Rita E. Numerof, PhD

Rita E. Numerof, PhD, is the president of Numerof & Associates, a firm that helps businesses across the healthcare sector define and implement strategies for winning in dynamic markets. For more than 25 years, she has helped executives understand the implications of an evolving healthcare market. Working with leaders in the healthcare space, she has consulted with everyone from top academic and community hospital systems, payers, and Fortune 500 pharmaceutical, device, and diagnostics companies. She is the coauthor of several books, most recently, "Bringing Value to Healthcare: Practical Steps for Getting to a Market-Based Model" (2016).

Providers have an inefficient business model that’s become so deeply ingrained, they simply can’t fathom how else to do business as the industry shifts to value-based care.

“Excellence” doesn’t come solely from targeted efforts at extracting wasteful spending. True “excellence” comes from health systems making fundamental changes to the way they do business, namely by adopting a market-based model in which costs are connected to quality and providers are therefore held accountable for the outcomes they produce.

If we had a consumer-centered, market-based model that required transparency in costs and quality, accountability across the continuum with payments tied to outcomes, and real competition based on data that is made available in consumer-friendly ways, we wouldn't have the problem with surprise bills we see today.

The industry is speedily moving and advancing, and the only way for hospitals see continued success is if they stay nimble and capable of adapting to new developments. Looking to the future, healthcare systems should concern themselves less with size and instead shift focus to adopting business and payment models that bring value.

Instead of the promised benefit—patients paying less for quality care—horizontal mergers can actually cost consumers more. However, vertical mergers have the potential to create a new, profitable business model that can benefit consumers.

Under the current administration, CMS has made several good-faith attempts to revitalize the current healthcare system. These efforts demonstrate CMS’ commitment to move our industry closer to value-based payment and consumer-centered delivery models. However, each of these reforms exhibits concerning characteristics.

With the evaluation period for the Oncology Care Model at its midway point, there is an opportunity to discuss how the program and other bundled payment programs can better deliver on aims to provide higher quality care at the same or lower cost.