In 2024, healthcare and health IT will feel the continued erosion of traditional care paradigms, be impacted by a retail shift from exuberant expansion to the long game of execution, and will finally, at long last, witness the death of the fax machine.

This is the outlook for next year offered by Laura Kreofsky, digital transformation program director at Cascadia Health, a community health provider in Oregon, and executive advisor at Pivot Point Consulting, a health IT consultancy where she has spent more than a decade helping health systems of all sizes in digital transformation.

We interviewed Kreofsky for a deep dive into her views on what she sees as major changes ahead.

Q. You say in 2024, healthcare will experience the continued erosion of traditional care paradigms. Please elaborate.

A. Looking broadly at healthcare as we head into the new year, it’s clear it is fundamentally turning itself upside down. This is not a radical disruption, but rather a confluence of forces that will continue in 2024 and beyond.

The traditional model of care, which is rooted in primary care physicians guiding care with aligned specialists and community hospitals, will continue to fade in the rear-view mirror in 2024. Patients and their families have grown accustomed to managing their own health and wellness needs in a right-time, right-place manner.

Retail healthcare will continue to supplant primary care. The retail health market is projected to grow from $2.8 billion in 2023 to $6.4 billion by 2030. For consumers, getting care and services at the local CVS or Walmart will shift from novel to normal; this shift will have broader implications.

Hospitals and health systems will continue to own the majority of healthcare spend (65% as of 2020) for the foreseeable future, but their role will continue to shift from purporting to care for all patients at all phases of health and wellness to a "focused factory" model that brings a narrow product mix for a particular market niche – complex acute care and surgeries.

Importantly, this shift is not just about specialty hospitals and surgery centers, but the changing role of hospitals in the healthcare ecosystem as a whole.

The impact of social determinants of health and emergence of health equity as a social imperative is elevating the role of community health centers, community-based organizations, and connecting people effectively to resources. As the aforementioned shifts take place, these agencies are uniquely equipped to provide "whole person care.'

In fact, they may be the only organizations equipped to do so in the near term. What other care provider is committed to serving patients, regardless of ability to pay, across their often complex medical, behavioral health, dental and other needs? And for many physicians, advanced practice providers and other caregivers exhausted by the tolls of corporate medicine and yearning for the "mission" side of healthcare, these delivery organizations may become attractive employers of choice.

Q. In the coming year, you say retail healthcare will shift from exuberant expansion to the long game of execution. How do you see this playing out?

A. For the "Big Four Retailers" in healthcare – Amazon, CVS, Walgreens and Walmart – 2024 will bring a pivotal shift from the land grab of the past few years to strategically executing for long-term success. Of this group, CVS seemingly has the clearest ambitions and strengths in the market.

As the second-largest healthcare company in the world, with a more than $140 billion market cap, it has moved in home health, chronic disease management and care coordination, along with strong investments in data and technology – all critical for managing complex patient care in value-based payment models.

CVS leadership anticipated market challenges in 2024 as it continues to build strength across its holdings. Midyear 2023, CVS recorded a $496 million restructuring charge and eliminated 5,000 non-customer-facing jobs.

Walgreens Health also is expecting market challenges in the years ahead. In October of 2023, it announced a $1 billion cost-reduction initiative and the closing of 60 clinics in unprofitable markets. A month later, it announced an effort to "streamline operations by eliminating 267 roles in its corporate workforce."

Walmart Health will continue to expand the coming year – it plans to double its footprint of health centers nationwide by year-end 2024. However, in actual growth, this is only 28 new health centers. This slow and steady strategy may be critical to long-term success in healthcare for Walmart and its partners.

Meanwhile, Amazon continues its "big on splash, low on strategy" forays into healthcare. The $3.9 billion One Medical acquisition in 2022 expanded Amazon's reach into primary care with 220 clinics in 29 metropolitan areas and provided a trove of member health data from the more than 8,500 companies with which One Health contracts.

However, the integration of the two entities is slow-moving and amorphous. In the meantime, Amazon continues to promote its virtual first strategy by leveraging its Prime Memberships to enroll members into its subscription programs.

Q. And finally, you have quite the prediction for 2024: the death of the fax machine. What's going to happen?

A. The fax machine has been the reigning technology for care coordination for nearly 60 years. It’s also relied upon in insurance benefits enrollment among the largest healthcare payers.

Could it be, in 2024, integrated information exchange surpasses the fax for referrals, communications and care management across the health and community service ecosystem?

Platforms like Unite Us and Find Help continue to gain in adoption across provider organizations and community agencies providing the next miles of care – substance abuse treatment, food banks, shelter and transportation.

These tools serve a vital link in whole person care, making it easier to locate service providers and do close-looped referrals inside native EHR workflows. Importantly they also help reduce provider frustration and burnout.

Public and private payers recognize their utility in care management and care coordination, especially in the context of value-based care – so much so they are funding the acquisition and the use of these tools.

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