What Does the Changing Sick-Care Ecosystem Mean for Doctors?

Rules create ecosystems that drive business models. Those business models are the way entrepreneurs create, develop, deploy, and harvest value through the deployment of innovation. The Affordable Care Act has changed the sick-care ecosystem in many ways, both intended and unintended, and that means that doctors and non-MD providers will have to rethink how and where they do their work.

A recent report from consulting firm Frost and Sullivan highlights how things are changing:

• “The US hospital industry is in the midst of a major transformation of clinical and operational strategy, moving away from an era of a “heads to beds” provider-centric delivery system to a more collaborative care continuum, with the patient at the epicenter of attention.

• This paradigm shift has not come about as result of one “big bang” industry catalyst or business action. It is the culmination of a multitude of political, social, economic, and cultural influencers. Moreover, the movement to a value-based model for hospitals has driven inpatient day statistics down and increased outpatient procedures.

• Whole hospital revenue cycle algorithms are being re-evaluated and evolving to accept bundled payments and shared risk with suppliers, physicians and payers alike.

• Massive consolidation of physical plants, markets, and primary care networks is underway. Whole new legal entities or accountable care organizations (ACOs) are tethering hospitals to their healthcare ecosystem and organizational footprint.

• The way hospitals are reimbursed is also undergoing transformation, beginning with Medicare and Medicaid payments to virtually all third-party payors. Hospitals now are incentivized financially to meet targets for quality outcomes and for preventing readmissions”

Both employed and independent doctors cannot simply ignore the pace of change if they are to survive and thrive. Instead, they must:

1. Do what they need to do to get paid for their services.

2. Create a strategic communications plan that conforms to the new reality.

3. Make the business of medicine everyone's business and assign leadership roles to physician intrapreneurs that are designed to drive innovation, not manage processes.

4. Learn how to use techniques in health data science to manage cohorts of patients in an effort to reduce costs.

5. Align themselves with non-hospital community and home-based care partners who are delivering more and more of the sick care.

6. Learn to see around corners.

7. Adopt an entrepreneurial mindset

8. Unbundle the care model to include data librarians and clinical data navigators, chronic care managers, and other yet-to-be-created job roles.

9. Have a digical care strategy to use information and communications technologies to exchange medical information.

10. Demand and participate in the development of value added health information technologies that reduce, not increase, workflow , helps patients get better and prevent disease and lets doctors to do what they do best.

There is a new sheriff in town. You can be smart and adapt to the change or you can meet at sun up for the gunfight at the OK corral.