The future of healthcare holds immense promise and potential for transformative changes. In this thought-provoking conversation, we bring together HNI’s executive team for their perspectives.

Dr. Reuben Tovar (CMO), Blain Claypool (COO), Mike Gonzales (CEO), and Merced Gonzales (CTO) share their insights and visions for the healthcare landscape in the next decade.

When you think about the future of healthcare, what inspires you, what worries you, what do you think it will look like?

Dr. Reuben Tovar (CMO) – I think the high patient volumes that we see now in hospitals will not exist. Much more of the care that we deliver will be provided on an outpatient setting. We will also see a difference in how a patient accesses the hospital. 

Years ago, I had an idea for a restructure of the emergency department to mitigate the high cost of ED care. The concept called for a triage outside of every emergency room leading to one of three directions: those without urgent or emergent needs would be redirected to family medicine, those with urgent needs - but not emergent - would go directly to a hospital room to be seen by the appropriate physician, and lastly there’s a much smaller group of people that have emergency needs, those would be admitted to the emergency department. The EDs will need fewer clinicians with all patients receiving care from a physician. 

There will no longer be a need for a severity adjusted patient to be seen by an APP because all patients will have emergent medical problems. The “fast-track” in the ED will no longer be needed. 

Blain Claypool (COO) – Absolutely, I would say acuity in ERs would increase, but with a 50% reduction in volume. Part of what’s driving that is ACO provider groups and ACO reach. Providers and insurers that will keep patients out of the emergency room. ERs become trauma centers and everything else is dispersed to community or admit. 

Dr. Reuben Tovar (CMO) – As care becomes increasingly managed with more patients migrating to ACOs, MA plans, and bundled programs we will see length-of-stay pressure diminish. The approach will be to meet the needs of the patient in a manner that improves the patient’s chances for a home-to-home experience. There will be fewer patients seen in skilled nursing facilities as a consequence. Physicians will document primarily to communicate with each other and to capture medical necessity while the importance of the CPT - in particular with bundled programs - will be minimized. 

An opportunity for hospitals to remain most relevant and participate meaningfully in reimbursement would be to own bundles. If they do not, bundles will be owned by payors and providers groups. In that case, hospitals will be commoditized, basically rent the hospital bed for the night or nights. 

Blain Claypool (COO) – Yes, with more emphasis on outpatient you can reduce the number of beds and reduce the need for beds. I think we’ll also see growth in patients over 65 moving to outpatient, moving further away from the hospital, and I think the hospital will just become a place to house patients.

Dr. Reuben Tovar (CMO) – The influence of payors will continue to increase in healthcare, you can see a trend of hospitals becoming commoditized, and there’s a significant payor-driven vertical integration of service lines. 

It is foreseeable that hospitals will “rent” floors to specific payors to manage the care for their members through a particular set of providers. The goal in these units will be to be able to discharge patient to the home setting. I also think that for those patients who do need a SNF, an acute rehabilitation hospital, or a long-term acute care hospital – the barriers to transfer early in the hospitalization will be removed. Ultimately, it will be a refinement of the right care at the right time in the right location. 

Merced Gonzales (CTO) – Yeah, I think that leads to the whole idea of an integrated delivery network, but the question is: is that goal achievable? I think only if we’re able to share information better. (Health Information Exchanges) have become more and more relevant lately; They’re going to become a bigger part of interoperability and patient information.

Dr. Reuben Tovar (CMO) - I don’t believe we are ready for an acute hospital episode to occur at home in a hospital-at-home program. There is still enough quality to be improved and cost to be eliminated in the hospital setting for us to consider providing hospital care at home. 

Merced Gonzales (CTO) - If services won’t be happening in hospitals, acute care and chronic care management will need to leverage technology. Telemedicine and (Remote Patient Monitoring) will have to grow to make healthcare more accessible for rural populations with limited local services, those who have mobility issues, and also to deal with provider shortages and provider costs.
It seems like Medicare Advantage or that sort of managed care will start providing tech to their members more. I think patients are ready to find true partners that share data that actually improves patient lives. 

Everyone is interested in the future technology of prediction and prevention, and AI will continue to play an increasingly important role – for improving diagnostic accuracy and speed to predicting outcomes, trends and maybe to deploy new treatments. Though, there are lots of ethical and privacy issues that need to be addressed.

I think Precision Medicine will improve especially as we gain more understanding of DNA or the human genome and how it interacts with lifestyle, and environments.

I also think it’s important that there’s more transparency in healthcare with the aid of technology. 

It’s important that there is technology that will let people know about their health and their cost of care - built on AI and predictive analytics. 

Dr. Reuben Tovar (CMO) – Predictive analytics is super interesting because you it could help patients make more informed choices about their healthcare, while enabling providers to identify social determinants. 

Merced Gonzales (CTO) – Absolutely, there are already some big players that seem like they’re on the right track there. And as we move toward equal access to healthcare services, we need to address (Social Determinants of Health). Technology should be able to help there too – but it will also require policy changes. 

Dr. Reuben Tovar (CMO) – You know, if we’re truly going to help the population, the other thing that needs to change is access to behavioral health, and it has to be a societal change. The number of psychiatrists needs to increase, there needs to be better insurance availability to psych care, and better access to counselors and psychiatrists. 

Merced Gonzales (CTO) – I think the integration of mental and physical health is important – because mental health is so closely tied to physical health. It may help us focus more on preventative care and wellness.

Blain Claypool (COO) – I’m not sure about the adoption of telehealth, but it may be able to help behavioral health - the sheer need and the shortage of behavioral health may help telehealth become pervasive.

Mike Gonzales (CEO) – I want to say something that might be disruptive, 

I think AI will drive decision support for a lot of behavioral health, I think you’ll see robust algorithms calling people and communicating back to them a probability analysis of the best way to help them – and it will only exasperate the problem.

I don’t think technology that allows people to disconnect more from important relationships is a solution to behavioral health or wellness in general. We are still a carbon-based social species. Post Covid, what we are learning is that relationships with friends, families, and even medical professionals are critical to wellbeing. 

If we are going to prepare for the future, we need to examine the source of health issues - accountability. Why are human beings sicker than ever? Most “diseases” today are behavior-induced conditions. We’ve seen how much behavior affects the acuity of illnesses, and it’s getting harder for providers to affect the lifestyle choices many of their patients need to undertake. 

Why are human beings sicker than ever? I think it’s partly because they are not as engaged in healthy lifestyles or relationships. They don’t get that crucial or perhaps critical feedback from family or friends. 

Dr. Reuben Tovar (CMO) – Absolutely, and when you look into the root of health issues another problem is the food supply. Anything with a label has a combination of fat and carbohydrates that doesn’t exist in nature. There are populations who used to have low incidences of coronary disease, because they used to cook with ghee, and now they cook with canola and other seed oils, and you see the difference in the overall health of those people decline. 

Our food supply will be the cause of our next major epidemic which will be cirrhosis from non-alcoholic fatty liver disease. Food supply combined with a less active population is going to create issues. The weight we’re all carrying around could become an expensive disease. 

Blain Claypool (COO) – So it’s these behavioral causes that are pushing forward these poor outcomes, especially when compared to the rest of the world. So how do you change that?

Mike Gonzales (CEO) – It’s a problem that begs for a new kind of solution, and it might be that payors reward preventative, good decisions. It could be a move to lifestyle insurance premiums, one where thresholds are going to be based on health habits and lifestyle choices. 

Regardless of where the payors go, I think hospitals will look different. There are ways to build healthy communities – and hospitals will and should always be a part of what solutions are created. But they need to be integrated in their communities, not just a part of their communities. Building Clinically Integrated Networks is a start, and for HNI, we need to be focused on building Clinically Integrated Centers of Excellence. 

Dr. Reuben Tovar (CMO) – Hospitals understand in large measure the social realities that impact patient health. They understand the barriers that exist in accessing healthcare, but not just accessing healthcare, accessing wellness given their social realities. During the acute episode of care, these social determinates rise to the surface and become evident. Family support, food scarcity, transportation, the list goes on. So many of these are what drive recidivism rates. Food deserts are real in this country. We see evidence of them every day in the work we do in the hospital - and it’s not just access to food – it’s access to quality food. 

Blain Claypool (COO) –That’s an important point: to get to any of the government programs that provide food and food stability, should those programs focus on fresh food? Can packaged goods really be considered food? Statistically, a population that’s on those programs has every other negative social determinant of health, and that means a chronic disease time bomb ready to go off, including the possibility of a cirrhosis epidemic coming our way. 

Merced Gonzales (CTO) – And Covid really exposed that health inequity in our country, and why some people cannot get healthy - it’s often those that can’t access a quality diet.

Dr. Reuben Tovar (CMO) – I hope I’m not chasing rainbows, but if we could eliminate that 25% of treatment waste that takes place in today’s system, I wonder if we could use those dollars toward wellness as opposed to further treatment.

Mike Gonzales (CEO) – 100% Reuben.

Blain Claypool (COO) – It seems apparent that hospitals that move toward efficiency will deliver better outcomes and prove more economically sustainable. 

As they become a more integrated part of their communities, they will be an opportunity to take on a more important role in overall community care. 

And if they prove to be good stewards of dollars spent, they will be able to play a bigger role and control more dollars that flow through the system. It’s the only way to control their own destiny while delivering on the mission that many have.

Mike Gonzales (CEO) – I think there will be an increasing shift in the mindset from ‘I want to get healthy’ to ‘I want to be healthy’. There will no doubt be advancements in medical technology and planning, but the other side of that is: how do we get people to take charge of their own health? 

It starts with our relationships – our relationship with ourselves and then extends to our relationships with others - family, friends, community. Self-love requires accountability - and when and where you fall short - it’s having a network of relationships that gets you back on track. No amount of tech or medicine will make up for these critical pieces of being human. 

As we conclude this captivating discussion, it becomes evident that the future of healthcare will be shaped by a multitude of factors: shifting care models, the integration of technology, the involvement of payors, and the importance of fostering supportive relationships. Embracing outpatient care, leveraging predictive analytics, enhancing access to behavioral health, and empowering patients with information and decision-making tools are just a few aspects that hold promise for a more patient-centric and efficient healthcare system. With these visionary perspectives, we embark on a path where innovation and compassion intersect, paving the way for a brighter future in healthcare.

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