2020 Mega Business Trends


Find 2-3 2020 mega business/economic trends affecting midsize businesses in the US (in the Northeast, if available) for the following industries: Healthcare, Skilled Nursing, Dental Practices, Food & Beverage, Franchises, Infrastructure (e.g., construction, civil engineering, energy companies), and Law practices. Trends will focus on business and economic impacts. For each trend, we will try to provide what the trend is, why it is considered a trend, and how businesses are expected to implement it in 2020.

Early Findings


1. Evolving technology.

  • The increased uses of telehealth, artificial intelligence (AI) and more community-based facilities (such as urgent care centers) are changing the healthcare space.
  • The use of health AI is "spurring the transition of medicine from reactive to proactive care. "
  • Machine learning-based applications "will take action and prevent disease on a more personal level, rather than simply reacting to symptoms."
  • This will enable providers and payers to be better positioned to care for their patients’ needs with the tools to delay or prevent the onset of life-threatening conditions. Patients will benefit "from timely and personalized treatment to improve outcomes and potentially increase survival rates."
  • Digital connectivity is starting to change the way patients receive healthcare. Individuals can now manage their own healthcare options because of increased access to information and digital resources.
  • Telehealth is becoming more ubiquitous and more effective in delivering quality care that easily connects providers with patients, which minimizes patient's need for bedside treatment. "This trend, along with the incorporation of AI in imaging and diagnostics, means healthcare delivery will require less patient proximity to large-scale facilities."

2. Industry-wide transition to value-based care.

  • Larger, centralized healthcare systems are being created with "more expansive networks of agile, strategic facilities." The industry is "moving away from inpatient hospital settings and toward ambulatory care and community-based facilities as part of a larger healthcare system."
  • Community-centric facilities are becoming the norm, this affects construction and project managers as they must be "more knowledgeable and sensitive to the needs of individual communities, not just dense urban centers. With each outpatient and urgent care center comes a new set of municipal regulations, guidelines and codes."
  • Instead of traditional patient care environments, it is becoming increasingly common to find local wellness centers and urgent care facilities that are linked to medical records and centralized services, such as labs, due to increased geographical flexibility.
  • "Follow-ups, monitoring, aftercare and test results can be done online or over the phone. Smaller, alternative facilities, already common across the country, will only become more popular, making speed, agility and wide-spanning coordination key to the jobs of real estate development, construction and project management."

Skilled Nursing

1. Shift to Home Health Care

  • According to the latest quarterly trends report by Trella Health, home health care has officially surpassed skilled nursing facilities (SNFs) as the most likely post-acute referral destination.
  • In the first quarter of 2019, 23.3% of in-patient discharges were coded for home health care, while 21.1% were coded for SNF stays.
  • “A lower percentage of in-patient discharges to skilled nursing and decreased SNF utilization over the past four quarters could portend continued challenges for SNF providers.”
  • Massachusetts, New Hampshire, New Jersey and Maine (states in the Northeast) often had the highest rates of home health referrals in Q2 2019. In New Jersey, nearly 60% of in-patient discharges were sent to home health providers.
  • According to consulting firm, CLA, "roughly half of the SNFs in the country are not operating at a profitable level."

2. Decreasing Operating Margins.

  • Additional regulatory pressures, reimbursement drops, and a tight labor market are among the factors that have reduced SNF operators’ margins over the last half-decade.
  • "Moving forward, SNFs must pursue bold strategies to find long-term sustainability," the CLA stated.
  • Consulting firm, CLA, observed a "divide between the haves and have-nots in the skilled nursing space, separated by star rating. " They identified star ratings as “one of the most insightful indicators” of financial performance.
  • "A heightened emphasis on star ratings from hospitals, health plans, and consumers has increased the importance of these ratings for SNFs, the CLA analysts noted. “With the health care industry transitioning payment toward value and quality, this rating can impact financial performance.”
  • CLA recommends operators to operate and measure their business in "two distinct categories — short-term rehabilitation residents and long-term stay residents. By optimizing these two, SNFs can more effectively manage their operations and financial outcomes.

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