What Doesn’t Change with a New Administration and Health Care? The Rise of (and Responding to) Consumerism in Health Care. President Trump and the Republicans, leading both the House and Senate, vowed to repeal and replace Obamacare and the Affordable Care At. Earlier this month, the House Republicans made good on the promise and introduced repeal and replace legislation, The American Health Care Act. There continues to be speculation on what a final plan will look like, one thing that is not the subject of much speculation-the emergence of consumerism.

This movement results from myriad changes to health care payment and delivery and additional provider options, combined with consumers’ increased education and heightened involvement in their own health care. All these market factors necessitate consumer-driven strategies, which are a cornerstone of success for hospitals and health systems in this new era of empowered consumers. This paper highlights the reasons for the continual rise of health care consumerism as well as strategies to respond to this trend in your hospital or health system, specifically in area of senior services, as seniors are the largest consumers of health care in the United States.

Palliative care is not a newly introduced approach to care. The earliest record of the Latin word palliate, meaning to conceal or alleviate symptoms without curing, dates to the 14th century. Formally introduced in 1990 by the World Health Organization, palliative care is currently defined as an approach to care which improves quality of life for patients and their families facing advanced life-threatening illness through prevention, assessment, and treatment of pain and other physical, psychological, and spiritual problems.

In 2011, the Joint Commission launched the Advanced Certification for Palliative Care program, which recognizes hospital inpatient programs demonstrating exceptional patient and family-centered care to optimize the quality of life for adult and pediatric patients with serious and advanced illness. By 2014, palliative care had grown to over 1,500 inpatient programs nationally. Currently, more than 85 percent of hospitals with 300 or more beds have a palliative care program, 90 percent of teaching hospitals have palliative services, and 90 percent of National Cancer Institute (NCI) Designated Cancer Centers have palliative care, while 78 percent of non-NCI cancer centers have palliative care available.

The increased focus on improvement in the quality and delivery of health care, balanced with the goal of reduction in health care spending, requires providers to develop and execute operational strategies that result in the optimization of operational and financial performance. This optimization is not only crucial to providers, but for partners and payors for whom value is also created. Strategies to create and maintain value include revenue drivers such as volume growth, rate optimization, service line expansion, clinical program development and expansion, as well as ancillary payor and external provider partnerships. In addition to these revenue drivers, operational efficiencies for health care cost reduction may include developing new staffing models based on alignment of staffing to acuity, evaluating ancillary service expenses, and creating partnerships with material suppliers.

In what is lightning speed for Centers for Medicare & Medicaid Services (CMS), the July 9, 2015, proposal for mandatory bundling of joint replacement episodes was finalized on November 18, 2015, and went into effect on April 1, 2016.

In recent weeks, CMS also finalized rules for value-based purchasing for physicians and set in motion a nine-state mandatory value-based payment demonstration for home health. Medicare is continuing to push transformative policies with respect to alternative payment models and value-based purchasing.

The implications of these and other changes, such as the growth in accountable care organizations (ACOs) and the Bundled Payments for Care Improvement (BPCI) program, are profound and will be felt very quickly in many markets. Here is an update to our previous white paper on bundling, concentrating on the things that health systems and post-acute providers need to know right now in order to succeed in the new risk-taking environment.

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