Now that it’s possible to go to the corner pharmacy for a quick check-up – covered by health insurance – the idea of going anywhere farther away or more expensive is unappealing to many patients. This means that even with high-quality service, health systems must do more to keep patients within their system, especially for care outside the traditional hospital, like post-acute and ambulatory care.

The disruptions happening in health care today are massive. UnitedHealth currently has 15 of its MedExpress urgent care centers connected to Walgreens pharmacies through a pilot partnership started in 2016, and that number could increase. In the past year, CVS Health has announced plans to acquire Aetna, while Cigna has announced plans to acquire Express Scripts. And with Walmart, Apple and Amazon looking to enter the fray, the impacts on hospitals could be just as massive as the disruptions.

“The key question is how do we, the traditional providers in the market, remain relevant?,” said Tom Potter, senior vice president at health care strategy company Sg2, during a May webinar hosted by Vizient, Optimizing Resource Effectiveness Across the Care Continuum. “How do we remain the provider of choice in our marketplaces, given all of these additional options?

“And the answer, we believe, lies in your ability to master the System of CARE in your community.”

CARE – Clinical Alignment and Resource Effectiveness – is an operational model that Potter and his colleagues at Sg2 encourage hospital leaders to follow so they can see their patients across the continuum of care, not just at the inpatient level.

Inpatient discharge rates will decrease by 1 percent over the next decade, according to Sg2’s Impact of Change National Demand Forecast. Meanwhile, home nurse visits will increase 30 percent, skilled nursing facility stays will increase 19 percent, and visits to urgent care and retail clinics will increase 12 percent nationally.

Telehealth has been growing in popularity for several years, and Sg2 forecasts that in 2028, 17 percent of all evaluation and management visits – themselves predicted to increase in number – will be delivered in a virtual-care setting.

In other words, hospital leaders must give post-acute and ambulatory care as much attention as they give acute care, and possibly more. And, if it isn’t already, it must be a serious consideration in their business strategies – which isn’t the case for the vast majority of hospitals now, Potter said.

“I would say that just being in the ambulatory space is nowhere near enough today. If you really map out all of the places where patients need to go, it’s impossible to own all of those points. But we would contend that your ability to knit together, to build a more robust care continuum that allows the patient to remain in your system, is possible and is a really important piece of strategy.”

The key, he said, is to bring other providers into the fold, through partnerships, joint ventures, co-management and other strategies.

Consumer care

Then, of course, there’s the insurance question. The American population is aging, meaning patients are moving from commercial plans to Medicare. Given that shift, traditional providers need to figure out how to remain relevant for commercial patients. Specialty providers are often already aligned with employers and, by extension, insurers. So, Potter said, the ability to reach commercial consumers now has to move upstream: primary care providers.

“We’re still seeing radical differences across the country” in terms of primary care independence, he said. In many regions, primary care practices aren’t aligned with specific health systems, meaning hospitals can partner with those practices to become the provider of choice in those areas.

But in other regions, particularly the northernmost parts of the country, primary care practices have aligned with health systems. So in that case, Potter said, hospitals may have to move even further upstream to expand their System of CARE, by aligning with employers.

And beyond that are the consumers themselves – often the “ultimate payer,” said Potter – meaning health systems may have to try direct-to-consumer strategies. That’s new for many hospitals, and it means leaders will have to factor in a range of consumer behaviors as they develop their strategy.

Consumers with high-deductible plans often make cost-conscious choices: for example, delaying care, seeking care elsewhere (perhaps an urgent care center over a hospital), or forgoing care altogether. “At the end of the day, meeting the consumers where they are is becoming increasingly important,” Potter said.

‘How long do I have?’

“We’re asked very often, ‘How fast is this all coming?’ ‘How long do I have?’,” said Potter.

Again, it’s different across the country. In regions where payment models have already transitioned from fee-for-service to value-based care, and health care players are willing to take on greater risk, hospital administrators must act quickly to strengthen their network of care across the continuum before they fall further behind the competition. Health systems in other regions may have more time.

But in the long run, traditional providers will have to adapt.

“Step one is having a strategy to assess your non-acute or ambulatory business and knitting together a cohesive and robust System of CARE,” said Potter, “so that when patients enter, they can stay.”

For more information, contact us at, or listen to a recent webinar, where clinical, operational and supply chain experts share insights on how to optimize resource effectiveness across the care continuum.

Published: September 11, 2018