By Bissan Biary, MHA, MMS Senior Practice Solutions Specialist
How will medical practice evolve through 2019 and what do those changes mean for physicians? Vital Signs has identified seven key trends. These trends are driven by underlying market forces, including the expanding adoption of value-based payment models, the rapid development of health information technology, new policy and regulatory mechanisms, and more. The Medical Society helps physicians navigate the shifting landscape through general and customized support, on-point CME, and advocating for legislative and regulatory changes that prioritize physician wellness, reasonable compensation, and administrative simplification. Key trends include:
1. Shifting toward Population-Based Care
Population-based care systems use data derived from large patient populations to guide the care of individuals. They aim to help practices provide proactive, evidence-based interventions and coordinated care, ultimately improving clinical outcomes at lower cost. For example, the electronic health record (EHR) may flag patients who would benefit from certain vaccines, or a case manager may identify patients who share certain characteristics and work with them on self-care. Data from two Massachusetts state agencies, the Center for Health Information and Analysis and the Health Policy Commission (HPC), show physician-led organizations performing well on population-based measures. The new MassHealth accountable care organizations (ACOs), which provide care for 800,000 patients, are designed to coordinate medical care and social services. Throughout the rollout of the MassHealth ACO program the MMS has advocated for the primacy of the patient-physician relationship and the continuity of care.
2. Considering the Social Determinants of Health
The MassHealth ACOs now consider the social determinants of health (SDOH) — nonmedical factors influencing disease risk — in their care management systems. A related federal waiver has secured substantial funding for programming addressing the SDOH, which include education, socioeconomic status, neighborhood, food security, racial segregation, housing, public safety, transportation, and more. Addressing these factors is essential to improving outcomes and reducing disparities. Predictive technology can help identify relevant factors and flag patients for early screening and prevention. This approach can also help health care systems collaborate with community-based organizations to more efficiently manage the care of high-risk patients. Policy adopted by the Society in December will enable more targeted and comprehensive advocacy aimed at addressing the nonmedical factors influencing health (New Policy).
3. Prioritizing Physician Wellness
Health systems and provider organizations are increasingly surveying their providers for burnout and seeking solutions. These may include, for example, the use of scribes and templates to ease EHR use, social gatherings to help reduce isolation, increased mentoring, improved practice workflow and on-call coverage, and expanded provider wellness programs. The MMS addresses physician wellness through a variety of channels, including advocacy, research, CME, and building physician community. This year, in collaboration with the Massachusetts Health and Hospital Association, the Society convened a Task Force on Physician Burnout to identify evidenced-based solutions and advocate for their adoption. Physician Health Services (PHS), an MMS subsidiary, works with physicians experiencing burnout, and its MedPEP podcast, launched in 2018, explores strategies for thriving in today’s medical environment: see massmed.org/PHS.
4. Tackling Prescription Drug Costs
Spending on specialty pharmaceuticals, gene therapies, and orphan disease drugs continues to rise rapidly. The HPC, which monitors cost drivers, is recommending an increase in transparency and accountability in drug pricing, and an effort to enhance state negotiations of drug prices — priorities for which the Society is advocating at the state and federal levels. The MMS is working with stakeholders — including patient groups, drug companies, and legislators — to explore opportunities for collaboration and policy intervention. In October, physicians and public health professionals came together at the Society’s 15th Annual Public Health Leadership Forum to discuss how to address prescription drugs costs as a barrier to care (The State Approach).
5. Incorporating Artificial Intelligence
Advances in AI, robotics, and machine learning can potentially improve the quality of health care services and reduce costs. Emerging applications of AI include voice-enabled digital assistants for physicians, such as Amazon’s Alexa. AI applications have been used to schedule patient visits, refill prescriptions, supply laboratory results, and more. AI offers additional opportunities — from diagnostic algorithms to advanced treatment queries. That said, some aspects of AI raise regulatory questions and challenges. In May, 100 physicians gathered at MMS Headquarters to explore artificial intelligence and the future of clinical practice; the content will be available in early 2019 as an on-demand CME course.
6. Ongoing Mergers and Acquisitions
Health systems, hospitals, and payers are continuing their consolidation activities — witness the megadeals between Beth Israel Deaconess Medical Center and Lahey Health, CVS Health and Aetna, and even Cigna and Express Scripts. Merging health care organizations are aiming to expand care services, control costs, and gain market share and negotiating power. Consolidation continues to pressurize smaller practices. Providers are encouraged to improve care coordination across their networks and reassess compensation, benefits, practice software, payer contracts, and staffing. Solo practice physicians are encouraged to stay tuned to the market and preserve their patient-physician relationships to the extent possible. The MMS’s Physician Practice Resource Center helps physicians and practices adapt: see massmed.org/pprc.
7. Tightening Cybersecurity
With the increasing number of ransomware and malware attacks and other security breaches, we expect to see growth in cybersecurity methods in 2019 and beyond. Digital health technology requires medical cybersecurity to manage and protect patients’ health care records from viruses, hackers, and other cyberattacks. Physicians are encouraged to invest in cybersecurity training programs and software tools, adopt updated protocols in protecting information, implement analytical and risk assessment tools to detect potential attacks, and ensure robust compliance and encryption technologies. The Society is developing resources to help physicians comply with the 2020 state mandate for electronic prescribing.
