It is designed to help hospital and health system leaders better understand the health care landscape and the critical issues and emerging trends their organizations likely will face in the foreseeable future. The 2016 Environmental Scan is compiled from nationally recognized sources with recommendations from select AHA governance committees. Notable this year is the pace of change health care markets are experiencing and is a common theme running throughout the topics presented in the Environmental Scan. Moreover, health care also is a local phenomenon, with the pace of change being relative and varying from market to market.

The scan is produced by Gene J. O’Dell, the AHA’s vice president for strategic planning and performance excellence, with assistance from Donna J. Aspy, planning and operations manager, leadership and business development. Lee Ann Jarousse, H&HN’s senior editor of custom publications, compiled the information.


Consumers & Patients

Effectively managing the care of patients with chronic illnesses is critical to bending the curve of health care spending in the United States. Nearly half of all Americans have at least one chronic illness or more. For those age 65 or older, the figure is 85 percent. People with chronic illnesses cost the health care system $1.5 trillion, or about 75 percent of total health care expenditures. 1

Individuals with mental illness are among the highest-need, costliest patients in the U.S. health care system, yet they receive inadequate behavioral health care. Researchers have proposed various models that integrate behavioral health with primary care. These approaches have the capacity to improve patient care and outcomes in terms of both physical and behavioral health. However, the limited availability of behavioral health providers has been a major implementation obstacle. 2

Depression is the leading cause of disability worldwide, and is a major contributor to the global burden of disease. Serious mental illness costs America $193.2 billion in lost earnings every year. Approximately 60 percent of adults with a mental illness received no mental health services in the previous year. 3

The health care sector will begin to look and feel like those of other industries, catering to customers who expect one-click service. A true consumer-driven market is slowly taking shape. Patients are leading the way, bearing more of the cost of their own care — and making more care decisions. Patients are no longer satisfied with just meeting with their doctors. Increasingly, they expect to access lab results on their phones soon after leaving the medical center. 4

High-cost patients will be the focus of a U.S. health care industry under pressure to contain costs. Among the most costly patients in America are the dual eligibles — approximately 9.6 million individuals who qualify for both Medicare and Medicaid. In 2010, the Medicare fee-for-service program spent an average of $19,418 on each of these patients, compared with $8,789 on other beneficiaries. 4


A large proportion of primary care interactions involve mental health concerns. For this reason, the trend toward integration of behavioral health in primary care likely will continue. Mental health professionals — such as clinical psychologists, licensed clinical social workers, marriage and family therapists, and even nurses and health educators with specialized training — will become a part of the primary care team. 5

Three-quarters of consumers say they would be comfortable seeing a nurse practitioner or physician assistant for physicals, prescriptions, the treatment of minor injuries and ordering lab tests. Half would be comfortable going to a pharmacist instead of a doctor for some services. 4

In 2015, the U.S. Bureau of Labor Statistics predicts that millennials will be the majority in the U.S. workforce and, by 2030, they will make up 75 percent of it, causing employers to refocus their employee benefit strategies. Leading employers are pursuing strategies and tactics aimed at specific cohorts of employees while providing all greater flexibility, convenience, relevance, education and guidance. 4

Health care is the most dangerous industry for injuries and illnesses, with 653,000 nurses, aides, orderlies and others being injured or falling ill every year, according to a Public Citizen report. Among attendants, orderlies and nursing aides in 2011, the incidence rate of injuries requiring days off work was 486 cases per 10,000 employees, more than four times higher than the national average for all workers. More musculoskeletal injuries are suffered by orderlies, attendants, nurses and nursing aides than by workers in any other industry. Back injuries in the health care industry are estimated to cost more than $7 billion every year. 35

The supply of primary care nurse practitioners and physician assistants is expected to increase by 30 percent and 58 percent, respectively, during the next five years. 4

Info Tech & eHealth

Digital health technologies are rapidly proliferating: There are some 40,000 mobile health apps, hundreds of platforms aimed at improving health care communication and coordination, and new types of medical sensors or wearable devices making headlines every week. Digital technologies that serve as a communication bridge between providers and consumers have the potential to disrupt the U.S. health care system by enabling consumers to get care and support when and where they need it, while also making their needs and preferences known. Unlike other sectors of the economy, the health care industry has yet to realize the potential of digital technologies. 36/29

Almost 30 percent of clinicians aren’t satisfied with the technology used by their organizations. Of that number, 68 percent say the problems arise from different people using different technologies — those technologies might not work well together or create gaps that lead to security issues — and 55 percent indicate that not all members of the care team have access to the communications platform. Another telling statistic: For clinicians needing to communicate with another clinician about a patient’s medical condition, the electronic health record is used as a communications platform only 12 percent of the time. 37

While other industries have been far more successful at harnessing the value from large-scale integration and analysis of big data, health care is just getting its feet wet. The vast amount of data generated and collected by a multitude of agents in health care today comes in so many different forms — from insurance claims to physician notes within the medical record, images from patient scans, conversations about health in social media, and information from wearables and other monitoring devices. One of the earliest uses of big data to generate new insights has been around predictive analytics. These predictions may help to identify areas to improve both quality and efficiency in health care in such areas as readmissions, adverse events, treatment optimization and early identification of worsening health states or highest-need populations. 38