regular basis. That's according to a survey of 284 hospitals and health systems by the Deloitte Center for Health Solutions. Social determinants of health include such variables as housing stability, food security, transportation, education, utility needs, interpersonal violence, family and social support, and employment and income. Some 62 percent of the hospitals and health systems do screenings on a regular basis, and 26 percent do it on an ad hoc basis. The most common variable screened for is family and social support, performed by 81 percent of the hospitals and health systems. The least common was education, performed by 38 percent of the respondents. Hospitals and health systems with two or more value-based payment contracts were more likely to screen patients for all their social needs, with 70 percent citing improving health outcomes as their primary reason.