SOUTHFIELD — Fundamental shifts in health care, above and beyond reforms included in the Affordable Care Act, will need to be re-examined in 2013 according to a new report from the Southfield-based public accounting and business advisory firm Plante Moran.
In its latest healthcare industry outlook, Plante Moran identified five key dynamics that the entire healthcare value chain, specifically employers, patients, payors, suppliers and providers, must embrace in 2013 to stabilize and sustain the healthcare system in America.
“Although there is consensus that the current healthcare model is unsustainable, the commitment to drastic change is low. That itself has to change,” said Matt Weekley, national healthcare practice leader at Plante Moran. “Americans have to assume greater responsibility for their wellness and become better educated consumers of medical care. Similarly, the healthcare industry has to collaborate to reduce inefficiencies and defects.”
Plante Moran’s five-point formula includes:
•Wellness: With a greater emphasis on wellness and preventative medicine, more costly acute and post-acute services can be better avoided. This focus requires patients to make healthy choices and wellness part of their routine and will require healthcare systems and professions to invest in preventative health programs and personnel.
•Collaboration: The future of healthcare delivery lies in “patient-centered medical homes” that focus on treating the “whole person.” Bringing primary care physicians, behaviorists and social workers under “one roof” eliminates cost outliers and increases efficiencies. This transformation from an “event” centered healthcare system to a focus on healthy lifestyles requires coordination and collaboration among doctors, insurance companies and patients. The healthcare industry will also utilize technology, such as smart phone applications for EKGs, ultrasounds and telemonitoring of chronic conditions, to drive down costs.
•Pricing transparency: In 2012, approximately $2.7 trillion was spent on health care for 320 million people. That’s approximately 18 percent of the nation’s gross domestic product and is 50 percent more than most developed countries. The future requires patients to be active consumers; employers to move to high-deductible, defined insurance plans that provide greater flexibility and personalization; insurance companies to provide more retail-pricing models; and providers to bundle services.
•Success metrics: Success will not be measured by how many tests, admissions, surgeries or procedures are performed, but by how many people choose one medical service over the services of another. Payors, such as insurance companies, will be charged with keeping the total cost of delivering health care per capita at or below the rate of inflation. For patients, the success metric is very simple, “Am I leading a healthier lifestyle? Am I managing my own wellness plan?”
•Responsibility: Healthcare reform is leading back to an era of more individual responsibility, when insurance was considered to be for catastrophic coverage only and individuals picked up as much as 75 percent of healthcare expenses (compared with 25 percent today). Employers will be able to attract and recruit staff based on how much they subsidize defined insurance plans. Providers will have a greater focus on quality over quantity.
“Data has made it clear for a while that health care was on the frontier of disruption and in need of transformation. But when you listen to people at the grocery store or coffee shop talk about how to care for a loved one, the issues take on more urgency. Health care is a very personal issue for consumers, but it is also a very essential piece of a healthy, thriving economy. ” Weekley said. “Our nation, its businesses and its families, are looking to health care to bring back our competitive edge. To accomplish this goal, real cuts in the cost of care delivery will need to be re-engineered into the care process.”
The full report can be downloaded at www.plantemoran.com/perspectives/outlooks/Pages/2013-healthcare-industry-outlook.aspx.
Plante Moran is among the nation’s largest certified public accounting and business advisory firms, providing clients with tax, audit, risk management, financial, technology, business consulting, and wealth management services. Plante Moran has a staff of more than 2,000 professionals in 21 offices throughout Michigan, Ohio, and Illinois, with international offices in Shanghai, China; Monterrey, Mexico; and Mumbai, India.