When asked what non-medicalbarriers to care their organizations would address in the nextyear, 63 percent of respondents said care coordination.

Health care executives are keeping an eye on large companiessuch as Amazon, Apple and Walmart, with one-third of executivessaying they are worried about continued disruption from new entrants into the health care market.

This finding is part of the 9th Annual Industry Pulse Survey, conducted byChange Healthcare and the Healthcare Executive Group. The studyfound that one-third of health care executives (32 percent) saidthey felt new entrants into the market would disrupt currentbusiness models.

An accelerated pace of change

“This response suggests that health care leaders recognize thatexternal entrants will force the industry to change how it conductsbusiness,” the report said. It added that change has been aconstant in the industry for years, but the pace of change isaccelerating.

“Health care is navigating disruptions on multiple fronts, andas a consequence, payers and providers are finding themselvesstretched thin as they try to address a perfect storm of change,”said David Gallegos, SVP, Consulting Services, Change Healthcare.“As if insurance market changes, value-based care, consumerization,and regulatory uncertainty weren't enough, this year the industryis facing a new breed of market entrants and innovators whoseimpact remains unknown but could be substantial. Even the largesthealth care organizations don't have the people and processes tomove on all these fronts alone, yet they can't ignore thesechanges.”

Other developments that may disrupt the industry, according tothe survey findings, are:

• Innovations in care delivery (13 percent);
• Refinement of consumer experience (11 percent)
• Supply chain innovations (9 percent)
• The launch of vertical, all-in-one health care companies (8percent)
• Advances in artificial intelligence capabilities (7percent)

“With all these uncertainties, one thing is sure: Industryconcern over external disruption is widespread,” the reportsaid.

Social determinants of care

The survey also asked how health care organizations wereintegrating social determinants of health care into theirprograms. It found the results from 2018 were similar to the yearbefore. For example, in 2018, 19 percent of organizations said theywere coordinating with community programs and resources—about onepercentage point higher than the 2017 responses. Other measuresincluded offering a social assessment along with a healthassessment, and combining health data with social data sources suchas financial, educational, and geographic data.

Again, these findings did not change much, year to year.“Responses to this 2018 survey were not significantly differentthan a year earlier—which might indicate that the integration ofsocial determinants is in a holding pattern,” the study said. “Manysuch programs are in the pilot stage, so full implementations maybe reflected soon.”

Goal: improve care coordination

When asked what non-medical barriers to care their organizationswould address in the next year, 63 percent of respondents said carecoordination. Nearly 40 percent said their organizations wouldaddress transportation issues, and 27 percent said foodinsecurity/access was an issue they would address in 2019.

The study noted that some of these barriers to care areassociated with social determinants of health. “Organizations suchas Lyft and Uber are engaging with providers and payers totransport patients to doctor visits and hospitals, preventing thefinancial losses of missed or re-booked appointments—and avoidingthe costs of delayed or missed care,” the study said. In addition,it noted, “App-based food delivery services are a promising tool tofight the health hazards of food deserts.”

Shared risk—still just over the horizon

The survey covered many topics, but one that has been muchdiscussed, risk sharing between payers and providers, still seemsmore of an attractive idea than a practical solution. “Year afteryear, shared-risk, value-based health care (VBC) has appeared to bejust around the corner,” the survey said. “However, health careseems to be perpetually stuck at being three-to-five years awayfrom adopting shared-risk, value-based contracts. More than 90percent of respondents said that VBC won't be dominant for one tofive years or more—or that it will never happen.”

Survey respondents listed a number of obstacles to VBC,including limitations in data sharing; disagreements on outcomemeasurements; and a lack of incentives for payers and providers towork together. The study concluded that creating such arrangementswould require major changes in the business models of healthorganizations. With all the disruption already happening, it seemsfew organizations have an appetite for that particularchallenge.

Read more: 

• 12 biggest names in health caredisruption
• A secret weapon in our march toward value-basedcare
• 5 predictions for consumer-driven health care in2019