PwC on convergence

Convergence toward a healthier future. Collaborating for the common good.

As a result of significant scientific advancements, a new political landscape and rapidly changing regulatory environment, market demands from employers and consumers, and technology-enabled connectivity, the industry is undergoing a major structural transformation. This transformation is creating opportunities and challenges for traditional and non-traditional health-related sectors to converge around the promise of raising quality and lowering costs.

PwC summarizes today’s emergent cross-industry issues and their impact on industry stakeholders. These key issues affect the entire health industry. Solving any of them requires collaboration—and convergence of priorities and practices—among multiple stakeholders throughout the healthcare ecosystem:

Supply-chain management (SCM)

How could your organization benefit from optimizing your supply chain?

Segmentation, cold chain, personalization, and wellness are new ideas that will drive decisions in the supply chain of the future. It will be built upon flexibility, responsiveness, and reliability, and will increasingly align with the needs of your business partners and customer demands.

Health information technology (HIT)

Why should health organizations overcome existing barriers and complexities to capitalize on the promise of health IT?

Today, fewer than 20% of physicians use electronic health records (EHRs) to any meaningful degree. The Obama Administration hopes to boost that rate to 90% by 2015, by earmarking $20 billion in stimulus funding and lead the way to remedy privacy concerns and technology limitations. During the next five years, the secondary use of EHRs—extracting data from them and using it to improve patient care, predict public health trends, and reduce healthcare costs—could be the health industry's greatest asset.

Integrated health management

What if healthcare payers played a larger role in keeping you well?

Employers increasingly recognize that it is better to manage the health of their workforce than to manage the cost of illness, and they want their health plan providers to contribute to that effort. In response, payers are transforming their business models to focus on wellness and prevention to empower consumers and their physicians with information and tools to make better healthcare choices.

New delivery models

What can we do to improve access to healthcare?

You see evidence of jammed access to acute care throughout the U.S. hospital system. Overcrowded emergency departments and frequent ambulance diversions are just two of the more obvious signs. Health organizations are already developing flexible care models—such as medical home and accountable care organizations—to broaden access for all.

Personalized medicine

How can organizations capitalize on the move towards personalized medicine?

Personalized medicine has the potential to eliminate unnecessary treatments, increase the efficacy of appropriate treatments, reduce adverse drug reactions, and, ultimately and most importantly, improve health outcomes. Although new medical advances are disrupting long-established business models, they are also opening new opportunities for collaboration across industries and between the public and private sectors.

Privacy, fraud, and abuse

Are your privacy and security policies adequate to protect you from fraud and abuse?

The "American Recovery and Reinvestment Act of 2009" (ARRA) maintains and expands the current patient health information privacy and security protections, especially as patient health information is electronically transferred. These new protections represent a range of challenges and opportunities for all stakeholders to maintain relationships of trust while complying with new regulations and mandates.

Value for money

How will demands for transparency and accountability impact health organizations?

Health organizations have long been accountable for quality. Providers must compare favorably with benchmarks for patient outcomes. Payers need to show they are keeping members healthier for less money. Pharmaceutical and biomedical companies will see their products increasingly evaluated based on their comparative effectiveness, judging not only efficacy and safety, but value as well.

ICD-10

How could conversion to ICD-10 improve patient care and make the reimbursement process more efficient?

As reimbursements become more closely tied to quality and value, ICD-10 coding and analysis will provide the tools to reach these targets--and to prove the targets have been achieved. Greater accuracy and detail of medical coding will help identify and reduce ineffective or wasteful expenditures, and can guide treatment options toward better patient outcomes.

Insurance coverage expansion

How could decreased reimbursements change care delivery?

The current relationship between hospitals and physicians has been built around rewarding volume of services - not quality. That model is breaking down as Medicare is pushing toward value-based purchasing and experimenting with a payment system that rewards a system of coordinated care. For reimbursement to work, payers and providers need to develop collaborative business relationships and innovative care models with physicians to share the risk and rewards for quality of care.

 

Personalized medicine

Personalized medicine

Thought Leadership paper

Personalized medicine, which targets individualized treatment and care based on personal and genetic variation, is creating a booming market, but it is a disruptive innovation that will create both opportunities and challenges for traditional healthcare and emerging market participants.

 
 

Secondary use of health data

Secondary use of health data

Thought Leadership paper

The data that could be mined from electronic health records can improve patient care, predict public health trends and reduce healthcare costs, but the industry needs to converge together to address lack of standards, privacy concerns and technology limitations.

 
 

The Multiple Myeloma Research Consortium

The Multiple Myeloma Research Consortium

Case Study

PwC spent more than a year helping Kathy Giusti to realize her vision of uniting myeloma researchers in the quest for a cure. Today, the MMRC is directing research on a disease that, while still incurable, is no longer an orphan. This attachment is still forthcoming and I will send it to you next week.

 
 

A conversation with Chip Kahn, president of the Federation of American Hospitals

A conversation with Chip Kahn, president of the Federation of American Hospitals

Video (6:11 mins)

Chip Kahn, president of the Federation of American Hospitals, makes the case for patient-centered healthcare. As clinical and business processes and enabling technology converge, we can worry less about building an interconnected healthcare system and devote more attention to using the system to take better care of patients.

 
 

A conversation with Jack Dorsey, founder and chairman of Twitter

A conversation with Jack Dorsey, founder and chairman of Twitter

Video (3:15 mins)

Jack Dorsey, founder and chairman of Twitter, explains that networking through Twitter can be more than a social interaction. It can enable a running dialogue between patients and their caregivers at any time and place.

 
 

180° Health Forum executive highlights

180° Health Forum executive highlights

Brochure

PwC’s first 180° Health Forum met in the spring of 2008 to discuss quality, focus, and preparedness in U.S. healthcare. The forum highlighted the need to strengthen collaboration and convergence among stakeholders in both public and private sectors.