Few industries evolve as rapidly and drastically as healthcare, with breakthrough treatments, improving technology, governmental regulations and fluctuating price points, just a few of the factors constantly changing the landscape within the medical profession.
According to experts within the Evangelical, Geisinger and UPMC Susquehanna health systems, 2018 was especially pivotal for the healthcare industry. The Daily Item asked them to share some of the most important national storylines and local developments over the past year and how they will shape the medical playing field in 2019 and beyond.
One major underlying theme for many of these developments involves more cost-conscious care from providers throughout the region, according to Evangelical Community Hospital President Kendra Aucker.
“The focus is shifting drastically as health care professionals focus more on quality instead of just volume like in the old days,” she said. “As cost pressure mounts, payers are going to drive change from volume to value.”
Dr. Greg Burke, chief patient experience officer at Geisinger Medical Center, credits some of the changes involving the Affordable Care Act as main drivers for the new-found focus on affordability.
“The increasing cost of co-pays and deductibles readjusts much of the risk back on patients and physicians to choose wisely for their patients,” he said. “A big challenge for me in primary care is figuring out what works and what doesn’t — and what procedures offer the best value for the patient. It forces us to use a little more discernment of how we spend dollars. As more and more patients are paying out of pocket, it adds to the responsibility of the physicians to make wise decisions.”
According to Steve Johnson, president of UPMC Susquehanna, changing age demographics also plays a pivotal role in the affordability of healthcare.
“We have an aging population. When you look at the rate of people turning 65 and beginning to claim on medicare benefits, you realize we have a significant financial crisis on our hands,” he said.
Dr. Neil Martin, chief quality officer at Geisinger Medical Center, estimated that there are 10,000 people each day turning 65.
“We were focused previously on quality of healthcare, but now we are forced to factor in the value. That is pushing us to redevelop healthcare in many ways,” he said. “For instance, it is requiring us to redesign how surgery is done, driving advances in pain management and anesthesia and even how we are preparing patients for surgery.”
The increasing cost of services to this aging demographic forces providers to make up the difference when weighing what goes through the insurance company and what comes out of pocket, according to Johnson.
“Now, when a physician has a conversation with a patient about follow-up care, within that conversation needs to be a focus of where the patient can receive the best insurance coverage,” he said. “Cost and affordability has become part of the process of designing the treatment plan. This is a brand-new phenomenon. Five years ago, this never would have happened. Now it is common.”
The focus on affordability of care is one of the main driving forces of the flurry of healthcare mergers and acquisitions in 2018 — not just locally, but also nationally, according to Johnson.
“Our facilities have to buy supplies, upstream services and other components, and if we can purchase those items as a larger organization, it makes things much more economical,” he said.
According to Aucker, that mentality was behind Evangelical’s decision to strengthen its connection to Geisinger Medical Center in 2018. It was not a merger, but an opportunity to combat some of the increasing costs, she said.
“It was the biggest question everyone was asking — I’d even get the question while grocery shopping: Will Evangelical have to merge with someone. The answer was no, but by strengthening our relationship with Geisinger, it helps with the mounting costs,” she said. “The question can stop being asked. We manage our own operations and strategy. We are still competitors with Geisinger, but also working together with them.”
According to Johnson, UPMC Susquehanna’s efforts to expand beyond its original reach of Lycoming and Tioga counties into a 12-county region — including the more recent addition of Sunbury Hospital — goes beyond the savings from a supply chain purchasing standpoint.
“It has allowed us to hire more doctors and technicians that bring more knowledge closer to home. The mergers have allowed us to bring in advancements in brain, cardiac and robotic surgery we didn’t have two years ago,” he said. “It has added to our cancer continuum of care and advancements in pain management and wound care. We are part of the full national DNA mapping — looking at the full genome. We’ve even been able to provide living donor transplant clinics. None of that was available in the region before, and is all because of our merger with UPMC.”
While Johnson suggests forecasts call for another robust year with mergers and affiliations in 2019, Aucker expects a slowdown.
“Many of the systems that need rescued were part of the recent mergers and acquisitions,” she said. “I think 2019 will see things slow on that front. Of course, the economy and market have an impact, as well.”
Google. Amazon. Berkshire Hathaway. A merger between CVS and Aetna.
All of these and many more groups have impacted the healthcare world as they creep into the sector.
“What are people going to do when it comes to pricing? Hospital systems can struggle to keep up because they don’t have the purchasing power of a large chain such as those entities,” Aucker said. “It will ultimately have an impact on drug pricing, cost of care, premium issues and other elements. Whether traditional or not, these players will have a big impact on healthcare.”
Martin pointed to Walmart’s Center of Excellence program as an example of nontraditional companies having an impact on the industry.
“Some of the largest corporations are taking matters into their own hands. Places like Walmart are proactively incentivizing areas such as coronary surgery and bariatric weight loss surgery, referring patients to systems such as Geisinger,” he said. “As bigger corporations design innovative healthcare programs for their employees, it directly affects the medical field.”
Another major shift in healthcare is how physicians and patients communicate — thanks partially to advances in technology and driven by the constant underlying factor of efficiency and value of service.
“Alternative communication such as tele-health is moving forward at a rapid rate,” Burke said. “Now, we have patients emailing their physician directly or sending cell phone photos of a rash or other medical issue that can be treated without the traditional office visit.”
According to Dr. David Lopatofsky, of UPMC Susquehanna, tele-health success lies mostly in cases of routine care where symptoms and history can be factored in along with limited examination.
“It is great for urgent low-level visits such as cold or flu, dermatitis, upset stomach or other things that can be concerning to patients but done more remotely,” he said. “It offers another level of convenience and experience, easing the cost and hassles of traveling and waiting in a waiting room and coordinating an appointment during work hours that may not always be feasible.”
Both physicians and patients — once they experience tele-health — report that it works better than you would typically expect, Lopatofsky said.
“Those new to the technology can be skeptical at first — it is human nature to react that way. But once people see what is possible, and how much more convenient and cost-effective it can be, tele-health continues to grow rapidly,” he said. “To me, it is similar to the concept of us going to a physical library to look up something vs. doing a quick search on a laptop in the comfort of our own home.”
One area profoundly improved by tele-health, according to Martin, is the evolution of tele-stroke specialists.
“As soon as someone has a stroke, they need care immediately. As many as two million neurons die every minute that care is lacking and there aren’t enough stroke specialists to man every small hospital,” he said. “Our tele-stroke specialists can cover 15 hospitals throughout Geisinger, review a patient’s brain scan and restore circulation to the brain.”
Office visits reimagined
Geisinger has re-invented the house call for elderly patients suffering from conditions such as COPD and heart failure through the Geisinger Home program.
“These sort of patients struggle to understand the complexity of their care, and often gradually get worse and worse until they have to call 911 and be admitted for treatment that could have been avoided with preventative care,” Martin said. “We have healthcare providers make sure the house is configured for success, stop in to monitor weight and blood pressures and keep patients better managed without needing as many crisis interventions.”
The Geisinger Home program has identified 9,000 patients who benefit the best, and the first wave has started with expansion planned soon, according to Martin.
Meanwhile, Evangelical has creatively developed a way to reach underserved patients in more remote parts of the region with the Mobile Health Unit which started earlier this year.
“In a community health assessment, one of the biggest issues indicated locally was lack of access,” Aucker said. “Mobile health helps bring primary specialty care and important screenings to communities where access is a challenge.”
The $350,000 needed to start the program was completely donated by employers and others within the Valley’s communities.
“It shows that they felt it was a strong need, and understood the impact it could have,” Aucker said. “I look forward to growing this line even larger in the future.”
Technology is advancing medicine at a rapid rate, especially in finding ways to provide less invasive treatment that improves recovery and reduces costs of procedures.
According to Martin, one of the best examples of this is in how strokes are treated.
“Over the past 15 years, we’d use clot-busting medication that didn’t always dissolve the clot and sometimes led to bleeding into the brain,” he said. “Now, we can insert micro-catheters through a puncture in the groin up into the brain arteries and use a special snare to engage and remove the blood clot.”
The outcomes of this change in treatment are astounding, he added.
“We are seeing patients coming in paralyzed on one side that normally would be fatal or lead to a lifetime of disability that are able to speak and move again within minutes of the clot being removed. This is just one of many examples of how innovative technology is saving lives and making an impact.”
Constantly improving medication options are also at the forefront of healthcare advances, according to Burke.
“The continued development of new drugs to combat cancer and other biologic agents is available to patients at a rate I’ve never seen before,” he said. “It is making some cancers more treatable as they develop more personalized drugs thanks to better understanding of genetic diseases and precision treatment. More and more of my patients have access to these.”
Another recent trend that is expected to expand in 2019 and beyond — the use of artificial intelligence in healthcare.
“It is offering more and more benefits to healthcare and new insights into how we develop treatments. I predict we will see more and more artificial intelligence worked into patient care,” said Martin. “We are engaged at Geisinger with three smaller innovative companies involved with artificial intelligence. One is focused on determining who is most at risk for colon cancer and need additional colonoscopies. We are also looking at pulmonary and lung issues and who is most likely to have a stroke in the next year.”
As healthcare providers look to keep costs to a minimum, it highlights the importance of intervening earlier in the medical arc and preventing major conditions.
That is the theory behind programs such as Evangelical’s Mobile Health Unit and the Geisinger Home program, providing care in the patient’s home before a health condition leads to a medical emergency.
Another program focused on proactive health treatment is Geisinger’s Fresh Food Farmacy, which continues to expand and impact the region.
“Instead of waiting until there is a health crisis, this program focuses on giving patients and their whole families fresh, health food including fruits and vegetables and then teaching them how to prepare it and the principles of how to eat better,” said Martin. “We have found that it is much more cost-effective to provide free healthy food to certain patients than it is to later treat a condition medically. This past year, we’ve had 250 families treated using this technique.”
All of the major medical systems in the region are trying to spread the message about the value in preventative health measures.
“We’ve found that 60 to 80 percent of health issues can be prevented if a patient doesn’t smoke, doesn’t do drugs, maintains a healthy weight with a healthy diet and exercise,” Martin said. “The challenge is how do we influence people towards a more healthy lifestyle?”
Additional local advances
Beyond a number of the Valley-based advances and programs already shared — such as Evangelicals Mobile Health Unit, strengthened ties between Evangelical and Geisinger, the Fresh Food Farmacy and UPMC Susquehanna’s mergers and advancements — some other major news has developed locally over the past year or is on the front burner for 2019:
• Evangelical announces its $72 million P.R.I.M.E. project.
“This will allow us to modernize our facility and surgical areas while making sure each patient has a private room in an effort to provide a better patient experience. We are not intending to get bigger,” said Aucker. “Our goal is to render a good service. We are good at what we do, while serving the demographics of our region.”
• Evangelical expands its orthopedics program.
“As you see an increase in the aging population, you see more need for care for hip and knee problems, spinal issues and other conditions we can handle in orthopedics,” said Aucker. “We needed a better space to work out of, and we invested a significant amount of money into that space and continue to offer resources to the community that are wisely managed.”
• UPMC Susquehanna plans to open a medical detox center at Sunbury hospital.
“There are only a few of these across the state and none in central Pennsylvania. We are working with UPMC affiliates in Pittsburgh to open one of these centers in a currently unused inpatient floor at the Sunbury hospital,” said Johnson. “We could be looking at starting the physical work by the fall of 2019 once the Department of Health signs off, with service to patients open by late 2019 or early 2020.
“There is a period of about 3 to 5 days for detox, and then we’d be looking at some inpatient rehab. In 100 percent of cases, each patient would be linked to some sort of full-service drug and alcohol program to begin after discharge for follow up care.”
• UPMC Susquehanna is planning an expansion of the cancer center at its Williamsport location.
“We will be merging that care with the Hillman Cancer Center out of Pittsburgh, which is a world-renowned cancer center,” said Johnson. “Beyond the physical addition, we will look to add cancer services, medical oncology and other amenities that will greatly impact cancer care in the region.”
• UPMC Susquehanna will build a new trauma and physical rehab wing at the Williamsport hospital.
“We will be replacing some aging infrastructure and giving it more capacity while providing some of the best trauma services possible,” said Johnson.