Health care executives are keeping an eye on large companies such as Amazon, Apple and Walmart, with one-third of executives saying 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 by Change Healthcare and the Healthcare Executive Group. The study found that one-third of health care executives (32 percent) said they felt new entrants into the market would disrupt current business models.

An accelerated pace of change

“This response suggests that health care leaders recognize that external entrants will force the industry to change how it conducts business,” the report said. It added that change has been a constant in the industry for years, but the pace of change is accelerating.

“Health care is navigating disruptions on multiple fronts, and as a consequence, payers and providers are finding themselves stretched 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 industry is facing a new breed of market entrants and innovators whose impact remains unknown but could be substantial. Even the largest health care organizations don't have the people and processes to move on all these fronts alone, yet they can't ignore these changes.”

Other developments that may disrupt the industry, according to the 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 (8 percent)
Advances in artificial intelligence capabilities (7 percent)

“With all these uncertainties, one thing is sure: Industry concern over external disruption is widespread,” the report said.

Social determinants of care

The survey also asked how health care organizations were integrating social determinants of health care into their programs. It found the results from 2018 were similar to the year before. For example, in 2018, 19 percent of organizations said they were coordinating with community programs and resources—about one percentage point higher than the 2017 responses. Other measures included offering a social assessment along with a health assessment, and combining health data with social data sources such as financial, educational, and geographic data.

Again, these findings did not change much, year to year. “Responses to this 2018 survey were not significantly different than a year earlier—which might indicate that the integration of social determinants is in a holding pattern,” the study said. “Many such programs are in the pilot stage, so full implementations may be reflected soon.”

Goal: improve care coordination

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

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

Shared risk—still just over the horizon

The survey covered many topics, but one that has been much discussed, risk sharing between payers and providers, still seems more of an attractive idea than a practical solution. “Year after year, shared-risk, value-based health care (VBC) has appeared to be just around the corner,” the survey said. “However, health care seems to be perpetually stuck at being three-to-five years away from adopting shared-risk, value-based contracts. More than 90 percent of respondents said that VBC won't be dominant for one to five 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 outcome measurements; and a lack of incentives for payers and providers to work together. The study concluded that creating such arrangements would require major changes in the business models of health organizations. With all the disruption already happening, it seems few organizations have an appetite for that particular challenge.

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Health care leaders expect more disruptions, survey says

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