The Healthcare & Life Sciences Industry

Contents

1. 👨‍⚕️ Services Provided

2. 👩‍💼 Healthcare Provider Executives

3. 🩺 Provider Technology

4. 🤔 Industry Challenges

👨‍⚕️ Services Provided

👨‍💼 Healthcare Provider Executives

Important executives:

• Chief of Staff/Medical Director

  • Responsible for healthcare provider’s clinical services
  • Clinical services could mean:
    • Surgery, therapy, diagnostic imaging
    • Or departments focused on neurology, cardiology and orthopedics
  • Every department can have its own chief, like chief of emergency medicine

• Chief Medical Officer (CMO)

  • Staff executive that reports to the Chief Executive Officer (CEO) of the health care provider
  • CMOs have medical backgrounds and are responsible for ensuring and improving the quality of medical care provided to patients
  • Often responsible for medical staff development and technology designed to support the medical staff
  • This puts CMO in the leading role for projects related to Electronic Medical Records, Clinical Decision Support Systems, Health Informatics
  • CMOs are responsible for attracting and retaining the medical professionals and reviewing the medical credentials, training, experience and ability of physicians before granting them privileges to practice in the hospital

• Chief Nursing Officer (CNO)

  • Responsible for ensuring and improving the quality of nursing and overall patient care
  • Responsibilities include implementing care management policies and procedures
  • Staff executive that reports to CEO or Chief or Staff

• Director, Patient Care

  • Heads up a provider’s Patient Care group and usually reports to provider’s Chief Operating Officer (COO)
  • Responsible for patient services not provided directly by medical staff
  • These services include nursing services, care plan development to coordinate patient care between medical departments, social services, and administrative services such as patient admission and discharge. This group is also called Nursing services
  • In most hospitals, this group faces significant challenges related to staff shortages, staff training and budget constraints

• Director, Facilities and Engineering

  • Responsible for supporting a provider’s physical facilities, and this executive plays an important role in large providers (such as hospitals)
  • Facilities and Engineering group (Technology group) is responsible for:
    • Acquisition, testing and maintenance of medical technology
    • Real estate property management
    • Infrastructure support services associated with medical gases, refrigeration, water and power supplies
    • Environmental services, such as waste management and water treatment
    • Physical security services
    • Food services and housekeeping
  • Usually reports to Chief Operating Officer (COO)

🩺 Provider Technology

Medical technology:

• tech used to diagnose, monitor and treat medical conditions

Information technology used by healthcare providers:

• different from MedTech
• Types:
  • Clinical information management system or Clinical decision support systems
  • Administrative systems, operational systems, or health information management systems
• IT systems:
  • Electronic Medical Records (EMR) and Electronic Health Records (EHR)
    • EMRs are patient records stored digitally within a specific health care organization
    • EHRs are EMRs standardized and shared across multiple healthcare organizations (and sometimes payers) through secure health information exchanges or other networks
  • Nurses Stations
    • Allow on-duty nurses to manage the care of their patients by prioritizing tasks, reviewing medical information, documenting activities performed
  • Laboratories
    • Labs use complex, highly automated medical equipment to test patient’s blood, urine, tissues, etc.
    • This equipment is increasingly integrated with IT apps to improve efficiency and quality
  • Finance
    • Many finance systems used by healthcare providers are similar to those found in other large companies
    • More specialized finance systems found in healthcare providers include:
      • Patient accounting systems
      • Billing (A/R) systems that include medical coding software, claims preparation, electronic claim submissions in payer-compliant transaction formats, denials management and collections
      • Contract management systems to manage relationships with multiple payers
      • Supply chain management systems that integrate with departmental applications to optimize inventory levels
    • These financial systems are sometimes referred to as revenue cycle management systems
  • Radiology
    • Radiology uses x-ray equipment, MRI equipment, etc. to create images of patients to diagnose and monitor medical conditions
    • These high-resolution images are forwarded to the Picture Archiving and Communications Systems (PACS) typically located in hospital’s data center
    • Once in PACS, these images are available for other medical professionals to review
    • In more advanced IT ecosystems, these images are automatically linked to patient electronic medical records

🤔 Industry Challenges

• Pressure on profitability
• Cost control
	○ To lower healthcare costs, payers are:
		§ Lowering reimbursement rates to providers
		§ Developing alternative payment models
		§ Rationing patient access to healthcare
		§ Increasing patient cost-sharing
	○ These measures put pressure on provider profitability. In response, providers try to:
		§ Control costs
		§ Grow revenue
	○ Providers are employing various measures to overcome all of their challenges
• Revenue growth
• Regulatory compliance
	○ Most important regulations and mandates:
		§ Cybersecurity (regulations such as HIPAA, GDPR)
		§ Value-based care initiatives
			□ Traditionally, it has been fee-for-service (FFS), which has disadvantages
			□ Value-based care initiatives increases the incentives for providers to provide quality healthcare. Providers are payed based on patient outcomes, rather than the number of tests and treatments
			□ Value-based reimbursement methods require providers to meet payer-mandated metrics for quality, efficiency and patient safety
			□ Opinion-based medicine -> Evidence-based medicine
			□ Volume-based reimbursement -> Value-based reimbursement
			□ In the US, Medicare Access and CHIP Reauthorization Act (MACRA) requires Centers for Medicare and Medicaid (CMS) to manage a quality payment incentive program that rewards value and outcomes
			□ CMS does this through:
				® Merit-based Incentive Payment System (MIPS)
				® Alternative Payment Models (APMs)
					◊ Bundled payments
					◊ Accountable Care Organizations (ACOs)
• Improving patient experience
	○ Drivers for improving patient experience:
		§ Growing payer emphasis on patient experience as a part of quality care
		§ Increasing engagement by patients in their own healthcare
		§ A desire by providers to strengthen patient loyalty through a sense of membership
	○ Strategies:
		§ Employing portals and other self-service healthcare tools
		§ Easier access to health information
		§ Training staff to improve communication and responsiveness
		§ Implementing analytics to better understand customer needs and personalize interactions
		§ Using telemedicine
• Shortage of healthcare workers
	○ Reasons:
		§ Emerging markets
		§ Aging populations
	○ Impact:
		§ Longer wait times to receive medical care
		§ Reduced access to care, mostly in rural areas
		§ Increased focus on alternative delivery models, such as retail clinics and telemedicine
• Pandemic (COVID-19)
	○ Impact:
		§ Scramble to get extra beds, masks, oxygen, etc.
		§ Expand hospital capacities
		§ Use non-medical facilities and erect temporary field hospitals
		§ Call for additional healthcare workers, including retired medical professionals and medical students
	○ Providers have suffered financial implications, due to:
		§ Cost to treat COVID-19 soared
		§ Revenue fell, because healthcare facilities limit non-emergency surgeries to free up beds for COVID-19 patients; and patients postpone medical appointments to avoid virus contact
	○ Pandemic forced provides for implementing more innovative ways of providing medical care:
		§ Use of telemedicine has increased
		§ In-home screenings have increased (self-testing/diagnosis at home)

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