Trends that Will Shape a New Decade in Healthcare

The world of healthcare provider management and services can be characterizedby constant change. Some long-standing trends continue to affect this areaand are becoming more extreme, while others are moderating over time. Thereare ways in which one can see this functional sector of the healthcare industryadapting to changes in overall population demographics and altered payorrelationships as well as technology. Other process innovations are emergingas healthcare catches up to more advanced areas of the economy in how ituses technology to improve outcomes and operations. As a leading provider ofprovider management solutions in healthcare, VerityStream would like to shareand call attention to the following significant trends that clients and providersshould anticipate and factor into their plans for the coming year and near future

Physicians Will Be in Short Supply

The existing physician shortagewill continue and become an evenlarger problem across many areasof healthcare. According to a 2019infographic from the Associationof American Medical Colleges, theUnited States will see a shortageof up to nearly 122,000 physiciansby 2032 as demand for physicianscontinues to grow faster thansupply. The high end of the numberof doctors we could lack includesmore than 55,000 primary care physicians, nearly 66,000 specialists, and morethan 23,000 surgical specialists. Two factors are contributing to this problem—theU.S. "population is estimated to grow by more than 10% by 2032, with those overage 65 increasing by 48%. Additionally, the aging population will similarly affectthe physician supply, since one-third of all currently active doctors will be olderthan 65 at some time during the next decade. When these physicians decide toretire could have the greatest impact on supply" (AAMC, 2019). Rural and innercity areas will feel the shortage most acutely, as those are places physicians areless likely to want to practice. It is probable that the industry will see states andhospitals going to great lengths to retain the doctors they have trained and hired.There are already examples of financial incentives, such as loan forgiveness andbonuses, being used in some areas to hold on to physicians.

Physician Burnout Is Moderating

Many healthcare organizations have long been worried about physicianburnout, a long-term stress reaction in doctors marked by emotional exhaustion,depersonalization, and a lack of sense of personal accomplishment. The AHRQshares that in 2019, up to 50% of physicians are experiencing some level ofburnout, which can lead them to leave the profession, provide care that threatenspatient safety and care quality, or suffer disastrously from impaired attention,memory, and executive function (AHRQ, 2019). The American Medical Associationshares good news in 2019 that or the first time since 2011, the physician burnoutrate has dropped below 50 percent among doctors in the United States (Berg,2019). For comparison, the overall prevalence of burnout among U.S. workers was28.1 percent in 2017. The specialties with the lowest levels of burnout are plasticsurgery, dermatology, pathology, ophthalmology, and orthopedics. There's goodnews about the effectiveness of what the industry is doing to make headwayagainst burnout, from staffingchanges and reducing workloadsto lengthening patient visit length(AHRQ, 2019). With significantimpacts for physician burnout likemedical errors, physician suicides,and a cost estimated as $4.6billion annually (Oaklander, 2019),reduction in the prevalence of thisproblem is very good news forhealthcare.

Concierge Medicine Is on the Rise

Concierge medicine is a popular emerging alternative to how healthcare istraditionally provided. This subscription-based, membership medicine businessmodel occurs primarily in family medicine and internal medicine and has provento be ideal for patients with chronic conditions that require more time andattention from their doctor. Practitioners choosing this route tend to be moreentrepreneurial and forward thinking than their colleagues while garneringprestige from their peers (Concierge Medicine Today, 2019). Currently thereare approximately 20,000 concierge medicine physicians practicing nationally,with their ranks growing 3-6% annually. According to the Advisory Board (2019), concierge medicine can offer patients some combination of attractive careoptions. These may include same-day appointments, more appointment time withproviders, email and telephone consultations, personal health coaching, nurseguidance, and robust patient portals. This mode of practice appears to improvephysician satisfaction, with 95% of doctors responding they are more satisfied inthe profession ten years after making this change. An important patient benefitthat has already been identified is the reduction of medication use among patientsof concierge practices. Interestingly, though 44% of U.S. physicians practicingconcierge medicine have opted out of Medicare, their 2017-2018 median annualsalary is still more than $260,000.

Artificial Intelligence Will Transform Healthcare

Artificial intelligence (AI) researchand application within medicine isgrowing rapidly. In 2016, healthcareAI projects attracted more investmentthan AI projects within any other sectorof the global economy. Accordingto the British Journal of GeneralPractice (2018), investment bankinggiant Morgan Stanley estimates thatthe global market for AI in healthcarecould surge from $1.3 billion todayto $10 billion by 2024, growing at anannual compound rate of 40% (Buchet al, 2018). Harvard University tellsus why—advances in computationalpower paired with massive amounts of data generated in healthcare systemsmake many clinical problems ripe for AI applications. In Forbes, Accenture reportsthat the ten most promising AI applications for healthcare, led by robot-assistedsurgery, virtual nursing assistants, and administrative workflow assistance, couldcreate up to $150 billion in annual savings for U.S. healthcare by 2026. Just a fewexamples show that AI-informed healthcare can significantly improve outcomes,from outperforming physicians' ability to detect cancer (Harvard, 2019) andincreasing the time that doctors can spend with patients to screening medicationsfor effectiveness against the Ebola virus (Amisha, 2019).

New Physician Specialties Are Emerging

As medicine evolves, new types of doctors are emerging to meet the changingneeds. In some cases, these clinicians are in new specialties that didn't existuntil recently, and demand for some of these physicians is already high. TheAssociation of American Medical Colleges (2019) identified these five newspecialties that match where healthcare is headed:

• Cancer immunologist - This doctor will be adept at harnessing a patient's individual immune system to fight cancer while avoiding or treating immune system overreactions and treatment-triggered diseases.
• Nocturnist - Increasingly medically complex patients need the care continuity of doctors who practice hospital medicine primarily at night, a key addition to the level of safety and service offered.
• Lifestyle medicine physician - 80% of healthcare costs are connected to care for chronic diseases, and 80% of chronic disease is related to lifestyle choice. A lifestyle medicine specialist oversees a patient's food choices, exercise, sleep, stress levels, and ability to connect with others, whether in a primary care environment, lifestyle medicine clinic, or residential care facility. Demand to sit for this certification exam is exploding.
• Clinical informatics - This specialist collects and analyzes patients' health information and applies those insights to improve patient health. Growth in this area is related to provisions of the Affordable Care Act (ACA) and the proliferation of electronic health records (EHRs). The goal is to use the volumes of medical data now being generated to make better clinical decisions and guide research efforts.
• Medical Virtualist - This physician provides telehealth services, a sector of healthcare delivery that is expected to rise 30% each year between 2017 and 2022. Early uses include second-opinion consults, as well as telepsychiatry and telestroke services. Health systems are just beginning to add telehealth to their service mix, for primary care triage, specialty consults, and virtual rounding. The ability to create a successful telehealth experience for patients will be a key competency for this specialty (AAMC, 2019).

Provider Credentialing Will Change Significantly

With their constant attention on patient safety, Medical Services Professionals(MSPs) are taking on more complex roles as the healthcare industry continuesto shift to value-based care rather than a volume-based model. The NationalAssociation Medical Staff Services (NAMSS) says in its 2018 State of theMedical Services Profession Report that standardization, consolidation, andthe increasing importance of quality metrics will redefine the role of MSPs playin organizations in the coming years (Barajas, 2018). Electronic and softwaresolutions for credentialing and related services are growing rapidly as the industrymoves to digitize records and operations to support automation. The volume forcredentialing functions is predicted to increase as more nurse practitioners (NPs)and physician assistants (PAs) begin working in a hospital environment.

Physician Employment Is Slowing

According to the American Medical Association (AMA), physicians are close toevenly spit between those who are employed (47.4%) and those who own theirown practices (45.9%) (Henry, 2019). While this is a milestone achievement, andthe culmination of a long trend towards physician employment, HealthLeadersreported in 2019 that the momentum of increasing employment has slowed.From July 2016 to January 2018, the number of hospital-employed physiciansincreased 6%, much less than the staggering increase from July 2012 to July2015 of 49% (Cheney, 2019). Nevertheless, the growth in employed physicianscontinues, albeit far more slowly. The AMA also explains that when talking about"employed physicians," it isn't just limited to hospitals or healthcare systems actingas employers. In some cases, the employer is actually a practice wholely ownedby another physician. Private practice, it needs to be acknowledged, does seem tobe holding its own. This structure is more prevalent with older physicians (54.3%among physicians 55 and older vs. 25.5% of those under 40), especially amongsurgical subspecialists (Henry, 2019).

Cool Technology Is on the Horizon

As in recent years, technology promises to transform more areas of healthcare, inthe near and more distant future. A 2019 Forbes article offers multiple exampleswhere great changes and advances are expected. A starting point is robotics, whose potential extends far beyond the application for surgery, which is alreadywell-known. Tremendous growth is expected in the use of robotics for healthcare,from a telepresence in rural areas where doctors are scarce and for the transportof medical supplies within an organization to disinfecting hospital rooms, tohelping patients with rehabilitation and micro-bots involving specific patienttherapies. Another example, the wearable device, has potential uses that go farbeyond the fitness tracking and counting steps that we all know. Wearables canbe put into service to monitor heart rhythm, ECG, blood pressure, temperature,etc. Technology is driving the rise of genomic medicine, where a person'sgenomic info is used to determine personalized treatment plans and clinicalcare. Computer analysis of genes and gene mutations will facilitate personalizedmedical treatment for such situations as organ transplant rejection, cystic fibrosis,and especially cancer. Some of the uses that healthcare will find for 3D printingwill include patient-specific practice organs to be used by surgeons, on-demanddevice and tool manufacturing, customized prostheses, and transplantabletissues and organs. Look for enormous growth in virtual and augmented realityfor healthcare—Forbes estimates its market will be $5.1 billion by 2025. Not onlyis this technology extremely beneficial for training and surgery simulation, butit's also playing an important part in patient care and treatment, from treatingpatients with visual impairment, depression, cancer, and autism, to an augmentedreality environment that supports healthcare practitioners during brain surgeryand reconnecting blood vessels. Two other developments with promise are thedevelopment of digital twins to enable doctors to explore outcomes, as well as the5G wireless network that will allow better data transfer, telemedicine advances,and remote monitoring, among many other benefits (Marr, 2019).

TeleHealth Is Becoming Easier to Practice

Telehealth promises to be an important solution to some big challengesin healthcare, from the shortage of clinicians and lack of rural providers toskyrocketing care costs. An impediment to telehealth has been the need forphysicians to be able to practice beyond the limited geographic area of oneto a few states that has been typical. The Federation of State Medical Boardsoffers that this is beginning to change, with the launch of the Interstate MedicalLicensure Compact (IMLC) in 2015. Not only does it offer a new, expeditedpathway to licensure for qualified physicians who wish to practice in multiplestates, but it also allows states to work together to address shared needs orissues. As of late 2018, 24 states, the District of Columbia and one U.S. territory are participating members (FSMB, 2018). The number of annual IMLCs has mostlyrisen every quarter since it was established, leading many experts to believe thattelemedicine will soon be available across a large part of the United States.

Retail Competition Is Heating Up

Expectations about the convenience of healthcare are changing, exemplifiedby the embrace of healthcare within a retail environment. The New York Timesreported in 2018 that people are now flocking to clinics and urgent care centerslocated in strip malls or shopping centers. Some 12,000 are already scatteredacross the country in these kinds of more accessible locations. At the sametime, office visits to primary care doctors declined 18 percent from 2012 to 2016,even as visits to specialists increased (Abelson & Creswell, 2018). Patients aremore interested as well in appointment hours that work better with a workingschedule, including evenings and weekends. Another development with largerimplications involves the merger of retail drugstore chains like CVS with insuranceproviders like Aetna. The impact on provider networks, advertising, etc. could besignificant. In addition, much of healthcare is waiting to see what Amazon andother big players in the digital economy may do to disrupt the traditional ways thathealthcare is provided, supplied, and scheduled.