在2022年医疗金融领域打胜仗:How to Tackle Lower Volumes, Higher Costs, and Big Competition

The question isn’t ifCOVID-19will permanently alter the healthcarefinancial前景,但会怎么做。大流行引发的金融逆风从新的竞争对手——包括垂直整合的保险公司、创新的医疗服务提供商和大公司(如亚马逊和沃尔玛)——到医生招聘大战等等。这些大型医疗生态系统和新的创新模式的增长速度超过了医疗服务提供商，推动了商业格局的根本转变，并使卫生系统处于守势。

由于这些新的竞争对手的目标是供应商的收入，美国医疗保健必须面对即将到来的挑战，作为一个业务问题，而不是技术或医疗问题。这种以业务为中心的格局将推动首席财务官和其他财务领袖发挥更大、更协作的作用，增强医生的能力，以提供更好的医疗服务，并利用以前未充分利用或未实现的资产和优势。

今天的供应商必须将他们的战术从防守转向取胜。实现这一转变需要医疗保健领导者理解不断变化的竞争格局，并为其财务领导者和团队定义新的角色和技能。

The Healthcare Financial Outlook: Uncomfortable Trends Are Pushing Provider Transformation

COVID-19 is driving fundamental shifts in healthcare finance, leaving many health systems unsustainable.Volumes, including adjusted discharge and patient days and emergency department visits, have dropped, while expenses, including per adjusted discharge, labor, and non-labor rise (Figure 1).

Meanwhile, new well-funded and consumer-centric entities in the healthcare space, such as the vertically integrated systems, new busines models, and large retail corporations mentioned above, are succeeding where the relatively small health systems are falling behind. Giants from other industries—the likes of Walmart, Amazon, and more—are dwarfing traditional health systems.

Competition Is About More than Patients—It’s Also About Clinicians

医疗保健领域的新进入者吸引更多患者的原因有很多，从成本到便利。然而，竞争不仅仅是针对患者的，也是针对临床医生的。While clinicians at traditional systems reportdissatisfaction and distress, including unacceptable levels of burnout (42 percent), burnout starting before the pandemic (79 percent), and suicidal ideation (one in eight), too many health systems aren’t taking action to improve the team member experience (Figure 2).

Innovators, on the other hand, are reinventing how they treat clinicians; they’re responding to the largely preventable contributors to burnout and poor experience, attracting clinicians from health systems to these new entities. Disruptive care delivery companies are addressing clinician concerns and well-being by aiming to reduce stress and administrative burden and increase support and flexibility. For example, one such innovator,ChenMed, promotes a practice model with the following vows:

• “Healthcare reimagined for you and your patients.”
• “Fewer patients, more time for everyone.”
• “Empowering physicians to deliver better outcomes.”

Healthcare Providers Must Prioritize a Business Solution

With decreasing volume, increasing cost, and a rise in competitors, health systems must prioritize business to play to win in today’s landscape. More than technology or care, misaligned incentives and antiquated leadership styles, especially regarding CFOs, are relegating health systems to defensive, rather than competitive, roles.

Health systems traditionally silo their CFOs, keeping them inaccessible to clinicians and preventing collaboration. In COVID-19’s wake, however, mounting and shifting financial challenges require providers to view CFOs as part of clinical and operational team—as allies, not adversaries.

To shift to a collaborative role and support clinicians to deliver the best care, finance must develop the following new skills:

• Understand clinical and business operations—including what these teams do daily.
• Understand healthcare costs and methodologies at the patient level—finance must understand cost to reduce cost.
• Develop expertise in various economic models—it’s not just a fee-for-service world anymore, and playing to win means understanding innovative models, how to apply them, and how they impact overall business.
• Leverage effectivelyanalytics, statistics, anddata science-金融需要分析技巧，从数据“噪音”中转换，并认识到真正的问题。
• Invest in technology to empower finance teams to do data science—such asaugmented intelligenceand self-service analytics.

Health Systems Still Have a Superpower: Data

While there’s a lot stacked up against provider networks in the pandemic-driven new healthcare landscape, health systems have a unique superpower—data．尽管有创新和大行业的竞争，数据仍然是智能医疗决策和降低风险的关键。

With decades of cost and clinical data, health systems have significantly more of this mission-critical asset than the new competitors. These high-value data stores include patient satisfaction,revenue(more than just claims spend), geospatial, market, and social determinants (SDOH) of health and contain game-changing insights into business and clinical operations (Figure 3).

Data is providers’ key differentiator on healthcare’s new playing finance field and under its new rules. To play to win, health systems must continue to acquire and manage data and nurture data leadership and skillsets. This winning strategy will enable providers to make competitive changes and partnerships, including vertical integration, national remote patient monitoring, provider-sponsored health plans, and innovative care delivery.

Playing to Win: A Healthcare Financial Strategy for a New Era

With decades of deep data (e.g., clinical, cost, claims, and SDOH), traditional healthcare organizations have a strong advantage over their new competitors—but only if they use that data to make more strategic financial decisions. A successful strategy for the new healthcare business landscape will require understanding the evolving competition, as big corporations, insurers, and innovative care delivery will continue to take market share. Providers also must break down silos between finance and clinicians and operators, enabling collaboration across enterprises so that comprehensive data drives all decision making. By taking this business-centric, data-first approach, providers are ready to play to win with today’s healthcare financial outlook.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

• Six Strategies to Navigate COVID-19 Financial Recovery for Health Systems
• Own Your Value-Based Care Future with the Health Catalyst Value Optimizer™ Solution
• Health Systems Share COVID-19 Financial Recovery Strategies in First Client Huddle
• 2021 Healthcare Trends: What Leaders Need to Know from COVID-19 to New Administration Policies
• From Volume to Value: 10 Essential Strategies for Navigating the Healthcare Shift