Healthcare finance professionals: Are you ready for the big wave of consumerism and transparency?

Do you feel it? The tremors? The shaking has started, and the threat is real.

And it’s going to get stronger and more pronounced. The healthcare industry is being pushed to do better by our state and federal governments, employers, opportunistic companies and the patients we serve directly and indirectly. The latest salvos are from CMS on transparency and interoperability.

Given this environment, I’m amazed that numerous big and influential organizations — for-profits, not-for-profits and associations alike — are choosing to engineer smallness and go into protection mode. We strive to protect our way of doing business, our model and our self-interests. With enough money, that may work for a while, but I am convinced that approach in healthcare today will end the way it did for Sears, Kodak and Blockbuster.  

With transparency and interoperability or anything of significance, it is reasonable to weigh in and question a method. But if you want a voice, and you actually want to move forward, you have to live the words of Teddy Roosevelt by getting into the arena with your face “marred by dust and sweat and blood.” And in doing so, you can offer a solution that helps our patients and allows competition and innovation to serve those patients better.  

A recent NEJM Catalyst article (“Build vs. Buy: What Should Health Systems Do?” Sept. 18, 2019) looked at why it’s so hard for legacy healthcare providers to get out of protection mode. The authors said, “[Health systems] have years of experience building highly successful businesses that maximize local market scale, delivering high volumes of very complex high-quality care, with management systems reliant on high-cost labor and inflexible, expensive enterprise software.” They noted that many consolidations have been driven by two considerations: “more scale to leverage pricing negotiations with payers and a larger geographic footprint to potentially offer narrow network products.” In short, it has been about building fences and keeping people in. That is a dated strategy.  

The new play is to provide superior care and a great experience for patients and reduce the cost of care. It requires investment in primary and chronic care, home-based models and patient-focused technologies. It requires taking risks and trading the profits of yesterday for the model of the future. So I ask: Are we ready for the biggest wave of the day to sweep over our heads? The time to get ready is now.

HFMA is not in protection mode. We are evolving as an association and have many resources to help our members evolve as well, including a new Consumerism Maturity Model and resources on transparency and patient financial experience. Start the revolution here! I dare you!