The Future of Healthcare: Innovations in Provider Strategy

In an era where the only constant in healthcare is change, ClearPoint Strategy's thought leadership webinar, "The Future of Healthcare: Innovations in Provider Strategy," offers timely insight into the evolving industry. We had the pleasure of hosting Tenfold Health Co-Founder Mike Bonetto, who has over 20 years of experience in healthcare strategic planning and policy, for a thought-provoking discussion on the challenges and opportunities facing health providers today. The following recap covers policy shifts, technological advancements, and planning tactics essential for navigating the future with strategic foresight.

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The Evolutionary Pulse of Healthcare

Whether you’re a health system, insurer, state department, or local health collaborative, changes in the industry are pushing organizations to think differently than they did 10-15 years ago. This evolution is driven by an unyielding pace of technological innovation alongside complex policy changes, setting the stage for a sector that must continuously adapt to improve healthcare delivery.

Challenges in the Healthcare Industry

Regular challenges facing healthcare providers range from regulatory hurdles to systemic inefficiencies, complicated by the relationship between healthcare providers, insurers, and patients. Oftentimes, providers serve patients who are not necessarily the individuals paying for care. It could be an employer or government, both of which have their own set of contractual deliverables, creating a challenging regulatory environment – all while providers try to deliver quality healthcare.

Recently, there has been a shift towards value-based care, which aims to link the quality of healthcare services with financial outcomes. It presents a significant obstacle: linking performance measures directly with payments. Healthcare providers now must meet the varied metrics and expectations of different stakeholders, including Chief Medical Officers (CMO), Chief Quality Officers (CQO), and Chief Financial Officers (CFO), who face an array of measures like:

• Healthcare Effectiveness Data and Information Set (HEDIS) measures, which serve to hold health systems accountable and can affect reimbursement rates or payor contracting
• Hospital Star Ratings for Medicare, which provide transparency to consumers and insurers for both hospitals and health plans, respectively
• State quality measures to adhere to for Medicaid
• Individual sets of metrics from commercial health insurance companies

A CQO, who is responsible for the overall quality of the organization, will look closely at health outcomes, such as readmissions, disparities, patient satisfaction scores, etc. The CMO, then, will work (closely with the CQO) to create a system that executes actions to improve them. These metrics concern the CFO as well, as performance trends influence reimbursement rates and revenue.

On top of that, add cost efficiency and other operating measures to manage. It’s incredibly complex and difficult!

Synthesizing Disparate Data

As healthcare systems adjust to this new model, they often find themselves working in silos. Dealing with a multitude of variables and having to submit requests to IT departments to pull necessary data from different places can cause complications over project prioritization and resource allocation. Differing reporting cadences in government monitoring, from which data comes long after services have been delivered, also make it hard for providers to adjust their strategies based on current performance. This makes it extremely important to stay on top of real-time data to anticipate performance ahead of time.

       If you’re surprised by a dip in performance, it could cost you millions of dollars in reimbursements.

With multiple sources, and without having a comprehensive view of the entire picture, how can healthcare providers bring together all these different pieces of data to make informed decisions that improve quality care and financial health?

Make the proactive investment. The ability to stay ahead of performance trends is challenging, but achievable, with a strategic approach of cross-departmental collaboration, technological investments, and real-time data analytics. The objective is to find a balance where quality care is recognized and rewarded within a value-based framework, leading to better health outcomes and a more efficient healthcare system overall. 

See how platforms like ClearPoint pull together the enterprise picture. Watch Bonetto’s webinar here (18:04).

Strategic Focus Areas: A Culture of Quality, Communication, and Innovation

In the quest for efficiency and effectiveness, strategic direction is often influenced by organizations’ available capital for investment. By linking specific initiatives or programs to outcomes, leaders can make data-backed decisions about where to allocate resources. They can also communicate the why: how certain investments will not only improve care, but improve financial returns in a value-based health system as well.

       It’s one thing to talk about where your HEDIS, Star measures, etc. are, but where does that fit within everything else you’re trying to do as an organization?

Bonetto brings forward innovative solutions for addressing these strategic challenges, highlighting the use of artificial intelligence (AI) and machine learning as tools for predictive healthcare management. His insights illuminate the value of a culture that encourages experimentation and embraces failure in breeding breakthrough innovations. 

Both Bonetto and Ted Jackson, ClearPoint Co-Founder, agree on the necessity of adopting a structured approach, including setting clear goals, diligently tracking progress, and establishing a feedback loop for continuous improvement. This strategic mindset will help navigate the complexities of healthcare today, ensuring that organizations not only meet current standards, but are also well-prepared for the future. 

Expert Insights: Envisioning Healthcare's Future

Bonetto and Jackson paint a future where data and technology do not just support, but lead healthcare strategy. Bonetto, with deep experience in health tech startups, emphasizes the role of technology in creating new models of patient care that are more efficient, effective, and personalized. Jackson's insights complement this by highlighting the importance of strategic frameworks that enable organizations to leverage technology in alignment with their core mission: improving patient outcomes.

ClearPoint Strategy provides a software solution built to evolve with you. To see how ClearPoint helps healthcare organizations like yours, schedule a free demo here.