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If health care had a crystal ball, a peek into it might show the industry's future looking something like this:

Patients will interact with physicians much more often, including through telehealth visits and smartphone apps. Structured clinical teams of physicians, nurses, pharmacists, dietitians, care navigators, and others will deliver more collaborative care and support patients even when they're well.

Employers who buy coverage for their employees will continue to demand quality, better results, and affordability — pushing the industry ever closer to value-based care .  

Such predictions were among those of physicians, hospital executives, insurers, and employers who shared the stage at the Pittsburgh Business Group on Health's (PBGH) 16th Annual Health Care Executive Leadership Forum. Held March 13 in downtown Pittsburgh, the event attracted some 200 PBGH members and guests seeking a forecast on health care's future.

A panel discussion was held with four regional physician-health system leaders on the evolution of care delivery in the face of ever-increasing costs. A second panel discussion with representatives of four health insurers was held to discuss how coverage and payment are changing to keep care affordable.

After each talk, a panel of three employer purchasers of care took the stage to voice their reactions.

Care Delivery to Center Around Wellness and Technology

In the next decade, wellness and condition management will emerge as priorities to reduce hospital stays and manage costs, according to physician-health system panelists.

"Primary care will become the most critical asset of any health care system," said Susan Manzi, MD, chair of the Medicine Institute at Allegheny Health Network (AHN), who served on the provider panel. "We're going to see more team-based care, with physicians, nurses, advanced practitioners, behavioral health specialists, and pharmacists all managing patients, and not just for acute episodes. Rarely will you see one doctor in an office with only a nurse and a medical assistant."

Telehealth visits and remote home monitoring of patients will become commonplace, and care delivery will move more toward "protocolized care," she added.

"Doctors don't like that term. But today, if you ask 10 doctors how to treat a patient, you might get 10 different approaches," Manzi said. "Care needs to move toward evidence-based protocols that minimize unwarranted variation."

Providers and Insurers Finding Common Ground

Care providers and insurers increasingly are seeing each other as partners, noted members of the insurer panel. And both parties agree that care and cost transformation begins with primary care.

"Last year, we launched our True Performance pay-for-value incentive program because PCPs impact a significant part of the health care premium — not only in terms of quality measures but also in managing costs," said Anthony Benevento, senior vice president of Regional Markets for Highmark.

Conversations between insurers and PCPs start a data exchange that can speed up the transition to value-based care, he noted. "We've seen an incredible thirst from doctors to provide them with data on where cost and quality meet,” Benevento said. “It's just the first step in changing the way we pay for care.”

Members of the employer panel were:

  • Jan Klein, chairperson of the Allegheny County Schools Health Insurance Consortium
  • Carrie Rust, director of human resources for Ellwood Group Inc.
  • Lisa Harris, director of benefits and compensation for Eat 'n Park Hospitality Group

“Highmark is grateful for organizations like the Pittsburgh Business Group on Health that foster frank discussion and help move the health care industry forward together,” Benevento said. “We look forward to continued dialog.”