Editor’s Note: Oliver Wyman Health & Life Sciences Partner, Tom Robinson, presented alongside Providence St. Joseph Health, Oscar Insurance, and Baxt Communication at this year’s MedCity Engage breakout panel titled, “Engagement Track – The Hospital of the Future.” Here are Tom’s post-session reflections on the future of patient-centered care.
Walk into any one of the nation’s 4,840 community hospitals or 1,825 rural community hospitals, and it’s easy to forget how these institutions first started. Modern hospitals have emerged as a necessity, thanks to the advent of modern medicine. The increased need for larger and more complex diagnostic equipment, the advent of anesthesia and the operating room, and expanding knowledge and specialization of healthcare necessitated what has now become known as the “modern” hospital. But in a modern world of low latency, high speed Internet, autonomous vehicles, remote monitoring, and artificial intelligence, what does the future hold? Why does the healthcare industry gather sick people together into one place, despite risk of infections – and mistakes?
The future of healthcare does not have hospitals, at least how we know of hospitals today. The healthcare industry needs remote monitoring and autonomous Uber drivers as ambulances – not the status quo. The future “hospital” is a connected network of entities that share information instantly, coordinate care, and meet patients where they are. The future “hospital” will have babies at birth centers (not labor wards), home monitoring (not observation floors), phone imaging (not imaging centers), and cancer care at the drug store (not infusion centers).
Tomorrow’s patient may never actually step inside a physician’s office. We recently published extensive research through our brand company, Lippincott, about what this may look like. As an example, the “customer of the future”, which they named Dawn, is perhaps the new normal. Dawn, a 25-year-old who lives in the not too distant future, goes to the physician every week, but she’s never sat in a waiting room. There’s no way Dawn wants to go to today’s “hospital.” If Dawn wants overnight care, she wants it to be specialized, customized, and de-centralized – not industrialized and homogenized.
The healthcare industry may soon be 80 percent service and 20 percent physical location. Many facilities and organizations are reimagining how they’re designed to become a retail-based wellness hub of sorts, with valet parking and enhanced ambulatory services. But the natural trend will eventually be one of continued fragmentation, after the healthcare industry passes the point of peak consolidation of hospital systems.
The Road from Point A to B is Rocky
Mount Sinai, for example, is replacing its nearly 800-bed hospital with a 75-bed state- of-the-art facility including outpatient, home and community resources. Mount Sinai is one of many hospitals on the forefront of this change – not just acknowledging transformation, but paving the way for innovation. Nearly five years ago, Mount Sinai announced potential plans to merge with Continuum Health Partners. But opening in 2020 will be not a hospital as we know it, but a new state of the art facility – with not just 75 beds, but with outpatient, home, and community resources, as they seek to align themselves with their community’s needs.
But how does the rest of the industry get to this Point B? Given the industry’s existing footprint, and current financial support system for hospital construction, today’s hospital system is already struggling with overcapacity. The United States has 5,534 registered hospitals, with an average of approximately 2.9 hospital beds per 1,000 patients (similar to the United Kingdom). Should the healthcare industry hope to one day see an improved ratio, even with fewer beds, like Mount Sinai's initiative?
These forward thinkers seeking to answer questions such as these have great potential to become industry innovators who win share from traditional models by exceeding normalized expectations of experience and care quality.
Artificial Intelligence May Get Us from A to B
Artificial intelligence will allow dramatically more efficient, effective care delivery to be performed outside of the hospital. Just as it will soon become irresponsible to drive your own vehicle, it will soon become irresponsible to not let Alexa read your chart.
Consider China's radiologist shortage. China asked the firm Skymind to analyze radiologist images to provide physicians with better leverage. When machine results were compared to human results, it was discovered radiologists work most efficiently and accurately first thing in the morning, but by late afternoon, their work is riddled with mistakes. It’s a quality of care issue – which artificial intelligence can solve.
The healthcare industry has much to learn from a developing world quick to adopt new technologies, as lack of physician access means reliability on remote assistance. Take Aravind Eye Hospitals in India with cataract care costing $25, or Narayana Health where open-heart surgery is $1,500. They reinvented the economics, with better reported quality outcomes than top US hospitals. Both models focus on “industrialization” where the single discipline hospital creates process steps that are repeatedly delivered by the lowest possible cost resources, resulting in high quality repetition, standardization, and volume.
These are merely examples of what’s potentially to come; many pre-op steps are performed by low cost labor, where a medical procedure is done by the skilled surgeon – but only that part requiring a particular skill.
What’s Next Around the Patient-Centered Bend?
Expect huge changes in data management. Today’s electronic health records look like Siebel before Salesforce struck CRM. Future consumers will own their data, once current systems are superseded, just like they own their financial plans today. Just as in the financial services industry, transparency will help foster appropriate lifestyle changes. As transparency and ownership can stimulate retirement planning, so can it nudge consumers toward finding a primary care provider (human or virtual) or educating themselves on a chronic condition.
And, printing out devices and implantables, and robots for home monitoring will soon become the norm. (Japanese company Winsun can 3D print 10 entire houses within 24 hours – and that was four years ago. The days of printing anything – even printers – is here.)
The inherent footprint of a hospital cannot be radically changed without significant investment, and steely nerves as the hospitals of yesterday start to struggle. But for investors in the “hospital of the future,” opportunity lies in creating a more cohesive health system of the future that leverages seamless experience across inpatient and outpatient settings, with room for even greater scale. The future of hospitals depends on it.
Tom Robinson Partner, Health and Life Sciences, Oliver Wyman