TriMedika is an active member of the Association of British HealthTech Industries participating in the US incubator which includes a 12-month support program allowing companies to create and strengthen their US strategy, de-risk market entry, and expand their US business by leveraging ABHI’s guidance, skills, and connections in the US. Completing our second year as part of the cohort has offered a host of learnings.
US Market Structure
The US healthcare sector is a mixed-payor system involving a combination of public and private, for-profit and nonprofit insurers and providers. The federal government finances the national Medicare program for individuals 65 and older, as well as some people with disabilities. There are different programs for veterans and low-income people, such as Medicaid and the Children’s Health Insurance Programme. States control and fund local coverage and the safety net. Private insurance, the most common type of coverage, is mostly supplied through employers. Uninsured people account for 8.3 percent of the population, according to a report from the Census Bureau. Under federal and state guidelines, public and commercial insurers design their benefit packages and cost-sharing structures.
Key Findings
- There is an emerging transition within the US healthcare system as a result of the shift to a service-led, outcome-centric model of care, which alters not just the stakeholder structure but also the healthcare as a whole. Currently, a fee-for-service structure dominants the sector however a value-based approach is beginning to surface. McKinsey report detailed value-based care growth has increased from around $500 billion in enterprise value now to potentially amounting to $1 trillion as the landscape matures.
- As private payors become more vertically integrated, procedures will be moved from hospitals to urgent care centers (U.C.C.) and specialty clinics with reduced costs. Similar to walk-in clinics, U.C.C. is more convenient for consumers, the market has grown between 2017 and 2022 by 7.1% per year on average. Consumer Reports shows 6,400 U.C.C in 2014 to 8,100 in 2018, with an additional 500–600 openings anticipated to reinforce the shift.
- Remote patient monitoring will act as a preventive model to manage the cost of care. According to Research and Markets, the global RPM systems market will be worth over $1.7 billion by 2027, a nearly 128% increase from the $745.7 million potential valuation.
- US employment levels for RNs experienced the largest decline in at least 20 years paired with around 60% of nurses’ time spent performing non-nursing duties. In facilities with insufficient hospital staffing levels, a patient’s chance of a post-care-associated infection rose by 15%, according to a 2019 study. Further support is presented in a study in California which linked an increase of one more work hour per patient per RN to an 8.9% decrease in pneumonia infections among surgical patients.
These emerging trends provide an opportunity for new innovations to help combat and overcome US health systems’ challenges redirecting the focus back to the patient and lessening the pressure placed upon healthcare professionals which has evolved into a drought of healthcare staff especially within nursing staff.
“There are simple steps that we can take to dramatically reduce risks”(Jason Salemi, Schreiber, 2022).
Useful links
- American Hospital Directory provides detailed information on specific hospitals e.g. bed numbers, and revenue figures. https://www.ahd.com/
- SAM gov– active/inactive bid opportunities. https://sam.gov/content/home
Key terms
IDN-An integrated delivery network (IDN) is a company that controls and operates a network of healthcare facilities including hospitals, care centers, physician groups, clinics, surgery centers, and other healthcare institutions.
GPO-A group purchasing organization (GPO) is an organization that assists healthcare providers, such as hospitals, nursing homes, and home health agencies, in realizing savings and efficiencies by pooling purchasing volume and using their influence to negotiate discounts with manufacturers, distributors, and other vendors.
Medicare-Medicare is a federal health insurance program for adults 65 and older, as well as particular individuals under 65 who have specific disabilities or illnesses.
Medicaid-Medicaid represents a joint federal and state initiative that offers medical coverage to those with limited financial means.
Safety-net hospitals-They can be rural or urban, public or nonprofit (such as a county hospital), or both. The majority of hospitals have a specific mission or obligation to serve a low-income population, regardless of insurance coverage, capacity to pay, or immigration status of patients.
Value-based model-Health care systems are incentivized or rewarded for satisfying a variety of interconnected goals under value-based agreements. These objectives often seek to enhance quality, cost, and equitable measures.
Fee for service model-Health care professionals, such as physicians and hospitals, are paid for each service they deliver under fee-for-service. In essence, they receive compensation for volume — they are reimbursed more if they provide more services, even if their desired results are not achieved.
Reference list
About-Atme, Z., Khanna, G. and Levine, E. (2022). Investing in the new era of value-based care | McKinsey. [online] www.mckinsey.com. Available at: https://www.mckinsey.com/industries/healthcare/our-insights/investing-in-the-new-era-of-value-based-care.
Carayon, P. and Gurses, A.P. (2018). Nursing workload and patient safety—a human factors engineering perspective. [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK2657/.
Chew, J. (2022). What is an Integrated Delivery Network? [online] Healthcare Analytics & Data Companies. Available at: https://www.trellahealth.com/resource-center/blog/what-is-an-integrated-delivery-network/#:~:text=An%20integrated%20delivery%20network%20(IDN [Accessed 28 Jul. 2023].
Findlay, S. (2018). When You Should Go to an Urgent Care or Walk-in Health Clinic. [online] Consumer Reports. Available at: https://www.consumerreports.org/health-clinics/urgent-care-or-walk-in-health-clinic/.
Healthcare Supply Chain Association (2023). What Is a GPO ? [online] HSCA. Available at: https://supplychainassociation.org/about-us/what-is-gpo/#:~:text=A%20group%20purchasing%20organization%20(GPO.
HHS.gov (2022). What is the difference between Medicare and Medicaid? [online] HHS.gov. Available at: https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html.
IBIS (2022). IBISWorld – Industry Market Research, Reports, and Statistics. [online] www.ibisworld.com. Available at: https://www.ibisworld.com/industry-statistics/market-size/urgent-care-centers-united-states/#:~:text=The%20market%20size%20of%20the%20Urgent%20Care%20Centers%20industry%20is.
ISPOR (2022). ISPOR – US Healthcare System Overview-Backgound. [online] www.ispor.org. Available at: https://www.ispor.org/heor-resources/more-heor-resources/us-healthcare-system-overview/us-healthcare-system-overview-background-page-1.
Michel, O., Garcia Manjon, A.-J., Pasquier, J. and Ortoleva Bucher, C. (2021). How do nurses spend their time? A time and motion analysis of nursing activities in an internal medicine unit. Journal of Advanced Nursing, [online] 77(11). doi:https://doi.org/10.1111/jan.14935.
Mitchell, G. (2019). Patient infections 15% ‘more likely’ when nurse staffing low, study finds. [online] Nursing Times. Available at: https://www.nursingtimes.net/news/research-and-innovation/patient-infections-15-more-likely-when-nurse-staffing-low-04-06-2019/.
Peter G. Peterson Foundation (2022). Nearly 30 Million Americans Have No Health Insurance. [online] www.pgpf.org. Available at: https://www.pgpf.org/blog/2022/11/nearly-30-million-americans-have-no-health-insurance#:~:text=In%202021%2C%20as%20the%20coronavirus.
The Commonwealth Fund (2023). Value-Based Care: What It Is, and Why It’s Needed. [online] www.commonwealthfund.org. Available at: https://www.commonwealthfund.org/publications/explainer/2023/feb/value-based-care-what-it-is-why-its-needed#:~:text=In%20value%2Dbased%20arrangements%2C%20health.
Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A. and Wharton, G.A. (2020). International Health Care System Profiles: United States. [online] www.commonwealthfund.org. Available at: https://www.commonwealthfund.org/international-health-policy-center/countries/united-states.
USAHS (2021). The 2021 American Nursing Shortage: A Data Study. [online] University of St. Augustine for Health Sciences. Available at: https://www.usa.edu/blog/nursing-shortage/#:~:text=The%20Bureau%20of%20Health%20Workforce.
