As I have mentioned several times, health care is extremely complex. Therefore, it requires much time, effort, and focus on daily operations—particularly in light of the constant changes occurring in the regulatory environment.
However, an additional complexity of health care is that the trends we are seeing today are causing such radical changes in the delivery of care that if we don’t pause now to give sufficient time to envisioning the future, it is a very good possibility that when we reach the future, we will be inadequately prepared.
Consequently, since its inception in 1999, CHRISTUS Health has committed a significant amount of time and effort to monitoring health care trends and planning for the years ahead. After completing our first round of future planning (Futures Task Force I utilizing scenario planning) we recognized that the two major drivers of health care change for both CHRISTUS Health and all of U.S. health care would be:
1) the declining reimbursement under the control of both the federal and state governments, and
2) the rapid introduction of technology that would move a significant amount of health care from an inpatient setting to the non-acute arena. At CHRISTUS, we define non-acute care as “care and services that do not require an inpatient acute care hospital stay” (i.e., outpatient sites, clinics, continuing care retirement communities, long-term care, etc.).
In fact, when we began future planning, we believed—and have subsequently proven—that this introduction of non-invasive technology would be so rapid that it would be disruptive. In fact, it is so disruptive we could not respond rapidly enough to its introduction and were burdened with the question, “Should we purchase the first generation of the technology, or wait to purchase the second generation?” Technology is changing so rapidly that with limited financial resources, this question needs constantly to be asked, and then, as objectively as possible, be answered using data as rationale.
A living example of this dilemma which occurred in the last 10 years, was the introduction of lithotripsy. If you are as old as I am, you can recall that this technology was first introduced by requiring that patients be immersed in a water bath. It was clear to me as a practicing physician that this technology would not be long-lived, particularly because
1) If patients coded in the tub, how could they be revived without significant movement?
2) It would eliminate a large number of obese patients who were unable to be placed in the tank.
3) And it would eliminate a large number of patients who were afraid of water.
However, I was bombarded by requests from Urologists to purchase this technology as quickly as possible. Those of us who owned the first generation of lithotripsy devices soon realized when the second generation of dry lithotripsy was developed in response to all of the concerns outlined above, that we had indeed wasted $1.5 million and had to find another use for the small swimming pool we now owned.
With all of this learning, CHRISTUS Health has utilized these drivers to recognize that acute care will be significantly changing in the future, and that a much greater emphasis needs to be placed on the non-acute product lines. In addition, CHRISTUS is somewhat unique because of our strong international presence, predominately in Mexico.
Because of this, we have begun the transformation of our portfolio to one-third acute, one-third non-acute, and one-third international. I will cover each of these thirds in more detail in future blogs.
However, today, it would be appropriate to discuss two more drivers of this transformation, those being:
1) the senior aging process and
2) the large number of baby boomers who are reaching 65 years of age.
With regard to the former, it has been our observation while studying the seniors on our senior campuses (independent living, assisted living and long-term care), that these people—often with average ages between 85 and 90—are not aging like our parents. They are staying healthy for a prolonged period of time, have a strong desire to stay in the most independent living situation possible, and in their final weeks, are often facing an acute illness such as a heart attack or stroke, which cause them to request hospice care for a shorter period of time.
This is verified by our data that indicates that people stayed approximately three-and-a-half years in our long-term care facilities in 1999. Now, they spend less than 9 months on average there, instead spending most of their time in the independent living or assisted living locations.
It is important to note, also, the findings of an ongoing study in the United States of over 4,000 people who are over 100 years of age. These people have no common characteristics related to avoiding common health risks, i.e., obesity, smoking, alcoholism, etc. This population includes all of these health-risk factors. Instead, surprisingly, the four things they have in common are:
1) They are optimistic people; they always see the glass as half full.
2) They have learned to accept loss and move on. Most of these people have buried their spouses and all of their children.
3) They stay on a relatively routine schedule each day, meaning they get up at pretty much the same time each morning, eat their meals at the same time, and go to bed at the same time.
4) They all have an avocation. It may be as simple as meeting at Starbucks or the local diner for their morning coffee, or as complex as a daily golf round or a bridge session.
For me, this data indicates that if you live beyond 65 to 70 with a chronic illness, you have reached a stable relationship with that illness and will probably not die early because of it, or one of its major complications. For example, we do not find a large number diabetics in their 70s or 80s who develop gangrene or blindness, because they have learned to manage their disease. Consequently, when their final demise occurs, it is rather related to a short-lived acute episode as mentioned above. Therefore, this population of people—rather than requiring extensive inpatient stays and therefore new hospital beds—will want their care in non-acute settings accompanied with outpatient hospice support.
The baby boomers, on the other hand, are a population of people who want their care as rapidly as possible, as affordable as possible and with the highest quality possible. They are also being burdened with increasingly larger co-payments and therefore are much more focused on where, when and from whom they are going to get their care.
By doing a survey of this population, we have learned that they will much prefer to have their care in a patient-centered urgent center, mini-clinic, or other outpatient facility. They will only opt for inpatient beds which when absolutely necessary. And if it is necessary, they will want a room that is far different than our present hospital rooms. They will want them to be large enough to accommodate families at all times—much like we have in Mexico—and they will want full access to all the internet technologies so their communications, either from themselves or from their family members, will never be disrupted.
So our transformation has been driven by a clear understanding of the present complexities, the future vision and the major drivers of health care in the future. Transformation, we believe, is required if this future is going parallel with what patients and their families will desire and demand in the next 10 years.