Sunday on Meet the Press, both the President of Mayo Clinic and the CEO of Cleveland Clinic were discussing healthcare in 2014.  Both made these observations:

1. Everyone will be paid less in 2014 for services.
2. Healthcare delivery models must become more efficient.
3. Payment for services will migrate from payment for activity to payment for outcomes.
4. Neither understood fully the provisions of the ACA, nor how it will affect healthcare delivery.
5. Medicare insolvency must be addressed by congress and others.

These observations offer us some insight on how the largest and best healthcare delivery institutions are looking at the future.  There are some interesting “take-aways” for practices based on these observations.

It was obvious that these large, best in class organizations did not have a handle on all the provisions and implications of the ACA, the so called Obama care. It appears to be a fluid law…changing and adapting to realities as new sections of the law are unfolded.  This trend will undoubtedly continue as more and more elements become clear, change is inevitable.

Secondly is the whole spectrum of efficiency.  Gaining efficiency in any practice must become a part of the practice culture to really effect meaningful change and realize benefits.  Using and properly manipulating data must be a part of that effort.  As the use of EHRs becomes more sophisticated and the learning curve more manageable, data analysis can not only increase efficiency but also make a real impact on tracking and ensuring outcomes.

Outcomes do not only depend on aggressive treatment but also on patient compliance.  Insurers and providers have incentives to communicate, educate, follow patients more closely, especially those with chronic diseases.  Practices must make a commitment to positive outcomes using technology to continuously monitor patient activity and compliance.  That commitment must re-define provider and ancillary provider roles in the day to day practice and work flow must change with that re-definition.

Citing that 50% of healthcare cost is derived from Medicare, the leadership of both Mayo and Cleveland Clinics stated the biggest task in the near future but least talked about is the over-haul of the insolvent system of Medicare.  Not only is it a politically hot potato, but a complex system involving almost every aspect of the healthcare industry.  How to re-vamp Medicare and avoid political fallout is almost impossible.  How to re-vamp Medicare in a way that takes care of patients who most need care and pay providers who deliver that care will require the voices of all healthcare leaders.

Remember that famous line Betty Davis delivered in one of her old but wonderful movies…..”Fasten your seat belts, it’s going to be a bumpy night.”