By David Grandy, FACHE, CMPE
Across the healthcare landscape, delivery models are shifting. In general, we are organized around the historical model of acute-episodic care. But that’s changing. In many parts of the world, prevention is becoming commonplace as both patients and providers recognize the physiologic and economic benefits of wellness.
Five drivers make the case for ambulatory and community based healthcare delivery. These will be among the most significant forces to shape emerging healthcare models, particularly in outpatient venues.
1. Technology
As the development of the Internet, digital devices, micro-technology and social networking is further enhanced, we’ll see these influences merge into robust tools and delivery models that push more care into ambulatory, community and home settings.
Diagnostic instruments are becoming more pervasive and, likewise, lend themselves to ambulatory applications. Expensive, complex hospital infrastructure is no longer required. Reverse innovation— consider what GE did to take cardiac diagnostics to rural India — will also play more of a factor as less expensive modalities are delivered by the developing world to developed nations. This effect will arguably change the acuity of cases seen in outpatient venues, as more acute-episodic and complex care will be driven to larger ambulatory centers.
2. Medicine
Medicine is becoming both more predictive and more personalized. A future in which we can anticipate with greater certainty which people will succumb to
serious infirmity is not far off. And tailoring treatments through pharmacogenetic applications is likewise within reach. Providers will soon be able to identify with pinpoint accuracy the five to 10 percent of patients most likely to experience a catastrophic event that could be prevented through intensive intervention in ambulatory settings.
Simultaneously, reimbursement policy changes that reward providers that achieve low-cost, highly effective outcomes will force providers to link the cost of care with clinical results. Together, these forces will likely push more advanced diagnostic capabilities into primary care arenas and require access to real-time cost data to aid fully informed decision-making.
3. Academic affiliations
In order to develop and execute population management models, and research-driven practices like predictive and personalized medicine, community providers will seek out academic affiliations. Academic providers, who will benefit from access to larger patient cohorts and more distributed delivery networks — especially in primary care — will embrace these partnerships. As a result, clinical research will make its way into ambulatory care venues at a more accelerated pace than what is experienced today. Multidisciplinary collaboration spaces often associated with translational health sciences will arguably be needed in comprehensive outpatient settings.
4. Patient engagement
Wearable and, in some instances, implantable biosensors will provide continual physiologic monitoring. When combined with the development of rich data sets and deep analytics, these sensors will allow for real-time feedback and access to information, two key drivers of patient engagement.
The notion of getting patients engaged in care — whether at the healthy preventive or complex chronic side of the continuum — will fundamentally reshape the role of providers, particularly primary care providers in outpatient settings. Providers will become the interpretive hub, particularly in primary care, helping patients understand clinical complexities and laying out treatment plans.
5. Current trends
Trends like globalization, cultural diversification, and the aging of the baby-boomers will influence both patient expectations and delivery models. The integration of outpatient healthcare, lifestyle retail (e.g. exercise centers, health food stores, etc.) and community focused services will become the norm. The design implications here are clear. In some locales, such models may have broader appeal to insurance carriers interested in owning primary care or large employers interested in implementing workplace clinics as part of more comprehensive wellbeing initiatives.
David Grandy is director of innovation for HDR Architecture, Inc. During his 15-year career in healthcare, he has administered an NIH-sponsored study of the implications of the Human Genome Project, and managed clinical and non-clinical operations for a 350-bed tertiary care hospital. He is an adjunct faculty member in two healthcare administration programs and was awarded the ACHE Regent’s Young Executive Award in 2007. He can be contacted at david.grandy@hdrinc.com.
