As technology advances in healthcare, so does the cost of adopting it in the treatment of patients. With a growing focus on bespoke and precision medicine by device, genetics and robotics companies, this cost appears set to only continue to rise in the foreseeable future at a rate far outpacing economic growth1.
Add the compounding factors of ageing populations and the resultant increase in comorbidities, the increase in self education by patients resulting in a heightened expectation of levels of care, and the finite resources that today’s hospitals can work with, and the proverbial cliff looms closer than ever for healthcare systems across the globe. Australia is no different. The needle has to move.
This year, for the first time ever the number of people aged over 60 will outnumber children younger than 5 years of age.
One area explored across the globe is Outcomes Based Healthcare, often called Value-Based Healthcare. Attempts like Obamacare have demonstrated how difficult it is to make the shift, but governments, health ministries, hospitals and health insurers all appear to acknowledge that a change is needed. Economics is only one aspect of this topic. Many of the adaptations required could – and arguably should – be implemented by forward thinking organisations regardless of whether the reimbursement model is fee-for-service or fee-for-outcome.
Several key themes have emerged based on recent experience from around the globe:
- The KPIs need to change
Patient experience and/or Patient-Reported Outcome Measures (PROMs) will increasingly become a measure of value. The way care is delivered will be much more tailored and collaborative, leading to long term improvements in productivity and patient outcomes. Many healthcare providers in Australia have already commenced extensive works to map and understand their patients’ ‘journeys’. There is also evidence of a shift in health insurer advertising, advocating the merits of healthcare in the home.
- ‘Cost’ must be viewed holistically
Population health modelling that will be more easily facilitated by big data analytics and deep machine learning will invariably lead to an increasing focus on preventative measures. The role of hospitals will change, and services will need to adapt to the new roles expected of hospitals.
We are already witnessing at a global level with the World Health Organisation using population health analytics like FluNet and FluID4 to track spread and progress of seasonal influenza across the globe. Adaptive modelling can accurately predict the most likely locations of the next outbreak, helping to identify where countries should spend more to prepare and which regions will likely be spared.
Focusing in at health service level, providers will need to adopt a broader lens where the emphasis will be increasingly directed towards patients’ families, to ensure that patients and their environments are kept healthy. This requires a big shift in thinking from role- or discipline-focused care delivery to a patient-centric perspective where the aim is to focus more on preventing illness rather than just treating patients when they are unwell.
Australia has started the journey with the establishment of population focused primary health networks and general practitioner incentives focusing on prevention and wellness, but there is more work to be done for the entire health system to transform into a patient-centric care delivery model.
- Tailored healthcare can be more efficient
As patients take more responsibility for their care, as a result of the increasing availability of online information, they become more knowledgeable. They will increasingly exercise their rights as consumers of healthcare, and as a result, it’s likely the delivery of bespoke and tailored treatments will need to be managed in a new way. Hospitals will need to look more intently to other industries where processes run more efficiently. In 2015 Klaus Schwab, Executive Chairman of the World Economic Forum, coined the phrase, ‘the Fourth Industrial Revolution’, where the overall system leverages the strong interconnectedness and interdependence of stakeholder systems which profoundly transforms the overall systems’ productivity and efficiency3.
While the economic argument is only one aspect of this, one thing is for certain: demand for hospital care, in whatever form it is delivered, will continue to grow and change. This brings a requirement for additional capacity that is flexible enough to be up- or downscaled – and adapted – as hospital’s needs change.
The ageing population is not going away, and longer-term change is required to adapt to new conditions over the next 20 years, not least in terms of capacity, but also in terms of the types of treatments and procedures offered. Between 2015 and 2050 the proportion of the world’s population over 60 years of age will almost double from 12% to 22%2 , something which is likely to result in more patients suffering from multiple long-term conditions, such as dementia, cancer, diabetes, cataracts, heart disease and osteoporosis.
Between 2015 and 2050 the proportion of the world’s population over 60 years of age will almost double from 12% to 22%.2
As systems and operations are reinvented, hospital facilities will need to adapt and evolve in order to optimise the implementation of the new paradigms. Throughout this evolution, the pressure on service delivery and access to continued healthcare will remain unabated. Service continuity and the ability to ‘keep the doors open’, thereby ensuring patients are not turned away, diverted to other hospitals or having their treatments deferred, is a critical first step towards introducing a patient-centric culture.
Over the next decade, and very likely beyond then, solutions and temporary facilities that enable service continuity or interim on-demand capacity are going to play a more important role than ever before, as hospitals grapple with shifts in demand during the implementation of a new Value-Based Healthcare model.
- Schwab, Klaus (2015-12-12). “The Fourth Industrial Revolution”.