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Nothing quite captures the simultaneous permanence and uncertainty of the choices healthcare providers face as much as a solid steel I-beam dangling from a crane. 主要的实物投资策略悬而未决. The high-dollar decision to set that very permanent steel girder into place had better be made through a future-focused lens because it’s going to spend at least 30 years holding up a building that will operate under a care delivery model that may not yet be fully defined.
Most executives are grossly underestimating the level to which utilization has the potential to drop.
The industry has spent decades developing its fixed-asset platform for a fee-for-service reimbursement model. 将实物资产与数量与价值的比值挂钩需要时间. 这种转变究竟会如何发生,会以多快的速度发生,在很大程度上是未知的, but hospitals and health systems must make investment decisions today about facilities that tomorrow will be viewed as cost centers instead of revenue drivers.
Developing an appropriately informed physical asset plan for a value-based delivery network is imperative to avoid significant, 不必要的资本支出和降低运营成本. 这个计划必须考虑如何:
- 开发一个对付款人和大雇主有吸引力的交付系统
- 满足大量、多样化和地理上分散的人口的需求
- 降低单位运营成本
- 减少多余的临床能力
而基于价值的网络计划可能不会立即实施, 随着资本要求浮出水面,它应该会推动重大资产投资的决策. 我们可以自信地对未来做出一些一般性的假设, 哪些将有助于bet8网站备用规划出理想的资产分配.
1.利用率将会下降
“健康护理”而非“疾病护理”的提供将在未来五年内加速. 新的医疗bet8娱乐和报销模式, 注重人口健康, 而且,来自付费方的压力增加,将导致医院住院病人的使用率下降, 即使人口继续增长和老龄化. (见表1).)
虽然这是普遍理解的, 大多数高管严重低估了利用率可能下降的程度. 2014年3月库尔特·萨尔蒙对美国的一项调查显示.S. hospitals and health systems found that 63% of executives and board members expect a decrease in utilization of all inpatient services over the next five years (measured by admissions per 1,000 population); the average expected decrease was 3%. But estimates calculated using Milliman’s Health Cost Guidelines (HCGs) find that markets which shift to well-managed rates may experience as much as a 30% reduction in inpatient admissions when compared with current levels (which are already 10% lower than five years ago). 这个计算要考虑到实际情况, observed data from plans and providers with more mature population health-management methods in place.
Executives must consider these likely reductions and get more conservative with long-term capital asset planning. The transition to risk-based payment will require removing significant unnecessary utilization capacity.
2.产能过剩将普遍存在
假设利用率下降, 大多数市场将有多余的床位和诊断和治疗能力. 假设利用率适度降低10%,入住时间减少一天, 美国则需要100个,减少000张床位, 即使考虑到老龄化和人口增长. 医疗bet8娱乐提供者将能够以非常合理的价格购买或租赁床位. 进一步, digital technologies will affect how and where care is provided; physical locations will no longer be the automatic default for patients seeking care, and executives will need to shift their strategies to adapt to evolving patient expectations and to prevent costly overbuilding. This extra lower-cost capacity must be factored into the equation when determining the value that renovated or new assets will have in the future and whether the system should consider physical expansion.
3. 整合护理场所的压力将会增加
Most health care organizations will need to significantly lower their cost structures to maintain their viability moving forward. 这就需要重新组织医疗bet8娱乐网络,将bet8娱乐集中起来,同时:
- 获得规模经济并确保高资产利用率
- 保持或提高质量和患者满意度
- 提供方便的医疗bet8娱乐
多年来,许多bet8网站备用获得了大杂烩式的建筑, 导致某些领域的重复bet8娱乐. 在其他情况下, changing migration patterns and suburban growth have moved the target population further away from facilities.
现在是时候重新校准天平了. 在开始昂贵的设施翻新之前, health systems must consider the role each asset will play in their care delivery networks over the long term. They must balance the number of access points they offer with their ability to achieve lasting success.
4. 实物投资将成为沉没成本,而不是收入驱动因素
The costs of renovating or building new facilities pale in comparison to the costs of operating them over their lifespan. With a decreased ability to recoup capital investments in a value-based reimbursement environment, 这些资产中的大多数应该被认为是未来的成本中心. 在投入资金建造或翻新资产之前,需要问的问题包括:
- 有足够的人口支持它吗, 我们能否提供足够规模的bet8娱乐来创造经济?
- 附近的其他系统设施是否有类似的功能和市场?
- 这项bet8娱乐能否以较低的成本进行?
- 对病人方便吗?
- 该领域的潜在合作伙伴能否提供类似或更高水平的价值?
- 我们是否试图用资本解决方案来解决运营问题?
Health systems must consider how their asset portfolios will evolve in the future to guide their investment decisions. Conservative planning in the midst of this rapidly changing healthcare environment 建议, as it is more sensible to build or acquire assets in the future when needs arise than to risk overbuilding today.
The significant opportunity to remove duplication and waste and to create value will have a dramatic impact on the healthcare marketplace. The providers that move early to recalibrate for value-based care delivery will have a distinct market advantage over those that hang on to the old ways of doing business. 高管们必须相应地改变他们的思维方式, steering away from traditional “grow-and-expand” strategies and toward “assess-and-reorganize” strategies. Unless hospital executives are incented by system or regional goals instead of the growth and financial health of their respective hospitals, 改变将是缓慢的. The health systems that are able to lower excess utilization and significantly reduce their cost structures have the potential to go to market at a substantially lower price point and shift a considerable number of lives and amount of market share to their delivery networks. 实物资产将对这一过程产生相当大的影响.
Systems must plan for a future where their care delivery networks may need to be significantly different. Recalibrating for value-based network design requires difficult choices about assets and locations, 但它为成为高价值医疗保健提供商提供了必要的支点. Doing the hard work now has the potential to save billions of dollars in capital and operating costs down the road.
保守的计划.….建议, as it is more sensible to build or acquire assets in the future when needs arise than to risk overbuilding today.
The significant opportunity to remove duplication and waste and to create value will have a dramatic impact on the healthcare marketplace. The providers that move early to recalibrate for value-based care delivery will have a distinct market advantage over those that hang on to the old ways of doing business. 高管们必须相应地改变他们的思维方式, steering away from traditional “grow-and-expand” strategies and toward “assess-and-reorganize” strategies. Unless hospital executives are incented by system or regional goals instead of the growth and financial health of their respective hospitals, 改变将是缓慢的. The health systems that are able to lower excess utilization and significantly reduce their cost structures have the potential to go to market at a substantially lower price point and shift a considerable number of lives and amount of market share to their delivery networks. 实物资产将对这一过程产生相当大的影响.
Systems must plan for a future where their care delivery networks may need to be significantly different. Recalibrating for value-based network design requires difficult choices about assets and locations, 但它为成为高价值医疗保健提供商提供了必要的支点. Doing the hard work now has the potential to save billions of dollars in capital and operating costs down the road.
2015年12月1日发布