This year, Advisory Board's various research teams heavily focused on "site-of-care shifts" as Covid-19 has triggered a shift in demand for access points. Across more than 30 interviews with health system and industry leaders around the world, our team found that, in the global context, "site-of-care shifts" refers to the movement of care away from the acute-focused hospital campus toward new sites and modalities. These include virtual, home, ambulatory, and community settings, among others.

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This definition aligns with the policy trend taking hold across many markets, in which governments are calling on providers to shift the default care setting away from hospitals and into the community.

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Before Covid-19, some governments announced policy or infrastructure plans to shift access points away from the hospital due to sustainability pressures. In the UK, for instance, the NHS announced plans to hold newly-formed networks of health and social care providers accountable for a population's total cost of care, thereby incentivizing less costly delivery points.

Ontario's government called on providers to integrate into regional networks that elevate the role of community partners. And Finland gradually reduced the number of inpatient locations and beds and increase outpatient, virtual, and home care services.

Fast forward to 2021, and another wave of jurisdictions are following suit. Italy plans to create a network of over 1,300 clinics and medical centers across the country to provide GP and specialist care to patients in the community. And we know from conversations with members in Europe that Norwegian hospital networks are actively centralizing services into high-specialty hospitals while decentralizing lower acuity services into the community, and that Germany is also considering passing similar legislation that would shift the onus of care away from the hospital and into primary or community care.

As this trend is mounting, there is an open question of what the future health system access model will look like. Denmark's progress thus far may provide a case study of what the future holds. In 2007, the Danish municipality system underwent structural reforms.

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Over a 10-year period, the government nearly halved the number of hospitals with emergency departments in the country from 40 to 21. The goal of the reform was to replace a significant share of admissions with outpatient treatment by centralizing inpatient services into fewer, and larger facilities and converting some smaller hospitals into outpatient centers.

Now, Denmark is going a step further by gradually shifting cohorts of patients out of the outpatient setting into primary care or lower-cost community settings—continuing their movement away from a hospital-centered system. In this world, hospitals serve as high-specialty and trauma hubs, while a majority of their "traditional" hospital services take place elsewhere.

While Denmark may give us a potential destination, there are a handful of unanswered questions about how we get there: for which cohorts of patients do we prioritize shifting services? How do we keep up with increased demand from opening new points of entry into the system? How do we engage physicians and build confidence in this model? And what investments should we prioritize first instead of later? 

We'll explore these and other questions during our Executive Summits on Nov. 9 (Atlantic session) and Nov. 10 (Pacific session). In these sessions, we will take a look at what investments and opportunities organizations should pursue within three service types: specialty care, emergency care, and elective procedures. We'll also do a deep dive into how global exemplars have shifted these services from the hospital setting to virtual, outpatient, ambulatory, community, and home settings.

Please contact your account manager to register for the event.