What can we expect in healthcare with Clinton, Trump?

Now that our presidential nominees are set and the general election has begun, what do our nation’s hospitals and health systems need to do, whether Secretary Clinton or Mr. Trump is elected in November? They, and their parties, offer stark contrasts, but what will they mean for hospitals?

Keep, Improve and Expand

{mosads}Clinton would expand Obamacare by allowing a buy-in to Medicare starting at age 55, offering a public health insurance option and continuing the drive for Medicaid expansion. The Democrats would make care more affordable by expanding a system of subsidies for the commercially insured and mandating that insurers lower premiums and deductibles.

The Effect: Consolidations and closures will continue, and nontraditional partnerships will increase.

• The movement of reimbursement away from traditional hospitals and the leveling out of reimbursement across all payers will continue, and healthcare will disaggregate into ambulatory settings, the home, and even on and within the person — in the form of wearables and ingestible sensors — to provide lower-cost healthcare close to the patient. Hub hospitals that command large healthcare systems will survive, and some will expand.
• Digital health, in all its emerging manifestations, will thrive as new, nontraditional providers enter the market to leverage the incentives Clinton’s policies will create, putting additional pressure on traditional healthcare providers.
• Population health, the movement to increase the health and wellbeing of specific communities and reduce disparities in healthcare, will continue to evolve in partnerships with private, public and non-governmental organizations.

Repeal and Replace

Mr. Trump has adopted the Republican platform, which eliminates Obamacare and replaces it with consumer-based insurance plans. These are enabled by a series of tax, insurance and government payer reforms that incentivize the free market to reduce healthcare costs and put the customer-patient in charge of their healthcare. It converts the federal Medicaid subsidy to a block grant with fixed payment amounts.

The Effect: National and super-regional consolidation of healthcare providers and payers will accelerate.

• National and super-regional healthcare provider systems, in an effort to avoid having to accept any price for a service, will create hub-and-spoke models with distinct characteristics, some seeking the broad middle market, others the upper echelon.
• Commercial insurance plans, seeking to maintain their leverage with national and super-regional providers while meeting the demands of the customer-patient, will develop an array of products targeted to very specific customer-patient groups.
• As customer-patients become actual buyers of healthcare, cheaper forms of care, enabled by digital health, will develop further. They will be fostered by payers trying to undercut the efforts of providers who offer these alternatives, in an effort to maintain leverage over those providers.

What Can Hospitals Do Now?

Regardless of who gets elected, hospitals can do certain things immediately to improve the health of their communities and boost their bottom lines:

• Accelerate the development of lower-cost ambulatory and digital healthcare offerings. We are moving inexorably toward a future where healthcare is highly distributed in the community, the home and the person.
• Hold your physicians close. Under either party, physician reimbursement will change, and care will move out of the hospital, leaving less reliance on traditional settings and organizations. Be aware that physicians have more leverage and access to capital than ever before and could easily form their own care organizations.
• Form more partnerships with community organizations and others who have deep interests in improving community health. Whether we end up with macro-population or micro-population health, community organizations will be part of the solution.                 
• Seek greater operational efficiency and reduce your costs while increasing reliability and quality. Efficiency and quality go together, and we must raise the bar on both. Technologies and systems now exist in healthcare that can do this, and they should be applied to hospital and ambulatory care alike.
• Monetize and/or repurpose obsolete buildings. Space that is not producing revenue is a negative on your books, and you should address this sooner rather than later. Consider telemedicine centers, affordable housing and community living centers, or healthy food outlets.
• Rethink your customer-patient experience. Patients expect to be connected throughout their care journey and for all transactions to occur seamlessly. They do not expect to have to fill out three forms and sit in a waiting room, no matter how nice it is, to get care or to march down long corridors, even with the best wayfinding.

Elections matter, and while we may not see all the changes proposed by either candidate fully implemented, healthcare providers need to prepare now. These six action steps will go a long way to getting ready.

Bellefeuille is a leader in NBBJ’s healthcare practice, an architecture firm that designs hospitals and clinics for 11 of the 15 U.S. News & World Report Honor Roll Hospitals, including Massachusetts General Hospital, NYU Langone Medical Center, and Brigham and Women’s.