The health care industry has undergone tumultuous change over the past two decades. Industry and political leaders have grappled with several issues that impact access to care, quality of care, and the cost of care. The COVID-19 pandemic highlighted these challenges, as hospitals struggled to treat the overwhelming influx of patients, and public health officials worked to prevent the spread of disease.
As the pandemic illustrated, health care challenges are thorny and complex. Students and professionals who are drawn to health care administration because they’re interested in resolving such challenges may want to consider graduate study. A Master of Health Administration program, for example, can offer deeper insights into some of the current issues in health care and the solutions that administrators are developing to solve these problems.
1. The High Cost of Health Care
The problem: Perhaps the most pressing issue in health care currently is the high cost of care. More than 45% of American adults say it’s difficult to afford health care, according to a survey by the Kaiser Family Foundation, and more than 40% have medical debt. The cost of health care changes people’s behavior, with many forgoing seeing a doctor when they feel sick or avoiding preventive health visits entirely. A quarter of Americans can’t afford necessary prescriptions and may skip doses or otherwise not take medication as prescribed. Each of these behaviors can lead to serious health issues, increasing the cost of care down the road.
The solution: Cutting the cost of care involves the input and actions of the health care industry, insurers, and state and federal government agencies. Current initiatives focus on a commitment to reducing insurance premiums and instituting comprehensive price caps for service.
At the administrative level, however, there are steps that health care administrators can take. According to research from industry consulting firm McKinsey, 25% of health care spending stems from administrative activities, such as billing, scheduling, and insurance filing. Many of these expenses can be reduced by automating repetitive tasks, establishing payer-provider communications platforms, and implementing industrywide changes such as improving Medicare quality-of-care reporting.
2. The Concerns of Health Equity
The problem: The health care industry has long noted the vast disparities in health care outcomes between different populations. These disparities are not solely tied to income and the cost of care. Rather, environmental factors also have an outsized impact on health and wellness.
These factors, known as social determinants of health, include an individual’s ZIP code; race and ethnicity; air and water quality; and access to jobs, housing, education, transportation, and nutritious food.
Additionally, long-standing racial and social inequities have led to generations of poor health in some communities. All of these factors impact a person’s overall health and access to medical care. When underserved individuals have a health crisis, it’s typically more costly to treat, often leading to hospitalization or an emergency room visit.
The solution: As with the high cost of health care, health equity solutions involve the cooperation of local, state, and federal agencies with health care providers. Housing, transportation, and collaboration with health care nonprofits and churches can all be leveraged to address environmental factors and improve health care access for underserved communities.
Health care administrators can establish a number of different programs to meet patient needs. For example, telehealth can help patients who don’t have access to transportation, as in many rural areas — although internet infrastructure is still a challenge. Other programs include in-home elder care; care teams, which streamline patient care; and community partnerships.
3. The Promise (and Pitfalls) of Technology
The problem: This current health care issue presents great opportunities, but if not managed correctly, it can lead to many problems. Health care has become increasingly data-dependent. The challenge lies in managing this vast ocean of data. Even before the pandemic, providers and health care systems were generating roughly 80MB of data per patient each year, according to a report in Frontiers in ICT. This data includes not only information compiled in electronic health records (EHRs) but also administrative data, such as addresses, demographic data, insurance policy and claims data, payment records, and appointment scheduling.
The solution: The use of artificial intelligence (AI) has a growing impact on health care delivery and administration. AI and machine learning can make simple, repetitive tasks such as patient intake and schedule more efficient. This allows staff to concentrate on more complex issues, saving time and money. AI can also help predict staffing needs, making it easier for administrators to staff appropriately. Additionally, doctors can use AI to complete administrative tasks, allowing them to focus on patient care. Finally, some administrators and health insurers have begun using big data analytics and AI to predict health risks and to track and analyze outbreaks of diseases such as COVID-19.
4. The Move Toward Value-Based Care
The problem: Health care providers in the U.S. have traditionally used a fee-for-service (FFS) model. FFS means that medical staff bill for each service provided, using established billing codes. The more care a physician provides, the more they’re paid, which some critics have said leads to unnecessary tests and treatments.
The move to a value-based care (VBC) system is underway. In value-based care, Medicare and insurers reimburse providers based on outcomes. For example, hospitals are incentivized to decrease their readmission rates, which means they focus more on eliminating medical and surgical errors. Health industry leaders expect VBC to improve the overall wellness of a population and decrease hospital admissions and illnesses. However, proper billing for treatment is no longer as straightforward.
The solution: Health care administrators are moving toward value-based administration (VBA) and transitioning to payment and billing tools that can handle this new approach to care. This technology must make use of patient data and health care data analytics to track treatments, health programs, and outcomes — and bill accordingly. Health administration dashboards must be able to track health outcomes on a population basis, as well as an individual basis. These dashboards take into account social determinants of health and other factors and must be able to quantify health care outcome data. Stakeholders in VBA include hospitals and other providers, Medicare and private insurance companies, and public health programs.
5. The Growing Provider Shortage
The problem: The pandemic highlighted one of the most serious issues in health care: the provider shortage. Several issues are contributing to this shortage: an aging population, which requires more medical care; localized health care provider shortages, where a region lacks sufficient numbers of doctors and nurses to serve the community; and burnout, which occurs when medical staff are overwhelmed and overstressed or work too many shifts, leading some to leave the profession.
The Association of American Medical Colleges estimates the country will have a shortfall of nearly 140,000 physicians by 2033 due to the increase in demand.
The U.S. Bureau of Labor Statistics projects the demand for registered nurses will grow by 9% between 2020 and 2030. That projected growth jumps to 45% for advanced practice nurses, such as nurse practitioners and nurse anesthetists.
Roughly 96 million Americans live in a designated Health Professional Shortage Area (HPSA), according to the Health Resources and Services Administration. These areas are often rural, although not always. They may lack primary care physicians or nurse practitioners, dentists, or mental health providers.
The solution: Providers are using creative solutions to address the shortage. This may entail overhauling recruitment efforts and focus on long-term workforce planning. It may require health administrators to examine salary, paid time off, and benefits to create an attractive compensation package. Taking steps to make sure departments are adequately staffed can help prevent overwork, medical errors, and burnout. Other changes could focus on training and advancement opportunities as a way to increase employee satisfaction.
Address Health Care Challenges with a Master of Health Administration Degree
With all the current issues in health care consuming administrators’ attention, this is both a challenging and exciting time to work in the health care industry. Although these issues are complex, health administration leaders are developing innovative solutions to positively impact the health and well-being of millions of Americans.
With coursework and projects in quality management, health policy, and health information systems, the online Master of Health Administration program at Regis College provides a foundation for this rewarding field. Explore the program today and see how you can make a difference in health care.