The needs of the baby boomer and millennial generations are driving the changes in health care delivery around the state.
Less time spent in a hospital, lower costs of care, more use of technology and creating a one-stop shop at each medical facility through partnerships are the current goals of health care providers.
Delanor Doyle, senior medical director with Aetna, told attendees at a New Jersey Bankers Association event Friday that the reactive approach to health care is changing.
“The goal is to provide the right care for the right cost at the right time,” Doyle said.
Virtua Health CEO Richard Miller said there need to be more outpatient services focused around the patient’s needs.
“The technology is going that way, partnerships are going that way,” Miller said.
“It’s not about getting a knee replacement and (asking) are you walking again. It’s about are you skiing in three weeks. That’s the mindset of the baby boomer community,” Miller said.
Miller, Doyle and Hackensack University Health Network CEO and president Robert Garrett were on a panel to discuss health care at the event.
Millennials are the new puzzle for the medical industry to solve, Doyle said.
Telehealth may be one way to engage younger patients — using text messages to communicate and send reminders, and offering video conferencing or pictures as a way to be diagnosed or seen by a physician.
But the problem is, many millennials have no loyalty to any one physician, according to a recent survey Virtua conducted.
“The last bastion of loyalty we found is OB/GYN,” Miller said.
Time is one of the greatest factors contributing to the lack of loyalty. A shortage of primary care providers has overloaded the system, forcing many to wait long periods of time just to be seen at the doctor’s office.
“We’ve all been to our primary care office, right?” Miller asked the crowd Friday. “Nobody is sitting there for an hour anymore. It’s not going to happen. That’s how the (baby) boomers feel about it, and the millennials feel even stronger about it.”
Which is why the state is seeing an unfettered growth of minute clinics and urgent cares. And health systems are partnering or creating affiliations with these clinics and centers, in order to refer patients who need further care within their system.
“The millennials are driving a lot of the innovation and … we are reacting to them,” Doyle said. “We are trying to make more things convenient for them.”
One attendee asked how the industry is handling costs of care, since the market for hospitals and health systems has traditionally never had competitive pricing pressures like other markets.
Patients never used to be seen as consumers, but that is changing, Garrett said.
“Traditionally there hasn’t been pricing pressures built in to make it as efficient as possible,” Garrett said. “There are signs that some of that is starting to change — with the Affordable Care Act, with a focus more on value (fee structure), and these insurance partnerships that are starting to develop really can go a long way in controlling costs and bending the cost curve.”
“The health care insurance exchange is more consumers and more employers are getting involved in that and there is more information available. There is more transparency in terms of pricing. A couple of years ago, you wouldn’t be able to even find out what a particular procedure would cost, and now … you can find out. It’s not an exact science, but at least you have a range of what this health system is charging versus the next health system,” Garrett said.
All of these components have contributed to a slowdown in the increase of health care costs, he said.
Miller agreed, adding, “We are not seeing the cost increases year-over-year that we might have seen 10 years ago. Virtua’s cost last year, we saw net cost increase of 1 percent.”
With a shift in focus to outpatient and ambulatory services, as well as a focus on telehealth — how does this affect employment for health systems, which are the largest employers in some towns?
A reduction in the number of inpatient beds, repurposing buildings to include outpatient and ambulatory services, and a change in roles of nurses will all balance the scales, Miller said.
“Part of it is going to be retraining people in the outpatient settings,” he said. “It’s not that we are going to need less care, it’s going to be a different level of care.”
Garrett said that, as the system moves toward more outpatient or tech-involved care, there will be a “redeployment” of staff into different roles to adapt to the changes.
“The role of the advanced practice nurse, the role of the pharmacist has certainly changed. We are seeing more specialization in some of the more traditional professions,” he said. “We will continue to be a large employer; I don’t see that trend going any other way.”
And as the shift in focus to outpatient grows, the real estate needs of the industry will change.
Garrett said repurposing existing buildings is one route that many hospitals are already taking.
Doyle added: “Brick and mortar is kind of passé. It’s now about IT and infrastructure. That said, outdated and old, dilapidated buildings have to be replaced, to some extent. What you are going to do with excess space is probably convert it into a day care for seniors, since we are going to need that.”