Considerations that may be underappreciated by U.S. health system CEOs: A baker's dozen

  1. Downward pressures on inpatient demand are sustaining. Inpatient demand is “morphing” to outpatient service demand. Is your health system’s strategy designed to “re-capture” the shift?
  2. Health systems are not likely to have internalized the operating competencies required for the road ahead; especially competencies that are more “public health practice” in nature; e.g. total cost of care evaluations, epidemiology of  populations, the science of health behavior interventions, interprofessional team care and others.
  3. Physicians looking for private practice investment opportunities are a dying breed.
  4. The movement of U.S. accounting methods closer to international standards will favor applications of alternative financing methods; especially facilities. Alternative financing models will provide for enhanced strategy flexibilities.
  5.  Third party reimbursement methods will be an “experimental science” for years to come. The system’s financial structure must accommodate multiple payment options, including payments for physician services.
  6.  Operative physician compensation models may not square well with the need to deliver care from interprofessional, collaborative teams. Health systems will need to re-define “compensable productivity”.
  7. There are no published best practices on interprofessional team care. Models are idiosyncratic and often driven by philosophies and goals that misalign internal incentives.
  8. Hard asset capital structures have not advanced as fast as care models; e.g. 60% clinical care delivery in the outpatient arenas with 70% of hard asset investments on the inpatient side.
  9. Most I.T. platforms cannot readily recognize, evaluate and report total costs of care for defined clinical populations, nor are they geared to evaluate the performance of care teams over time.
  10. Care manufacturing and delivery models rarely consider scalability at the point of service. “Scalability” is typically a consideration for “corporate services” support only.
  11.  “Speed to market” will become an increasingly important factor in strategy; especially ambulatory care services.
  12. Collections of “doctor deals” won’t serve health systems well into the future; well-organized, well-led and well-incented professional services platforms are required.
  13. Physician leadership is an under-developed asset for many health systems. 

Daniel Zismer, Ph.D.2013