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October 27, 2014

Health care’s roller-coaster ride into the future

Progress can be frustratingly slow in the health care industry. It is a huge, unwieldy behemoth, and the often confounding combination of rapidly changing market pressures and increased government regulation can make it confusing to sort out whether it's moving in the right direction.

However, while it's debatable whether the industry is headed in the right direction, there's no argument that significant changes in the health care delivery system are taking place. That message resonated loudly and clearly at a recent forum held by the Worcester Business Journal on the future of health care in Central Massachusetts. The heads of the region's two largest hospitals and largest doctors group, a senior executive from a large new player in retail medicine, the CIO of a major Boston hospital and a senior exec from a leading HMO all said that the next decade will see accelerated change.

The big question is: Can our region's leading health care organizations be the masters of their universe, driving change and innovation through their organizations and assuring that their services are ultra-competitive and growing? Or will they become part of the inevitable consolidation that's happening as an increasing number of new competitors battle for their slice of the health-care pie?

The impact of the region's hospitals on the local economy is huge. A list of the 14 hospitals in Central Massachusetts shows total employment at nearly 22,000. As our only acute-care facilities, these hospitals are facing three pressures: competitors delivering more services on both the before and after ends of a patient's hospital stay, a shift in government reimbursements and how care is incentivized, and reduced stays for a wide variety of procedures, many of which drove a lot of revenue in the past.

These changes have placed enormous pressure on hospitals' operating margins, and there's no question that a challenging road lies ahead. Only well-run facilities that can embrace change and drive innovation through their organizations will survive and thrive in the new world.

Nontraditional health care innovators are all around us. For instance, Westborough-based eClinicalWorks is one of the fastest-growing electronic medical records providers in the nation, and established national players like CVS Health are transforming their organizations to build out their retail health services. Since 2011, CVS has opened more than 200 urgent-care “Minute Clinics” and has announced plans to open another 850 by 2017, with the goal of positioning them within short drives for most Americans. The change in the payment paradigm is also shifting rapidly to a point where doctors and insurers will be paid to manage groups to stay healthy and prevent expensive interventions, and will no longer be rewarded for the volume of expensive tests or procedures they order.

Technology is also going to drive significant changes in how we receive our medical services. Specifically, smartphones have capabilities to monitor all kinds of health indicators, and new apps are being developed weekly to address a myriad of needs. The tech world has awakened to opportunities in the health care marketplace, and we're sure to see an acceleration of new tools to better monitor and deliver care.

Will Central Massachusetts companies — both providers and technological innovators — be able to embrace the coming change and ride the wave of innovation to grow their organizations and serve their customers even better? We hope they're up to the task, and that our region's leading health care providers will transform their organizations to meet tomorrow's new paradigm.

Regardless, strap on your seat belts. It may well be a bumpy ride.

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