Looking Forward: The Healthcare Landscape After President Obama's Re-election

Is anyone able to help us connect with Theresa Caputo? Given our track record, some of us at GS&P are considering a spinoff on her TLC reality show Long Island Medium. During our “Strategies to Thrive in the Next Five” presentation at the Symposium on Healthcare Design that took place in Chicago on October 3rd, we made two predictions: President Obama would be re-elected by a wide margin and Congress would not be able  to come to agreement by January 1st. The first came true November 6th, and the second is looking increasingly likely.

Psychic powers aside, let’s take a look at what we know. Healthcare was one of the major points of contention in the election, and it will be a defining achievement for President Obama’s legacy. Given the election outcome, the Affordable Care Act is here to stay. For healthcare administrators this means that it’s time to stop pacing the halls and hesitating making critical decisions. It’s time to roll up your sleeves and start planning at the service line level with multidisciplinary teams and future market scenarios. 

Over the next few years, we are going to define who we are as Americans. The questions are complicated, the answers are simple: shared sacrifice, compromise, and negotiation. After all the professional wrestling tactics are over, taxes will increase and benefits will be reduced. The Affordable Care Act has many changes on the horizon. Starting in 2014, insurance companies must accept all applicants. The federal government will soon offer two health insurance plans nationwide in all states, through exchanges. One must be offered by a non-profit entity.

In addition to these changes in the insurance system, the 2014-2020 healthcare market must be evaluated on a state by state and service area by service area basis:

  • How many newly insured individuals will be added to the rolls?
  • Where and how will we provide access to care?
  • What is our Ambulatory Care Strategy?
  • What service lines are candidates for bundled payment?
  • How many inpatient facilities are viable in this market?
  • What services must be invested in and which can be outsourced?

To be competitive under the new business model of healthcare, hospitals need to identify the high probability scenarios and start planning what they might do as a result. The mega trends and consequences are fairly clear:

  • Consolidation and centralizations are givens in many multiple provider markets. Mergers and acquisitions have already started, and are not likely to stop soon.
  • Systemization: One hub, many spokes. Hospitals boards will reconsider the hub and spoke configuration, and honestly evaluate where they fit in. Eventually, one hub will serve a larger number of spokes.
  • Community hospital transitions. Many community hospitals will become critical access hospitals, and many will become ambulatory care centers with 24 hour Emergency Departments to treat, stabilize, and transfer patients.
  • Hospital closures. Hundreds of hospitals will close, appropriately. After initial angry reactions, most of these communities will receive much better inpatient care for the additional miles traveled.

Whatever your politics, these are the realities we face. It’s time to ignite your planning process at the service line level. Physicians are not only at the table, they are at the head of the table. Honest assessment, resourceful adaptability to change, and a clear eye to multiple futures will frame your ability to thrive in the next five years and beyond.


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  • December 7, 2012 @ 8:10 AM

    Joanna Dickinson

    Great article. I've been wondering about how these factors will affect our clients and projects for the furture.

  • February 17, 2013 @ 8:18 AM

    David voegele

    Several statements in this article are either wrong or wrong-headed. President Obama did not win by a large margin "as predicted" ....he slid through by by a small majority based on deception and class warfare. Healthcare will not be his defining "achievement"......it is going to be a huge failure that will bankrupt the country. Also, that you think forcing millions of people to travel to and then get in long waiting lines to be seen at metro hospitals after closing hundreds of community hospitals is "appropriate"....leads me to wonder what you are about.

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