Healthcare costs have been rising consistently and the pandemic has further worsened this trend, especially for healthcare systems. The US spent $4.3 trillion on healthcare in 2021 and this is expected to grow at 5.1% a year, reaching $6.8 trillion by 2030. Spending on healthcare will consume 19.7% of the nation’s GDP on healthcare, much higher than any developed nation. Health systems have faced the consequences, driving many into the red in 2022 and the rest with razor-thin margins between 1-2%.
These trends have motivated health leaders to develop more sustainable ways to provide care which is both affordable and high quality. In addition to using advanced analytics to drive care management, cost and utilization management, and patient and physician engagement, health systems are experimenting with out-of-hospital healthcare to bring down these costs. With advancements in clinical technology occurring at a tremendous pace and an ongoing shift towards value-based care, in-patient facilities are losing their charm.
The advent of Ambulatory Care Centers (ASCs), daycare centers, and virtual health have paved the way toward the provision of quality care to patients at a fraction of the cost to the health system and the payer. ASCs have gained popularity among health systems, payers. And even patients. In addition to being more affordable for all stakeholders, ASCs are more convenient for patients to use, provide a more personalized experience, and allow patients early discharge with an opportunity to recover in an at-home setting. For example, in orthopedics, having surgery at an ASC can lower hospital expenses by 17% to 43% compared to at a university hospital, while simultaneously improving clinical outcomes through early ambulation. This further strengthens the health system’s performance in a value-based setting.
Although many health systems realize the value of this shift to the ambulatory setting, only 40% are actually exploiting this strategy to its full potential. Approximately 30% of procedures have a variation in the site of care, which is dependent upon patient choice, accessibility, risk level, and specialty. Those procedures can be meaningfully selected by health systems and appropriately targeted for shifting to ambulatory care, saving millions in the cost of care without compromising care quality while actually improving the patient experience.
The post-COVID decade is projected to see ambulatory care grow 12% annually, with orthopedics and cardiology seeing the highest growth rates at 26% and 40% respectively by 2030, respectively. Health systems are encouraged to take advantage of this projected growth by expanding out-patient and ambulatory facilities, and also by focusing on three long-term strategies for success: (1) investing in physician and surgeon relationships and partnerships, (2) identifying experienced operational leaders, and (3) ensuring alignment with the contracting planning processes.
Here’s the rub: At the end of the day, accurate identification of patient risk is crucial to effectively transitioning to and succeeding in an ambulatory care setting. Knowing the precise risk status of a patient can help determine the most appropriate care setting and guide providers to consistently recommending the highest quality, lowest cost setting for care delivery.
How Can Innovaccer Help?
Innovaccer’s Population Health Management and Risk Adjustment solution makes it easy for health systems to perform prospective risk adjustments for their populations, and also helps improve performance on risk-based contracts. It facilitates accurate risk capture at the point of care, effective patient engagement, and offers advanced risk analytics, giving health systems valuable insights into the covered population’s risk profile. This intelligence allows health systems to accurately identify appropriate care settings for their patients, and achieve truly unprecedented cost savings and patient satisfaction levels.
Feel free to visit our website for more information on how our innovative solutions can steer your health system toward sustainable success in value-based care contracts or request a demo with our team of experts.