2015 was a tumultuous year in many ways. Mergers and acquisitions changed the landscape for both healthcare providers and the insurance industry, and legal challenges to the ACA provided uncertainty. Healthcare organizations continued to move from volume to value as they restructured and addressed costs and service delivery. Improving population health moved from discussion to action in many organizations.
As we begin 2016, we face challenges rooted in the issues we confronted during 2015. The goals of providing better care for individuals, better health for populations, and lower costs for healthcare overall remain the guiding principles of our efforts. This year, I think we’ll focus on the six major categories listed below:
As patients become more comfortable with “seeing” their physician via a mobile app or remote connection, the use of mobile medicine in all its forms will increase this year. I think we will see an increase especially in situations involving relatively minor complaints and with care for chronic conditions. New apps will be introduced and older ones will be enhanced, providing consultations from primary care to specialists to counseling and psychiatry.
We will also see more discussion concerning the ownership of patient records. As medical organizations solve those questions, we will see an increase in online information sharing among medical professionals, including lab results and interpretation of images and scans. Medical professionals in remote locations will have increased access to specialists via medical apps, and patients will have access to the care they need without increased travel time or expense. We may even see the emergence of “bedless” medical facilities or remote care facilities, providing new employment models for medical professionals.
As the amount of online medical information increases, we will see a greater emphasis on cybersecurity in all aspects of medicine – from storing patient records in hospitals and doctors’ offices to securing medical equipment with hard-drive storage to protecting online consultations. Budgets for online security will rise to keep pace with the demand. Privacy concerns will require any organization with electronic access to medical information to increase its awareness of security requirements and its emphasis on security preparation and procedures. Even with increase awareness and preparation, however, we will see continued security breaches this year.
Alternate Payment Models
With the repeal of the Sustainable Growth Rate last year, the new structure incentivizes the use of alternative payment models that focus on care coordination and preventive care. The Medicare Access and CHIP Reauthorization Act (MACRA) will consolidate the three Medicare quality-reporting programs into one. The Physician Quality Reporting system (PQRS), Meaningful Use of Electronic Health Records and the Physician Value-Based Payment Modifier, along with their penalties, will become the Merit-based Incentive Payment System (MIPS) beginning in 2019. The current programs will remain in place until MIPS begins. Emphasis will shift to alternative payment mechanisms, such as accountable care organizations, patient-centered medical homes, bundled payment arrangements, and other models.
High-deductible health insurance plans are everywhere, and consumers are looking for help to negotiate the new environment. Even organizations that provide health insurance for their workers are exploring the possibility of employees bearing a greater proportion of healthcare costs. Financial planners are beginning to meet consumer need for healthcare planning with programs that are similar to 401(k) planning for retirement accounts. As employers shift costs and insurance companies respond to a changing market, how healthcare is bought and paid for will continue to evolve.
As consumers struggle with higher healthcare costs, they are able to compare the costs and quality of most healthcare services and make choices based on their research. Healthcare organizations will continue to mine data to create new payment models and to reduce costs overall. Medicare has launched an initiative that sets goals for providers at 50 percent of payments in alternative reimbursement models and 90 percent of reimbursements tied to quality improvement.
We saw consolidation increase in the health insurance industry in 2015 and that activity is likely to continue. Other segments of the healthcare industry may merge in order to stay relevant. Merger activity has shifted away from traditional acquisitions in the recent past, and we can expect to see more affiliations, joint ventures and partnerships this year. Brand is important in the new consumer world and affiliating with a known brand, such as the Mayo Clinic, may supply a substantial advantage. The fallout may be that independent hospitals and clinical groups will find it more difficult to compete with the much larger merged organizations, forcing them to consolidate with other complementary groups.
Politics are inevitable in an election year. Although we won’t know the results of the election until November and won’t feel the effects of it until next year, decided political differences between the two parties result in heated rhetoric. Promises range from a single-payer system to an improved ACA to the repeal of the ACA entirely. We will know more as the year progresses, but what is sure is that we will not return to the healthcare system of 2010 when the ACA was enacted.
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