Strategic planning is one of the board's most important responsibilities. The annual undertaking is a formidable process of assessing the industry at large, forecasting future trends, and mapping the organization's course in response to present and forthcoming trends. Once completed, the strategic plan shapes meeting agendas and becomes a guiding force in all major decisions.

To provide a platform for launching the annual planning process, the Society for Healthcare Strategy & Market Development, a personal membership group of the American Hospital Association, and the American College of Healthcare Executives develop Futurescan, an environmental assessment of health care trends and their implications for hospital leaders. The annual publication combines expert insight with original research, and this year's report explores seven important trends — coordinating care for population health; measuring the success of population health; physician alignment; provider affiliations; reimbursement and cost management; information technology interoperability; equity of care; and efficiency.

Below are excerpts from Futurescan 2014, plus data highlights from a survey of health care leaders across the country on their views on the future.

1. Coordinating Care for Population Health

Forward-looking hospitals are engaging in challenging but necessary changes that promote population health. Whether improving the overall health of their population through better care coordination or working with community partners to improve the health of the broader community, hospitals are committing resources to promote population health. Participating in a health information exchange and sharing health data with other providers will allow hospitals to effectively address population health trends.
Hospital and health care system leaders recognize that advancing population health will enable them to thrive in a value-based landscape. With strong collaborations, formal structures that enable care coordination and the ability to leverage health data, hospitals can create population health initiatives that will lead to success in the evolving care environment.

Survey highlights:

  • Nearly 93 percent of CEOs predict that formal mechanisms will be in place in their organizations to ensure seamless coordination of care by 2019.
  • Almost all of the survey respondents predict their organization will participate in a health information exchange that allows the sharing of health information among providers.

2. Measuring the Success of Population Health

We must have a parallel strategy for keeping healthy people healthy and for managing the small percentage of patients who drive the vast majority of total costs in each of our local systems.
Some vexing questions remain that we will have to answer in the next five years. For example, who owns the patient? Is it the attending physician, the accountable care organization, the multispecialty group practice? Who is the real driver in improving the health of the population? Will this improvement all occur at the local, regional or national level? How will we measure our success? Will the Triple Aim be relevant in five years, or will the Leading Health Indicators become the front runner?

Survey highlights:

  • Almost all CEOs surveyed predict that their hospital or health system will have effective measures of population health in place to support the community health mandate by 2019.
  • Just over half of CEOs in the survey report it is likely that their hospital or health system will require that its governing board include at least one population health expert.

3. Physician Alignment

Although physician employment can simplify or eliminate many regulatory challenges, it is not a silver bullet for physician alignment. Because physician employment transactions can carry hefty capital investment costs and new practice expenses, large-scale employment is an impractical solution for many hospitals. Employment needs to be a carefully titrated ingredient in an overall physician alignment strategy. … Moving the dial on value will require expanded reliance on aligned primary care physicians, and you will need to face the financial headwinds that currently hamper progress. The creation of worthy financial incentives to fund and reward the transformation required to better manage populations at the primary care interface will be essential. Getting there will be hard, so start this work now.

Survey highlights:

  • A majority of respondents believe that by 2019 their hospital will have established physician-hospital organizations.
  • Almost all CEOs predict their hospital will increase resources for physician leadership training by 2019.

3. Provider Affiliations

The imperative for hospital leaders will be in honestly assessing and understanding how their organization can best serve its mission and the population entrusted to its care. Does the organization have the resources (financial, human, reputational and intellectual) to be a controlling consolidator in this market, or is the organization better suited to play a more defined, participating role in the broader continuum? Does the organization truly understand how all of the fragmented components must come together and operate as a whole to achieve optimal performance against the metric of population health? Is the organization better suited to lead or to participate in a more defined role?

Survey highlights:

  • Two-thirds of CEOs surveyed think it unlikely that their hospital or health system will be acquired by another provider, payer or investor between now and 2019.
  • Most (94 percent) of the survey respondents predict that by 2019 their hospital or health system will enter into affiliations or partnerships with other providers or payer organizations, either to expand their services or to realize efficiencies.

4. Reimbursement and Cost Management

With such phenomenal changes in the health care market, hospital and health care leaders have no choice but to seek new opportunities for growth while also driving greater affordability for consumers and patients. We will have to reinvent ourselves and develop new markets and niche industries to meet our patients' expectations for quality care that is also affordable. It will not be the biggest among us who will survive; it will be the most creative and resourceful. Bringing value to patients — focusing on our mission and not our margins — will drive innovation that leads to sustainable business in health care. As hospital leaders, we can be the solution that America deserves.

Survey highlights:

  • Most survey respondents predict that by 2019 their hospital will support a provider capitation model.
  • Almost all practitioners believe that their organization's strategic plan will, by 2019, include goals for decreasing unnecessary admissions.

5. Information Technology Interoperability

Some leading organizations, small and large, have begun to derive benefits from coordinated care supported by robust IT infrastructure, such as single-source clinical solutions. “He who has the data will rule” will be the mantra of the future. More important, he who has the data and can turn it into meaningful information will be positioned for long-term success.

Survey highlights:

  • Almost all of the CEOs surveyed believe that their hospital or health system will have full clinical data integration with at least two-thirds of referring medical staff by 2019.
  • Eighty-four percent of survey respondents predict that by 2019 a single IT vendor will provide clinical data integration for their organization's acute care clinical system and its affiliated ambulatory care sites.  

6. Equity of Care

We do not have all the answers yet, but through the Call to Action and the Equity of Care platform, we are sharing resources and guides to help the field navigate toward high-quality care for all. To realize the goal of eliminating health care disparities, hospital leaders must believe that results can be achieved. The survey data highlight that this belief and commitment exist.

Survey highlights:

  • The majority of CEOs responding to the survey think it likely that goals for improving the quality of care for diverse patient populations will be part of their organization's strategic plan by 2019.
  • A majority of those answering the survey predict that by 2019 the racial/ethnic diversity of their board will reflect their community.

7. Efficiency

Employers and other payers will engage with narrow networks, high-performing networks, centers of excellence or specialty units, sometimes through direct contracting. Employers will expect to benefit from increased efficiencies in the form of lower total charges and better results. For example, some savings may accrue to the employer and employee through faster patient recovery, fewer complications, fewer clinically unnecessary tests and less rework. On the outpatient side, employers and other payers will want alternatives to emergency rooms, such as retail clinics. They will also want care options that keep people out of hospitals and away from hospital-based services. As hospitals try to provide a continuum of care to retain patients and capture revenue, employers and other payers will seek lower-cost alternatives.

Survey highlights:

  • Of those surveyed, 78 percent predict that by 2019 their hospital or health system will develop or participate in narrow networks that offer net lower plan costs to health plans in exchange for a more limited choice of physicians and hospitals.
  • Seventy-three percent of CEOs in the survey predict that by 2019 their hospital or health system will contract directly with employers to offer packages of care for selected high-cost services lines, such as back surgery or certain types of cardiac care.

To purchase copies of Futurescan 2014, visit www.shsmd.org/futurescan15.

Mary P. Campbell (mcampbell@aha.org) is senior editorial specialist at the Society for Healthcare Strategy & Market Development, Chicago, and managing editor of Futurescan. Expert commentaries are provided by Heather Jorna, Stephen A. Martin, Ph.D., and Rich Umbdenstock, American Hospital Association; David B. Nash, M.D., Jefferson School of Population Health; Brian A. Nester, D.O., Lehigh Valley Health Network; Mark Parrington, Catholic Health Initiatives; Bernard J. Tyson, Kaiser Foundation Hospitals; John P. Hoyt, HIMSS; Michael S. Wallace, Fort HealthCare; and Helen Darling, National Business Group on Health.