The implementation of the Affordable Care Act is not yet complete, the recent midterm elections have brought change in the makeup of Congress, economic recovery continues its crawl across the country, and readers might be left to wonder: What does it all mean?
Here’s my perspective on the year to come.
Employers. Employers will continue to shift more of the costs of health insurance for their employees to employees and move from defined benefit to defined contribution plans.
We will also see more employers provide their employees with a menu of health plans to choose from through private exchanges.
We may see more small employers cease offering insurance plans to their employees and instead move them to the state and federal exchanges, and more people will enroll in high-deductible health plans in an effort to reduce their premiums, potentially facing financial challenges in the event of unexpected illness or injury.
Payors. We will continue to see consolidation in the health plan industry and a significant focus by payors on attaining greater market shares.
More payors will offer plans on the health exchanges, and insurers will continue their move to narrow (high performance) networks for most of their products (PPO, HMO, and Medicare Advantage).
Some payors will begin or accelerate acquisition of physician groups and other healthcare providers, while others will look for partnering opportunities and equity investments in networks.
A few of the cooperatives will continue to grow and succeed, but many will struggle and may not survive much longer after 2015, especially if they do not pick up significant membership from the exchanges in the coming year.
Information technology. The big focus in 2015 will be on interoperability. Pressure is mounting on the IT vendors to create interoperability solutions, and 2015 will be the year they agree to pursue these solutions.
At the same time, 2015 will be the start of the demise of some health information exchanges (HIEs), especially as interoperability solutions become more widely available. Start-up funding is expiring and HIEs will struggle to find business models that will result in sustainability.
ICD-10 will not be delayed again and will go into effect Oct. 1, and some small physician practices will not survive the transition. Other providers may experience increases in their days in A/R due to delays in payments.
Congress will consider changes to the Meaningful Use Stage 2 rules that will allow for a shorter reporting period to allow more physicians to qualify.
mHealth will continue to proliferate, and there will be more mobility apps and wearable technologies (Keep an eye on the Apple iWatch reveal in March!) that healthcare providers will begin to use to try to engage patients in their own health and fitness.
Advances in biomedical monitoring will allow for more care to be provided in lower-cost settings, including the patients’ homes. There will be more adoption of telehealth/telemedicine and e-visits, though the adoption rate will remain slow. I think 2015 will also be a year of high-profile data breaches and cybersecurity threats.
Healthcare reform. Though the House of Representatives will again vote to repeal the Affordable Care Act, the ACA is here to stay, however it will be tweaked and some timelines will be adjusted. Now that Republicans have control of both houses of Congress, we may see repeal of the medical device tax. And some states that held off on Medicaid expansion prior to midterm elections will expand their programs.
Retail medicine. There will continue to be significant growth in pharmacy co-located retail clinics, but we also will start to see healthcare providers coming up with retail-based solutions of their own, e.g., clinics with extended hours, urgent care clinics, free-standing emergency rooms, and clinics in retail settings that accept patients without appointments utilizing nurse practitioners and PAs, and/or e-visits.
Health systems. Cost containment will continue to be the prevailing focus in 2015. We will see more consolidation, some at local levels and much more at regional levels.
We will also see more regional collaborative “systems of systems” that will contract together while remaining independent health systems. Some health systems will begin acquiring post-acute providers in an effort to manage total cost of care for a population, and more health systems will acquire insurance companies or joint venture with payors to create their own private-label health plans.
More critical access hospitals are likely to be shuttered, and some will be acquired by health systems.
Few health systems will figure out population health and demonstrate the capabilities and competencies to manage the health of a population before the end of 2015; those that do will have a market advantage.
Health systems will continue their deployment of electronic health records and discover that a huge gap is data analytics. We will see more investment by health systems in data analytics, and less in data analysts.
We can expect to see additional downgrades of hospitals and health systems in 2015.
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.