Finding certainty in uncertainty: What health care can expect in 2017

There are a lot of unknowns about what health care will look like under the new presidential administration. But even in the midst of all this uncertainty, there are a few certain ways we know the health care industry (and capital development within it) will be changing in the years ahead.

By Michael Pukszta, AIA, CannonDesign June 2, 2017

Regardless of one’s political beliefs, everyone can agree that health care as we’ve come to know it under President Obama’s Affordable Care Act (ACA) will be changing. On President Trump’s first day in the oval office, he signed his first executive order aimed at dismantling the ACA. Although vague, the one-page directive gives federal agencies the authority to begin unwinding the measure.

Even with all of the uncertainty surrounding the future of the ACA, most agree a full-scale new solution will take time, and the executive order may not have much impact this year as government rules for 2017 have already been incorporated into contracts with insurance companies. Further, since the type of replacement the Trump administration is looking to launch is being positioned as a significant departure from the ACA, it could be many years before anything far-reaching is implemented.

Of course, everything will become clearer once a replacement plan is approved. President Trump recently told The Washington Post, “We’re going to have insurance for everybody,” though he didn’t provide details on how the insurance would be funded.

Long story short: there are a lot of unknowns about what health care will look like under the Trump administration. But even in the midst of all this uncertainty, there are a few certain ways we know the health care industry (and capital development within it) will be changing in the years ahead.

Partnerships and moonshots

In December 2016, Congress overwhelmingly passed the 21st Century Cures Act, which boosts funding for medical research, eases the development and approval of experimental treatments, and reforms federal policy on mental health care. The bill, signed into law by President Obama, provides $4.8 billion in new funding for the National Institutes of Health, with $1.8 billion reserved for the “cancer moonshot” launched by Vice President Biden and another $1.6 billion earmarked for brain diseases. Importantly, the legislation places a strong emphasis on science and evidence, pushing federal agencies to fund programs that are backed by solid research.

As a result, one trend we will certainly see continue this year and beyond is partnership. Specifically, we’ll see silos torn down between biomedical companies and academic medical centers while alliances emerge. For example, Novartis and Penn Medicine recently came together to launch the Center for Advanced Cellular Therapies—a facility designed for Chimeric Antigen Receptor technology, which enables a patient’s own immune cells to be reprogrammed outside of their body and re-infused to hunt for and potentially destroy tumors. The partnership between the two organizations is fueled by their mutual goal of finding more effective treatments for cancer.

Mental health care overhaul

Although the U.S. is making advances in the treatment of mental health, we have a ways to go before we bridge the gap between the current state and where we need to be. The relationship between physical health, community health, and mental illness is complex, and the challenges that need to be solved are plentiful—from education and access to costs and stigma.

Thankfully, as part of the 21st Century Cures Act, mental health care will also be getting a boost in funding. The Act provides $1 billion in grants to states to support efforts to prevent and treat the consequences of opioid misuse and abuse, as well as funds for a number of additional areas related to mental health promotion and prevention of illness. This, along with the continued insurance-payment advances that were stimulated by The Mental Health Parity and Addiction Equity Act, has turned mental health into a profitable enterprise for many providers.

Looking ahead, mental health providers will seek innovative approaches to destigmatize mental health care and normalize the treatment environment. We’ll also see a heightened focus on mental health for children, taking cues from trailblazers like the Virginia Treatment Center for Children—an institution set to open one of the most progressive pediatric behavioral health centers in the U.S. this fall. Proper usage will also continue to be a focus: Hospitals will look for new ways to make sure non-emergent mental health patients who present at the emergency department can easily be referred to primary or psychiatric care. For example, the new University of Kansas Behavioral Health Hospital features a crisis-intervention center designed to encourage appropriate usage and reduce visits to the university’s emergency department down the street.

Micro health on the rise

Outpatient care in convenient settings, such as in MinuteClinics and urgent care centers, continues to be a successful strategy in providing accessible health care. Based on the success of these models and the overall growth of the ambulatory care market, we’re now seeing a rise in the business case for microhospitals. Microhospitals are “micro” due to their number of inpatient beds (typically 8 to 12) and their overall compact size. In addition to being convenient for patients, they provide health care systems with affordable settings to deliver care and the ability to test demand in new communities or provide enhanced services in established markets without an extensive investment.

Of course, the ability to reduce costs and risk by testing a market before going all-in is extremely attractive in the midst of ACA-repeal talks. Although microhospitals usually require more upfront costs than ambulatory care and urgent care centers, they’re significantly more affordable than a full-service hospital—and they currently experience a much higher reimbursement than ambulatory care facilities due to their inpatient facility classification. Microhospitals are already being built across the U.S., and with a growing body of research emerging on this new approach to care, we anticipate the number of microhospitals will grow, too.

Continued value

The concept of value-based care is directly tied to the ACA, but even with the impending changes, it’s not likely the focus on value will change. Keeping people healthy and out of the hospital will continue to be a widespread goal of health care providers. While most U.S. health care providers still live in a fee-for-service world, there are value-based programs that reward health care providers with incentive payments for the quality of care they give to people, as opposed to the quantity.

One of the hallmarks of value-based care is preventive health care. As organizations strive to prevent illness and promote wellness, we’ll see increasingly more embracing a human-centered approach to medicine where the well-being of patients truly is the center of their universe. A great example is Allegheny Health Network’s new Wexford Health & Wellness Pavilion, an ambulatory care center designed to make health and wellness an ingrained part of every patient interaction. Part of doing this involves offering team-based and proactive health care, while a bigger part has to do with community outreach, education, and engagement. We’ll also continue to see an increase in health care organizations promoting a culture of health, not just health care in the traditional sense, and expanding into nontraditional health settings via partnerships with employers, retailers, and community organizations (e.g., Kaiser Permanente’s partnership with Target).

Reimagined health care education

The rate of health care transformation is becoming so rapid that it’s often difficult for established health care institutions and physicians to keep pace, let alone universities challenged to educate the next generation of health providers. Most experts agree we are looking at a shortage of health providers over the next 20 years as baby boomers age and put pressure on the health care system. Looking ahead, we’ll see medical schools emphasizing an interprofessional model of health education where physicians, nurses, and pharmacists as well as public health and allied health students will become accustomed to practicing medicine together. This will allow the highest-educated health providers to extend their reach by using lower-educated professions. Additionally, since hiring innovative health professionals is essential to health care systems seeking to increase their own levels of innovation, it’s likely we’ll see more providers separating themselves from others by completely reimagining their approaches to education with inventive new pedagogies.

For example, one of the biggest headlines related to health care education in 2016 was Kaiser Permanente’s announcement that it will open its first medical school. The school, which will enroll its first students in 2019, will enable Kaiser to influence its physicians literally from the beginning of their professional training—teaching them the Kaiser Permanente “way” from day one. In response to health care staffing shortages, we’ll also continue to see an increase in health-education degrees provided at the college and community college level. City Colleges of Chicago recently opened Malcolm X Community College in direct response to the projected 84,000 regional health care jobs set to come online over the next decade. The college was designed with input from local health care organizations to ensure the school could funnel students directly into these high-demand jobs.

Patient experience

Orchestrating exceptional patient experiences isn’t a new concept, but with a health care marketplace filled with established institutions and startups competing for the same patient population, it’s never been more important. But it’s not always easy to get right; the patient experience encompasses every interaction a patient has with a health care system—from parking, check-in, and wait times to somewhat subjective feelings about design, the quality of cafeteria food, bedside manners of health care staff, and that list goes on. With user-review platforms like Yelp increasingly being used by patients to share “real-time” experiences, the pressure to perfect the patient experience will continue to intensify.

Health care organizations will continue to invest in strengthening patient experiences by seeking new links between technology, design, and service excellence. With a growing body of evidence-based research about the role design plays in health care experiences and outcomes, they’ll not only look to improve and measure the overall patient experience, but also give patients the ability to control their own personal experiences. At the University of San Diego Health’s new Jacobs Medical Center in La Jolla, every patient room is equipped with an iPad that can be operated from the bed. The iPad empowers patients to customize their environment by controlling window shades and temperature in addition to ordering meals, controlling an in-room Apple TV, and accessing their treatment schedule, medical records, and doctor conversations.

The new University of Minnesota Health Clinics and Surgery Center is also enhancing patient experience via technology with a program called CareConnect. Patients are given a badge with a tracker when they arrive at the clinic, and the CareConnect program allows clinic staff to easily find patients and get alerted if they’ve been waiting too long. Coupled with a patient experience modeled after Apple retail stores where concierges greet patients with mobile technology, the clinic has been able to decrease wait times and improve personalization and privacy.

While health care re-reform will mark another important moment for U.S. health care—and will likely create change that is, at this point, difficult to exactly predict—all of the aforementioned advancements will continue to shape the future of health care capital development, regardless of what that future ends up looking like.

Mike Pukszta, a member of CannonDesign’s health practice’s core leadership team focused on practice strategies, has worked alongside many of the nation’s top health care institutions, providing trusted direction on how to flexibly plan and adapt for tomorrow’s health care reality. This article was originally appeared on the CannonDesign Blog. CannonDesign is a CFE Media content partner.

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