HEALTHCARE’S COMING TSUNAMI   

author: Joe Shockey       Nov 7  2023 

Healthcare is on the precipice of a profound transformation. As leaders in this sector, understanding and harnessing this change isn't merely a strategic move—it's an imperative.

Key Drivers of Change

The catalysts behind this evolution? Innovation, Consumer Behavior, and Regulatory-Policy Change. When these forces converge, they pave the way for revolutionary shifts in society. In this case, the cannon is aimed at how healthcare is delivered and managed.

Regulatory-Policy Impetus: Chronic Care Management (CCM), a little-known program initiated by Medicare in 2016, focuses not on the 5-10% high-risk patients but rather the 60-80% with manageable multiple chronic diseases. Within the first few years, the merits of CCM showed noticeable reductions in readmissions, improved patient outcomes, and significant cost savings. So much so, provider compensations were adjusted upward by a staggering 40-50%. With that type of increase and performance, it’s only a matter of time before Medicare drops the copay and mandates CCM as part of Medicare service, further increasing pressure on Healthcare staff and its capabilities, those not able to keep up through effective implementation of a CCM program will likely go the way of the independent pharmacist, They thought mandatory consultation was going to be their savior, rather it exposed their weakness as being unprepared and over worked, resulting in increased waiting time for their patients to have their prescriptions filled, by contrast it showed the strength of the big chains as more efficient  and a more reliable source for pharmaceutical information and consultation.  CCM will prove to be the undoing for many healthcare providers not prepared for its implications. 

The Consumer: By 2030, projections suggest a surge to nearly 80 million Americans under Medicare. They’re technologically proficient, informed, and demand a more evolved healthcare approach, emphasizing the significance of preventive care. They have a better understanding of the value of early detection and lifestyle adjustments; they expect healthcare systems to offer services that not only treat illnesses but actively promote wellness and prevent disease. This is a marked change from reactive healthcare to a proactive model, necessitating healthcare providers to recalibrate their services. Programs like CCM align perfectly with this mindset, offering continuous, comprehensive care management that goes beyond the episodic treatment of acute conditions. This proactive group of Medicare consumers is not merely a demographic shift; it’s a clarion call for healthcare systems to evolve. Embracing this change means investing in technology, prioritizing preventive care, and fostering a healthcare environment that is responsive, patient-centric, and holistic. As we approach 2030, the healthcare industry must adapt to meet these emerging needs and expectations, fundamentally reshaping the way healthcare is delivered and experienced.

Innovation: CCM's success isn’t solely regulatory-driven. It’s estimated that between 82 and 90 percent of Medicare patients have two or more chronic diseases. A requirement for CCM eligibility. CCM symbolizes an innovative stride in patient care, where patients have round-the-clock access to nurses, the ability to pick up the phone and ask questions without costly visits. This level of access is particularly vital for chronic disease management, where timely interventions can prevent complications and reduce the need for acute care.

Beyond convenience, this approach is about closing the care gaps that have traditionally hindered chronic disease management. With CCM, healthcare providers can proactively address potential health issues before they escalate into more serious conditions. This is not only beneficial for patient health outcomes but also significantly reduces the financial strain on healthcare systems. Preventative care and early intervention, hallmarks of effective chronic care management, are far less costly than treating acute conditions or managing advanced stages of chronic diseases.

Additionally, CCM fosters a more coordinated approach to patient care. It involves regular, structured check-ins with healthcare professionals, who work as part of a multidisciplinary team. This team collaborates to ensure that all aspects of the patient’s health are addressed, from medical needs to lifestyle and behavioral factors. This level of coordination is crucial for effectively managing chronic conditions, which often require a multifaceted treatment approach.  Such innovative approaches aren't just enhancing patient care; they're reshaping the economic viability of healthcare and how it’s delivered.

The New Strategy:  Patient enrollment =  Patient engagement = Financial Health.

Consider this: An average clinic or practice introduces a CCM program for 400 Medicare-eligible patients. At an average of $65 per patient monthly for a year, we're talking about an added revenue of $312,000 annually, If you factor in additional screenings or the closure of care gaps, AWV’s and reduced readmissions it could add an additional $350- 480 per patient to the bottom line. That’s significant for a small provider. For larger healthcare facilities, the implications, both in terms of revenue and patient care, are colossal. For years, the healthcare industry has paid lip service to population health management without significant impact. Now, properly implemented Chronic Care Management emerges as the first service to genuinely improve health outcomes for the most vulnerable populations. CCM, when implemented properly will truly move the needle in a positive direction for community care.

The pivotal point, regardless of the institution's size.  Patient enrollment. The centrality of patient enrollment in Chronic Care Management (CCM) cannot be overstated, especially given Medicare's stipulation that a patient can only be registered with a single provider for CCM services. This policy underlines the strategic importance of enrolling patients promptly and effectively. Under CCM, the mandated monthly engagements not only foster continuous patient-provider interaction but also build a robust and ongoing relationship. This increased contact frequency is a key factor in patient retention, as it ensures that patients remain 'in-house', receiving coordinated and continuous care under their enrolled provider. For healthcare providers, this translates into a fundamental shift in strategy. Moving away from the traditional fee-for-service model, the focus now intensively shifts towards a patient-centric approach where the aim is to secure and sustain a stable patient base. It becomes a competitive imperative: providers who excel in patient engagement and retention under the CCM framework are positioned to succeed, while those who lag risk losing their patients to more proactive competitors. This evolution towards value-based care underscores a significant transformation in healthcare dynamics, where patient loyalty and long-term engagement are becoming critical determinants of a provider's success.

Market Movements and Strategic Alignments

Market dynamics further underscore the importance of CCM and its potential implications. Healthcare giants, like CVS Pharmacies, are diversifying their portfolios and establishing themselves as primary care providers. Their recent acquisition of Oak Street Health indicates a shift towards becoming a holistic healthcare hub, capable of enrolling patients in CCM. The overarching strategy? Positioning themselves at the nexus of healthcare provision, optimizing patient care, and maximizing revenue streams. Want proof, Google, and watch the first 5 minutes of CVS’s – CEO, Karen S Lynch on Axioms, What’s Next. It’s clear where they see healthcare heading and the avenue, they are taking to be at the forefront of obtaining and maintaining Medicare patients. Major Hospitals and large clinics are now moving to capitalize on CCM. These industry movements are not just tactical but are indicative of a broader strategic transformation in healthcare where the providers who understand that acquisition of the patient determines the financial health of that provider and the detriment of providers who fails to recognize the transformation that’s taking place.

The Choice Ahead

If you are a decision-maker in the healthcare sector, the choices made today will dictate the trajectory of your financial future tomorrow. Embracing this evolution isn't just about staying relevant—it’s about pioneering a future where healthcare is more efficient, holistic, and patient-centered, those who ignore or wait to introduce CCM will lose patients to providers who offer Medicare patients more.  In essence, CCM is reshaping the economic viability of healthcare by demonstrating that proactive, technology-driven chronic care management not only improves patient outcomes but also optimizes resource utilization. It’s a prime example of how innovation in healthcare delivery can lead to more sustainable, efficient, and patient-centric systems. As we move forward, CCM's integration into healthcare models is expected to be a defining characteristic of high-performing health systems, highlighting the critical role of innovation in addressing the complex needs of a growing aging population with chronic health conditions.

Healthcare's Coming Tsunami