A few months can make a big difference in strategy for health and human service organizations, which is why nimble is the new (must have) competency for executive teams. Changes in the payer landscape, evolution of health plan policies and practices, and new competitive factors in service delivery make strategy adjustments inevitable.
Each quarter, our team looks at recent developments with an eye on strategy—which developments should executive teams keep top of mind when adjusting their strategic plans and approaches. We highlighted the most important strategic developments and their implications for strategy in our recent elite member webinar OPEN MINDS Big 5 Briefing—Developments Of The Past 90 Days That Could Reshape Your Strategy. Our picks? Expansion of retail and in-home primary care, bold new moves from Medicare, digital health developments, trauma-informed care requirements, and possible changes in addiction privacy rules.
Retail Care Expansion
In the third quarter, we continued to see an increasing number of retail health centers and the use of in-home primary care gaining ground. Walmart, CVS and Walgreens all made major announcements expanding their health care service capacity:
There were also major payer endorsements of the concept of in-home primary care. The models are slightly different but share the goals of “upping” the consumer convenience quotient and bringing specialist care to consumers via telehealth:
These developments present strategic challenges to traditional specialty service provider organizations in terms of revenue and role in the delivery system.
The Center for Medicare & Medicaid Services (CMS) has been busy making bold changes to policy during the last few months. Policy announcements included changes to medication assisted treatment (MAT) and home health reimbursement, which create strategic challenges and new opportunities:
It’s been a while since the original Adverse Childhood Experiences (ACES) study was published and concern about how trauma influences outcomes is getting more traction from payers and health plans. Some recent developments:
Six states including Colorado, Massachusetts, North Carolina, Ohio, Washington, and Wisconsin are also implementing training, screening, and support systems to deliver trauma-informed services, and more states are likely to move in that direction soon.
Digital Health Makes Inroads
Tides are shifting toward digital health, which will decrease market share for traditional face-to-face services. Some of the developments of note include:
Preparing for an on-demand world will require executives to assess, invest in, and use appropriate technology to remain competitive (see Do It Now!). Every executive needs to be thinking about a virtual strategy to survive (see How Do You Compare On Tech Spending & Adoption? and The Health Center Of The Future In The Palm Of Your Hand?).
Finally, a note on interoperability, which continues to be an issue for integration and the survival of specialty provider organizations. One of many impediments to achieving health system interoperability is the regulation for sharing addiction treatment records—42 CFR Part II. A rule was proposed to update and dispel rampant confusion with 42 CFR Part 11, reduce restrictions, and improve care coordination (see SAMHSA Proposes Changes To Addiction Treatment Privacy Rules).
Confusion about this regulation has wreaked havoc in health care circles, and this proposal would mean that the whole record doesn’t have to end up under the provision as long as teams segment a record (see The Confidentiality Of Substance Use Disorder Consumer Records Regulation: An Update). Many provider organization executives would like to see SAMHSA get off the dime to liberalize these rules and have standards in sync with HIPAA. Without that change, specialty provider organizations will be at a competitive disadvantage in any integrated care initiative.
My overall message to executive teams: It’s messy out there right now but look for opportunities among the threats. To hear more recommendations for how executives can prepare for future success, listen to the recording of our session OPEN MINDS Big 5 Briefing—Developments Of The Past 90 Days That Could Reshape Your Strategy and check out these resources from the OPEN MINDS Circle Library:
- Prioritizing Innovation: It’s About Discipline & Thinking Creatively To Solve Challenges
- What We Can Still Learn From Mickey Mouse In 2019
- Making Innovation Work—Think Past, Present, Future
- Medicare Learning Network: Opioid Treatment Programs Medicare Enrollment Fact Sheet
- Executive Order Issued To Study Medicare FFS Pricing Alignment with MA & Commercial Plans
- Prepare For Impact: The New CMS Home Health Payment Model
- Expanding Access Through Technology: Innovative Approaches For Improving Access To Care
- Innovation Adoption Among Specialty Provider Organizations: The 2019 OPEN MINDS National Innovation Survey
- Building A Value-Based Sustainability Strategy: How To Develop Innovative Programs & Manage Your Service Line Portfolio
- Opportunity & Innovation In The Autism Market: The Beacon Health Options Strategy
And for even more join me February 14, 2020, for my keynote presentation, “The Integration Imperative: What You Need To Know & Do To Remain Relevant” for a real-time strategy discussion during the OPEN MINDS 2020 Performance Management Institute in Clearwater, Florida.