As CIOs and industry executives grapple with the rate of change of technology, CEOs – especially in healthcare – grapple with an increasing number of unknowns in the environment that could disrupt their businesses. A survey by consulting firm Deloitte in May 2017 makes a telling statement: While CEO-level themes have remained largely the same since 2015, the urgency levels have ratcheted up. The study indicates that while CEO’s are concerned with protecting margins and managing the transition to population health and value-based care in an uncertain policy environment, they are also very concerned with technology and cybersecurity risks. The increasing consumerization of healthcare has become a CEO-level issue in a sector that barely cared about the healthcare consumer till recently.
In an era of rapidly changing and evolving business priorities, the biggest strategic issue is the shrinking shelf life of strategy itself.
Ed Marx, EVP of The Advisory Board Company and acting CIO of the New York City Health & Hospitals, says, “It used to be that organizations had the luxury of months to develop a strategy and then execute over the course of three five years. Every year, we would pick up the strategic planning document and make some tweaks to it, but pretty much stayed the course for the planning period. Today, that time period has shrunk to the point where we are leveraging agile processes in strategy development and execution.”
Marx and others in his position now find themselves working on strategy on a continual basis. The challenge now for CIOs is to architect and implement systems that can easily adapt and pivot without knowing all the changes that may be required with the changing business and technology environment. Here are some themes that are playing out in healthcare today that could impose rapid and even sudden changes in business and technology strategy:
Policy uncertainty: While the temperature has fallen on an immediate repeal and replacement of the Affordable Care Act (ACA), there are still big variables, examples being the fate of Medicaid expansion and the continuation of insurance exchange subsidies. While the former has serious implications for health systems, the latter impacts health plans that have made significant investments in exchange products and technology infrastructure. Along with them, their technology vendors could find themselves owning technology assets that have diminished in strategic value. A case in point would be the significant investments made in technology solutions for the individual exchange markets that are now in limbo. Even if exchange subsidies continue, the long-term future of exchange markets remains open to question.
Entry of non-traditional players: Healthcare is a sector ripe for disruption. The healthcare technology community is closely watching the emergence of new players that could disrupt not just technology firms but also healthcare enterprises. In the recent past, news of Amazon’s secret initiatives to develop a proprietary EHR system and enter the retail pharma space have been doing the rounds, as have rumors of Apple’s expected push into healthcare (Apple has already entered the clinical trials space with its ResearchKIT platform). While Amazon’s plans are still under speculation, the potential for a fully integrated platform that provides all manner of healthcare services directly to consumers can be disruptive to healthcare enterprises and technology providers alike. Google and Microsoft have been making aggressive moves in healthcare through their artificial intelligence (AI) and cloud capabilities. The common thread among all these efforts: aggregating consumer health data by going around the incumbent EHR vendor community.
Healthcare consumerism: Regardless of how healthcare policy plays out, one thing has become certain: The financial burden of healthcare costs is shifting irreversibly towards consumers who in turn now seek price transparency and choice, more control over their personal health data, and better engagement with their healthcare providers. User experience, which may have been a mere “check box” in corporate strategy and technology architecture choices a few years ago, has now become table stakes in a rapidly evolving consumer landscape. New digital health experiences are being developed to help patients navigate their financial choices and their engagement with care providers, and make informed choices about treatment options. Digital health startups, averaging over $ 4.5 billion a year in VC money raised over the past three years, are providing solutions with superior user experiences compared to monolithic electronic health record (EHR) systems to enterprises seeking ways and means to attract and retain patients in a hyper-competitive marketplace.
Emerging technologies: Remember big data and Hadoop? That is so 2015. In the past year, AI and cognitive computing using cloud-based infrastructure have surpassed the erstwhile big data solutions architecture in the context of data and analytics. IoT devices and solutions, especially wearables, are struggling to demonstrate real benefits, while the risks of data breaches from cyberattacks on smart devices continue to outweigh potential benefits in the eyes of health system executives. Speaking of cyberattacks, the amount of money now thrown at cybersecurity has seen a sharp rise in the past couple of years. The result? Budgets for new technology initiatives get crowded out by increased IT security spend. Now that the CIO has to pivot to a new strategy, he or she has to turn to automation to reduce the labor footprint and get in front of the productivity curve. It’s unlikely that any of this was on the three-year strategic plan for any CIO in 2015.
None of this means that the IT function in healthcare enterprises has to be paralyzed and frozen in inaction due to these rapid changes. Marx provides a few tips for CIOs overwhelmed by the rate of change in the technology environment:
- Deploy a flexible architecture that will be able to respond to the chaos of healthcare and help guide the organization in making sound business and clinical decisions.
- Build the ability to assimilate and analyze data in real time, which is foundational to the effort to a transition to value-based care.
- Continuously build out and strengthen the foundation so you can become resilient and responsive to economic market forces.
Despite the high levels of entropy in the technology markets, healthcare leaders still have to make strategic choices that involve significant budgetary outlays. While the shelf life of strategy has shrunk considerably, we must still anticipate the future and to the extent possible, create it.