By Brandi Greenberg
Vice President, Life Sciences & Health Care Ecosystem Research
Advisory Board
If you like this piece, please register for the Oct. 8 webinar, “The new health system supply chain mandate: What every SAM needs to know,” hosted by SAMA and presented by Advisory Board’s Brandi Greenberg.
As a strategic account manager (SAM), you know how important it is to speak your customers’ language and see the world through your customers’ eyes. But for SAMs across the health care industry, the customers’ language and worldview are changing. With 100 of the largest integrated delivery networks (IDNs) now representing more than 50 percent of U.S. inpatient revenues, the relationship-building stakes for SAMs have never been higher; every customer interaction matters.
Over the last two years, mega-mergers between companies like CVS and Aetna resulted in different-in-kind delivery networks. And Amazon, Apple and Google each announced ambitious plans to improve health care efficiency. Amidst all of this disruption, IDNs see financial and existential threats on all sides: more demanding purchasers, more cost-conscious consumers and more lucrative services moving out of acute care settings.
To grow your IDN customer relationships, you need to understand how the health care market is changing and where your organization fits into the ever-evolving health care ecosystem. These days, there’s no shortage of commentary about health care disruption, but the most successful SAMs are able to go beyond the headlines to separate hype from reality, noise from news.
At Advisory Board, we work with over 4,900 provider organizations, 90 health plans and 400 suppliers to produce syndicated research studies about U.S. health care dynamics. Earlier this year, we took stock of the myriad forces impacting health care delivery and boiled everything down to four major health care trends that every SAM needed to know in 2020. And then COVID-19 struck, disrupting everything and rewriting the health care landscape in ways we are only starting to comprehend.
Our hope is that these insights can help you, as a strategic account manager, ask smarter questions, have more productive conversations with IDN administrators and position yourself as a trusted partner in improving health care delivery.
Trend #1: Payers, technology companies and consumers are all converging on “everywhere care,” changing the locus of control for health care services
Where are we now? While many wrote off house calls as a thing of the past, we were seeing renewed buzz around the benefits of virtual care and care at home even before the coronavirus struck. Patients communicate with their doctors over Skype, order drugs through smartphone apps and even perform basic genetic tests from home. What’s more, payers – both public and private – are expanding coverage for these services while employers are encouraging, if not mandating, that employees get care in the lowest-acuity setting possible. In response to COVID-19, the Centers for Medicare & Medicaid Services (CMS) has reduced barriers to access and expanded coverage of telemedicine services for Medicare patients, further accelerating this trend. “Everywhere care” offers patients the luxury of care whenever and wherever they want it; but as it becomes more common and widespread, it will erode the traditional care pathways that define your health system partners’ operating and financial models.
What to watch for next: It’s tempting to think that we’ll soon live in a world where all but intensive care is delivered at home. But before jumping to that conclusion, it’s worth analyzing some of the risks that come with everywhere care. For example, expanded virtual care can exacerbate the digital divide that excludes individuals without access to or fully understanding of the needed technologies. If we move too quickly without addressing such disparities, everywhere care could end up worsening some of the access and affordability challenges that it professes to alleviate.
Our take: Everywhere care is already decentralizing the locus of control for health care services. Efforts to slow the COVID-19 pandemic have forced both patients and provider organizations to get comfortable with virtual and home-care options far faster than anyone anticipated. Even after the coronavirus crisis subsides, your health system partners, who currently sit at the center of the care delivery ecosystem, will need to accept the “new normal” of everywhere care; they’ll need to work more collaboratively with other providers, payers and third parties to coordinate care and ensure both patients and their health information flow seamlessly across disparate sites.
Trend #2: All eyes are on independent physicians as agents of change, but independence alone won’t drive down costs
Where are we now? Back in 2009-2010, the architects of the Affordable Care Act (ACA) assumed that integrated delivery networks were the answer to health care’s affordability problem. Physician groups thus responded to ACA-era programs by running for cover, aligning with or selling their practices to IDNs. Today, the superior performance of physician-led ACOs has led public and private payers to rethink that assumption. Instead, these payers are implementing programs that encourage physicians to remain independent. With private equity groups, large practice management companies, and innovative practice models (like ChenMed and Iora Health) all looking to grow, physicians have many more options if they want to remain independent.
What to watch for next: This is not the first time the industry has shined a spotlight on independent physician practices. Back in the 1990s, an influx of investment in physician practice management companies (PPMCs) yielded a financial flop; eight of the ten largest groups declared bankruptcy by the end of the decade. This time around, we’re cautiously optimistic, both because many practices are focusing narrowly on specific population segments and because new technologies are enabling smaller practices to coordinate back-end administrative services and cross-continuum care. Still, independents’ success is far from guaranteed. Looking back, some experts posited that PPMCs’ fatal flaw was pursuing growth at the expense of integration. To succeed, they must avoid those pitfalls. Practices that integrate their processes, people and infrastructure in service to defined population segments will help redefine what physician practice looks like in the 2020s.
Our take: Regardless of ownership type or practice size, the most successful independent groups will be those with clear visions, effective governance structures and sufficient capital to withstand temporary disruptions. Even before COVID-19, changes in financial incentives and patient preferences were creating real winners and losers in the physician practice environment. The pandemic’s abrupt, massive disruption of routine office visits and elective procedures will likely force even more small physician practices to close shop or affiliate with larger entities, but only time will tell if those physicians align with IDNs or one of these newer alternatives. Just like IDNs, strategic account managers must understand which physician groups are positioned to be creative, collaborative partners over the longer-term.
Trend #3: Artificial intelligence (AI) is slowly starting to impact clinical care, but broader applications will be limited by the quality of data used to train those systems
Where are we now? In an industry that was overdue for change well before COVID-19 hit, many of us imagined how AI might enable more accurate diagnoses and better predictions about health outcomes. Early in 2020, many health care organizations were already leveraging AI to improve decision making and automate difficult or tedious tasks. For example, we’ve seen health systems use machine learning to manage appointment scheduling or aid in supply standardization efforts. Amidst the pandemic, IDNs and government agencies teamed up with Big Tech in attempts to leverage AI in both microscopic analyses of the viral genome and macro-level analyses of regions primed for potential outbreaks. While these developments are promising, we must temper the hype by remembering that the near-term opportunities for AI in health care remain focused on narrow, administrative tasks. We’re still a ways away from the “doctor robot” or “Big Brother” figure that many imagine when they think about AI in health care.
What to watch for next: Using tools like wearables and connected sensors, providers, payers and third parties have access to more data than ever before. However, many of the barriers that inhibit broader AI adoption pose even greater challenges in the clinical setting. For one, AI is only as good as the data and algorithms that support it. For example, some early clinical applications have revealed unintended racial biases in their recommended care pathways. To advance our comfort with and adoption of clinical AI applications, technology leaders must address patient and provider concerns with bias as well as privacy, workflows and reimbursement.
Our take: Even after the COVID-19 crisis subsides, we don’t foresee a near-term world in which algorithms drive end-to-end treatment. Still, SAMs must remember that your IDN customers are already using AI tools at many points along the care continuum, which, in turn, has implications for all the provider organizations you engage. Whether automating information gathering at intake or aiding clinical documentation, AI as a facet of health care delivery is inevitable. While it’s too early to know for sure, the national response to the coronavirus may also make certain kinds of health care surveillance and personal data aggregation more acceptable in the name of public health. Whether or not your organization’s solutions have an AI-component, you can help your provider partners ready themselves for AI applications by helping them identify their biggest needs and then thinking through the technology, staffing and workflow implications that any AI solution will bring.
Trend #4: Clinical innovations will continue to have transformative potential, but their value may be limited by affordability and workflow constraints
Where are we now? The last few years have brought dramatic advances in manufacturing techniques and treatment modalities, fundamentally changing the care delivery landscape. 3-D printed medical products can be personalized to meet individuals’ health needs and scaled to help address global ventilator shortages. Breakthroughs in treatment modalities such as gene editing technologies or bio-electric therapies may soon allow us to manage previously untreatable conditions. And one or more of the many novel coronavirus drug and vaccine candidates, in trials at the time of this writing, could transform the trajectory of the disease. All of these clinical projects and innovations hold incredible potential, but life sciences leaders must ensure that they are affordable, integrate into clinician workflows and are backed by evidence that supports their medical value – not just their safety and efficacy.
What to watch for next: For many IDNs, innovation is as much about investing in novel technologies as it is about managing the appropriate use of those new (and often expensive) clinical tools. In the coming years, we anticipate more payer and provider scrutiny of all clinical innovations – with a hyper-focus on affordability, efficiency and evidence to support appropriate use. We also see growing purchaser interest in creative contracts that align manufacturer and purchaser incentives. This includes not only contracts with bonuses or penalties tied to clinical outcomes, but also contracts that encourage wide-scale use of vaccines or curative therapies (e.g., Hepatitis C).
Our take: Your companies may be the ones driving clinical and technological innovations, but your success as a SAM will depend on your ability to understand your provider customers’ processes and pain points. Make sure you understand how each innovation will fit into clinician workflows, reimbursement models and broader population health initiatives. Be prepared to help your IDN customers understand not only the clinical benefits of your technology, but also how your innovation fits into the larger web of activities required to improve patient care.
Trend #5: COVID-19 changes everything; at the time of his writing, we just don’t yet know how or for how long
Given the rapid pace of change in state, national and global efforts to fight the COVID-19 pandemic, any attempts to summarize “where we are” or “what to watch for next” will be out of date well before publication of this article. Our nation’s initial response laid bare our health system’s weaknesses and vulnerabilities. But it has also inspired newfound reservoirs of creativity, heroism, scientific advancement and public/private partnership. And it has unleashed a wave of unprecedented regulatory changes, cultural changes and economic changes – with short-term and long-term implications we can’t yet fully surmise. Among the questions we think all health care leaders – in any part of the health care economy – should consider are:
- Will the lowered barriers to telemedicine use and reimbursement finally push virtual care services toward a tipping point in terms of broader adoption?
- Will the economic shock of “shelter in place” mandates leave millions more Americans unable to afford basic care, let alone elective procedures?
- Will the unprecedented surge in demand for certain medical and protective supplies change how provider organizations manage inventories and vendor relationships?
- Will the clinical and economic shocks to the system force the closure of more facilities and a new wave of industry consolidation?
- Will consumers and policymakers emerge from the crisis with different expectations for government’s role in health care?
While there are no easy answers to these questions, we anticipate that the COVID-19 crisis will force all industry stakeholders to step outside their silos and seek collaborative, cross-industry solutions to these and other emerging health care challenges.
How SAMs can help providers navigate the path forward
When we project likely trajectories for each of these trends, clear best- and worst-case scenarios emerge. Virtual care will allow patients access to care at any time and in any place, but we run the risk of improving access for some at the expense of others. Propping up independent physicians may counterbalance health systems’ market dominance, but if independents don’t integrate well, then they too will fail to reduce costs. Artificial intelligence tools could prove to be a silver bullet in improving efficiency in health care, but those applications could perpetuate biases and threaten patient privacy. We may achieve unthinkable success in treating the un-treatable, but only if providers, payers, and consumers have the will and the way to adopt new technologies. And society’s response to the COVID-19 crisis could accelerate the adoption of game-changing clinical and technological innovations, or it could wreak such economic and societal havoc that much of our health system will need to be rebuilt.
Collectively, the top trends of 2020 will inevitably shift the balance of power across industry segments; in some cases, the locus of control shifts to payers, other times to consumers and other times to third parties. However, no trend effectively bridges the existing gaps across industry stakeholders. Moreover, the COVID-19 crisis exposed just how fragmented and misaligned our health care infrastructure is today. Outstanding questions around information ownership, social determinants of health, affordability, public/private partnership and change management will be of utmost importance to your provider partners as they navigate the eventual post-COVID-19 health care landscape.
If your business is in any way tied to health care, we hope that our insights can push your thinking on the actions you can take today to support your health care partners in the future. Download and share our infographic that supports this article and join our Oct. 8 webinar, “The new health system supply chain mandate: What every SAM needs to know” to learn more from Advisory Board.
Brandi Greenberg is Vice President, Life Sciences & Health Care Ecosystem Research, at Advisory Board
About the Advisory Board:
Advisory Board helps executives and future leaders in health care work smarter and faster by providing provocative insights, actionable strategies, and practical tools to support execution. With 40+ years of experience, a team of 250+ experts, and a network of 4,900+ member organizations that span the payer, provider, and supplier industries, we support life sciences firms’ commercial leaders with research and educational resources that develop market strategy, enrich customer insight, and more.
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