Market forces, dramatic changes in regulatory rules and concerns over sustainability – combined with advances in technology and the ability to better predict and manage health care risk – are creating a unique opportunity for broad transformation of the health care industry. Innovative business models and new methods of collaboration and care coordination aimed at increasing value for consumers and patients are the product of this confluence of events.
“Convergence” is a powerful concept for understanding these changes, both in the United States and globally. Health system participants are increasingly re-evaluating their roles and strategically considering how the different pieces of the health care system interact and fit together. Evidence of change abounds – with providers taking on greater performance and even insurance risk, traditional retailers becoming care clinics, health plans moving more directly into care delivery, and employers and government changing rules and payment policies.
This accelerated level of convergence creates challenges for health system participants. However, it also creates new opportunities for organizations to reshape their business models and services; consider innovative ways of providing better, patient-centered care; and empower consumers to take greater responsibility for their health.
As part of our efforts to consider convergence, the AHIP Foundation’s Institute for Health Systems Solutions and the IBM Institute for Business Value researched the topic and conducted interviews with representatives from health plans, providers and life science organizations to validate our research. The result is a report that highlights how convergence as a concept captures and categorizes events occurring today. We provide insights into what is driving convergence and the implications for consumers and health system participants, as well as offer key questions and responses for public and private organizations seeking direction in a convergent world. Unfortunately, there are no complete roadmaps or templates from other industries that can be used to guide the health care industry through the changes it’s experiencing. However, we believe that organizations that harness the new and required constants while continuing to operate their core businesses effectively will be better positioned for success through the service of patients and consumers – regardless of the uncertainty of the final model.
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