Traditionally, health systems have been the ones to shape the way care is provided. In today’s environment, however, externally derived factors such as changes in reimbursement, regulations, and customer demands, are forcing health systems to respond and adapt the way they operate.

Shift in care setting. Cost pressures on providers, as well as patient preferences, are shifting healthcare provision out of the traditional hospital setting. From a cost standpoint, the increase in value-based contracts that reward on outcome over volume, incentivizes providers to find lower cost healthcare settings. Settings such as outpatient and ambulatory care centers allow providers to deliver procedures such as knee or hip replacement at 30-40% less than the cost of an in-patient facility.¹

From a consumer preference standpoint, patients are increasingly seeking more personalized and comfortable healthcare. Concierge and spa-like services offer clinical care in modern and luxurious settings outside of the traditional hospital. In addition to appealing to consumer demands, these types of services are also creating new revenue streams for health systems. Recently, several new companies have emerged that offer healthcare services in the comfort and convenience of a patient’s own home. Through companies such as Ready Responders and Heal, patients use digital apps to request clinical care at a time that is convenient for them, similar to the ease of scheduling a ride through Uber.² Care is then provided either virtually or through an in-home visit depending on what the patient prefers.

The COVID-19 pandemic has accelerated this trend. With healthcare facilities shut down for non-essential in-person care, the industry was forced to shift to virtual care solutions that enabled healthcare providers to visit with patients in the safety and comfort of their homes. Patients and providers alike have reported positive experiences with virtual care as well as the desire for continued expansion of telehealth models with enhanced capabilities.^3,4

Continued evolution of regulatory and compliance requirements. Health systems face a range of regulatory and compliance requirements (see Image 1). While these standards were established to protect public health, promote the delivery of high-quality care, and enhance patient privacy, they have also placed a significant administrative toll on healthcare providers in order to comply. Healthcare entities must not only stay up-to-date on the constantly changing and evolving regulations but must also invest sizable resources to acquire, and implement, the technologies and processes necessary to meet requirements. A recent AHA report found that every patient admitted to the hospital, resulted in $1,200 of associated regulatory costs.⁵

Transition to a remote workforce. Businesses across industries are exploring remote workforce opportunities. For many healthcare organizations, remote workforces present a strategic opportunity: by shifting employees to home offices, health systems can realize significant real estate savings as well as access to a broader, stronger talent pool⁸ (see case study below).

Health innovation is on the rise. Funding for health tech innovators exceeded $7.4 billion in 2019.⁹ At the root of this technology expansion is consumer demand. Today’s healthcare consumers, and in particular Millennials, are more interested in healthcare that is convenient and digitally enabled than allegiance to a specific provider.¹⁰

Emergence of Disruptors

Traditional and non-traditional partnerships are paving a path to a new form of healthcare delivery. Walmart and Humana, CVS Health and Aetna, Cigna and Express Scripts, and Anthem and IngenioRx, are all new business models aimed at addressing the increased demands of Millennial and affluent senior populations. These players offer digital tools and technologies that provide a more consumer centric healthcare experience and reduce the cost of care. For example, CVS Health is building HealthHUBs within 1,500 neighborhood pharmacies where consumers can access in-person and virtual care services, chronic disease management, health education, wellness classes, and more.¹¹ Healthcare stakeholders that are unable to meet  the patient demands for increased transparency, convenience, and digital solutions, will be pushed out.¹²

Greater Ownership of Health

Consumers are becoming active owners of their own health. Wearable devices such as smartwatches, wearable mobile sensors, and other mobile devices can collect a range of health data including blood sugar, exercise routines, sleep, and mood. Platforms such as Google Fit and Apple HealthKit aggregate data from multiple sources providing a more complete picture for monitoring.

With close to 60% of US adults willing to wear these sensing technologies and the rise of devices that are compatible with electronic health records (EHRs), these tools are likely to play a significant role in the management of chronic diseases. Large health systems are likely to roll out wearables as part of their preventative care programs allowing both care providers and consumers the ability to track and trend key health indicators.¹³

Interoperability, Security, and Privacy

A truly patient-centered healthcare system requires a seamless and secure method to share data across the technologies involved in each individual’s healthcare journey. Consider the benefits of interoperability expanding beyond traditional clinical data points delivering scenarios such as drawing insights and triggering activities to support the individual’s health. For example, automatic authorization and prescription delivery, or proactive and personalized follow up calls based on data provided from a heart-rate monitor.¹⁴

The traditional scenario of a health system creating and storing a patient’s data is being replaced by a marketplace of retail health clinics, health applications, and retail virtual health providers. All of which are creating critical data that is instrumental for a primary care physician to understand their patient’s complete health picture. While at the same time, all of which creating sensitive data, which is distributed beyond the traditional health system’s perimeter into cloud infrastructure and software as a service applications. Disparate data and the need for sharing (to create a holistic health picture) creates privacy, security, and legal challenges for organizations. Each element needs to be considered; for example:

Privacy – Is an organization authorized by the consumer to share their information? Are policies and procedures correctly aligned to pertinent laws or regulation?

Security – Is the transmission and storage of sensitive data done securely, and who has access to the data at any given point. Does the security architecture adequately and efficiently support the remote workforce?

Legal – Are there laws or regulations that need to be followed and are the appropriate business associate agreements completed for information sharing?

To support evolving business operations, security and privacy also need to adapt. Technical challenges of disparate workloads can be managed by leveraging architecture concepts like the Secure Access Service Edge (SASE). To maintain privacy and legal defensibility, options are available via subscription or retainer that can provide ongoing and up-to-date policies and procedures.