Interview: Healthcare Trends with Ellen Bailey


In this blog post, we sat down with MCG’s Ellen Bailey, Managing Director and Healthcare Leader to get an inside scoop into Healthcare today. During this interview, Ms. Bailey walks through trends and impacts that are shaking up the Healthcare world today from three perspectives, the Providers, the Patients, and the Insurance Corporations.

What is most impacting Healthcare today?

Uncertainty.  Uncertainty impacts planning and in healthcare, that is critical.  Providers need to budget and determine priority investments. Insurers need to plan policies offered based on participants and data models. Patients need to have transparency into their responsibility as a consumer of healthcare – understanding what they need to pay for.  There is tremendous uncertainty around the government’s recent decisions and directions on Obamacare.  Senate leaders are changing their votes, which are announced in the news.  There is a keen awareness of the impact of the governmental decisions on healthcare across Providers, Patients and Insurers.  Everyone is waiting to see what will change, and that is in the hands of our lawmakers.  [at time of writing, 2 more Senators retracted votes]

What changes are you seeing in models?

As an industry, Healthcare has evolved to a system of rule followers.  Regulations were issued and companies complied.  The rules are very important and can often trigger or decide investments in Healthcare.  For example, a hospital may want to build a new wing, or offer a new line of service in cancer treatment and research, but that is a significant investment.  Many Providers are waiting to determine new capital expenditures until the government decisions are reached.  That impacts projects, operations, and a litany of investments that while important, are currently on hold.

What are Providers focused on today and what trends do you see in that market?

There are 3 key provider focus areas: differentiation, innovations and managing risks.  First and foremost, Providers are seeking differentiation.  Most people view physicians as more or less equal in skill or care.  Providers such as hospital systems seek to distinguish themselves via their brand and offering special services, such as cancer care.  People used to identify with a hospital based on proximity, but with age and new advances, are now seeking those specialized services.  Hospitals can differentiate to the market with clinical trials, advertising the capabilities of their physicians, and investing in research. They become known in the market, and with that, comes new paying patients and new revenue sources.

Providers are also keeping an eye on the innovations of the future – DaVinci robotics, Proton therapies, and other technology.  Providers want to weigh the cost and benefit of these technologies to evaluate new service offerings.  Everything is moving at a rapid rate.  Note taking is done on mobile devices, patient records can easily be accessed (when that capability is in place) for delivering a higher quality of care.  Providers are trying to keep up with technology and innovations in Healthcare, offer their patient populations more, and make sound business decisions.

Providers are  in the position to mitigate risk- both financial risk and talent shortage risk.  Providers are balancing the financial risk of Insurers who want the provider to assume joint risk for financially covering non-paying Patients.  They also model what their company can afford.  For example, if you build a new wing and add 100 beds, can you fill that with paying Patients and can you afford to staff and serve that new service?  The talent shortage is another new risk.  This is a recognized concern and one driven, at least in part, by the financial models of healthcare today.  In the past, being a physician was an entrepreneurial endeavor. The career attracted individuals who wanted to be high income earners.  With cost pressures, risk and uncertainty, plus the trend to a flatter payment model, there is less attraction to the profession and we are experiencing a shortage.  The industry is trying to mitigate those risks and providers are taking steps they can control to do so.

What are Patient concerns?

Patients have to pay more out of pocket today and it is almost an impossibility to save enough individually to cover all the healthcare needs.  Pricing transparency with Providers, plus offering a single payer system is an area to watch.  The data supports various models, but consumers do have power.  I have seen a shift in the quality of care being more up front – meaning the average person believes a doctor, merely by nature of the profession, is good.  They may not have experience in determining quality care.  Now, online reviews make patient experiences more transparent, and help patients select their primary care physicians, pediatricians, dentists and more. I foresee a trend in consumers having the ability to select physicians, even within a provider centric model.  Patients also want the latest technology – robotics, new surgical tools, access to the latest pharmaceutical trials and medications, innovative therapies and more.  Providers are learning that patients will change providers for therapies they want.

What do Insurers believe? What are their concerns?

Insurers are seeking joint risk for Patients and rely on data to model their risk and cost.  They have to examine the populations within their state and consider public health risks like obesity, diabetes, and cancer. They produce rates based on these factors and want to mitigate those care costs with payers/ patients in the system. The Insurers are watching the government decisions closely, but have a desire to see the Patient population assume more financial and personal risk for their healthcare costs. It all comes down to money and financial models. Insurers are trying to keep track of the latest innovations, medicines and therapies to offer to remain competitive.

Anything else you want to share?

We all need to be aware and involved in the decisions the government is making for our healthcare. The system is changing. The need for companies with data analytic skills, financial risk modeling and innovation experience will be sought for their expertise in healthcare. Also, transforming patient portals, bill statements, and the overall patient experience are initiatives that are taking hold. Healthcare projects are continuing and consulting firms are engaged often to provide expertise and insight into their data.