The previous model for provider success was simple – if your reputation was strong enough, financial stability and achievement was likely. Volume, due to reputation, led to solid margins. Solid margins allowed for reinvestment into brand and reputation … which improved volume … and the cycle continued.
Not anymore. Reputation and access no longer guarantee a strong book of business with the exception of the fortunate geographic monopolies. Providers that have been surviving based on their location or an undeserved reputation will lose business as payers restrict consumer choice to higher value players. These results – measured outcomes in quality, cost, and service will “win” business and grow revenue. Fundamentally new cost structure driven by higher quality will be required to compete and achieve margin; significant ongoing reinvestment necessary to maintain competitive position.
In the future we know we will have fewer patients paying us less for the same services. Ongoing quality and cost performance enable larger and faster swings in market share. The spiral is exaggerated on the way up and really pronounced on the way down. Providers will need to work hard to stay ahead of the competition’s ability to deliver demonstrably better quality and cost. Managers and boards will need to pay closer attention to a provider’s competitive positioning; to win business, providers must deliver true value: Demonstrably higher quality at significantly lower cost.
Providers will need to move beyond improving execution in areas like productivity, supply chain, and revenue cycle. They will need to eliminate needless variation, address structural costs, and focus their portfolios in order to deliver the high quality that will be required at market-leading prices. New “unthinkable” cost structures will be required to compete.
Costs will be reduced through significantly higher quality enabled by physician integration and technology-enabled clinical transformation. Providers will need to invest in employing (and effectively managing) or tightly integrating with physicians and driving broad and deep adoption of best practices in order to thrive.
A new, smaller reality will require that we address changes in strategic and structural ways – not merely through improved execution.
The question remains: What will your new reality look like?
Galloway’s expertise spans these complex issues, bringing actionable solutions to your organization.
Our methodology expands to include the core competencies that drive the results – revenue – margin linkage in all high performing organizations.