We all know the healthcare environment is changing: pressure on reimbursements from both public and commercial payers, need to control runaway costs, emphasis on payment for value vs. volume, etc. I saw a video recently that steps back and discusses how the changes we are seeing in healthcare are tied in with much broader changes in society – what they refer to as “megatrends.” (I have to admit that the video, from Deloitte Consulting, is way too consultant-y for my taste, but it’s fairly short and raises many interesting points.)
Of the seven megatrends mentioned, five seem especially relevant to the pediatric world. The most obvious is constrained resources. In all segments of the economy, people are looking to do the same or more with less. Quite simply, the money isn’t there. Another is “big data.” We are living in the information age, and while not all of that information is terribly useful, we are awash in it. One the one hand, this gives us tremendous opportunities to learn, and to make data-driven decisions about care and our business; on the other, it means many others also have access to information, including patients, payers, competitors, etc. Medicine has often had an asymmetric relationship between providers and consumers with regard to information, but the playing field is being leveled.
A third trend is unparalleled connectivity, with which we are all familiar. Again, this is a two-edged sword. We have tremendous possibilities for innovative ways of communicating with patients and families. However, this connectivity has led to an increased expectation of consumer control in all walks of life. People expect to have the information they want and need when they want it. It’s another shift in the dynamic of the provider-patient relationship.
Consumer discontent is another general megatrend, manifest in the demand for demonstration of value. Whether we like it or not, people are increasingly viewing health care as a service not as dissimilar to other services as we have traditionally treated it. While I believe there will always be an important difference between medicine and say, dining out or financial planning, consumerism in healthcare is an inevitable consequence of consumerism in society as a whole.
The final megatrend is accelerated consolidation. While politicians love to give paeans to small business as the engine of growth, the fact is that consolidation is increasing in all sectors. This is not necessarily a bad thing; there are many gains in both efficiency and quality that come from increased scale. For example, numerous studies have demonstrated the association between volume and quality in medical procedures. But how will we operate in an environment where bigger is better?
One of the take home points for me about all this is that, to the extent that what we see in the healthcare environment is a reflection of deeper, broader changes in the wider world, it’s harder to think that we can simply “weather the storm” and wait for these new fads to pass. Bob Dylan was right, “the times, they are a-changin’.”