Healthcare in 2018 was marked by a growing impatience with the fierce political battles and partisan deadlock of the year before—in its stead were massive calls to action by employers and patients alike for healthcare to produce better access, better results, and better value. Below are a few of the forces that defined health care in 2018 and how we predict they’ll carry out next year.
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Patients demand better access to care.
In 2018, patients across the country demanded better access to care in an increasingly costly, complicated, and inconvenient system. As a result, healthcare became one of the biggest issues in heated political races throughout the country during the 2018 Midterms as voters demanded protections for pre-existing conditions, increased coverage through Medicaid expansion, and sweeping reforms through “Medicare for all” proposals. Retail clinics capitalized on this desire, continuing to expand sites in 2018 to offer more and quicker access points. And giant business deals like the CVS-Aetna merger moved forward, sealing the value payers such as Aetna see in scaling the retail clinic model.
2019 Prediction: Facing increasing demands to increase access to care, providers will take matters into their own hands to increase their capacity and convenience for patient access. Leveraging digital technologies that include artificial intelligence and machine learning, providers will begin to intelligently predict and orchestrate entire patient journeys.
Employers exercise their power.
In one of the most widely discussed healthcare happenings this year, Amazon, JPMorgan Chase, and Berkshire Hathaway joined forces in January to drive improvements to the increasingly complex and costly experiences their 1.2 million employees were having. In July, they named Dr. Atul Gawande, renowned surgeon and writer for The New Yorker, as their CEO, who stated, “I have devoted my public health career to building scalable solutions for better healthcare delivery…now I have the backing of these remarkable organizations to pursue this mission with even greater impact.”
As the largest purchaser of health insurance in the country, employers are increasingly recognizing employee dissatisfaction with their healthcare experiences including long wait times, growing deductibles and copays, and less-than-stellar outcomes. Large companies are looking to do more to improve the care their employees are receiving, keeping them healthier and more productive while doing more to attract new employees in the process. Apple launched a new line of clinics for their employees, AC Wellness, designed to focus on wellness and better patient experiences, and venture capitalists are recognizing this trend and investing in workplace wellness companies like Paladina Health that run similar clinics for large companies. Employers are demanding better value from the plans they procure, putting pressure on payers to better incentivize outcomes and streamline care for patients.
A Personalized Approach to Medication Nonadherence
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
2019 Prediction: As employers continue to put the pressure on payers to deliver better experiences, payers will pass that pressure along to providers who will be compelled to deliver faster, more convenient, and better quality services. Providers will be compelled to go online to sell their better experiences to new and existing patients, embracing the ability to improve the quantity and quality of their online reviews and addressing any issues that arise from them.
Value-based care moves forward.
As employers amp up the pressure, payers have increased value-based arrangements to properly align incentives and pay for better experiences, not more trips to the doctor. The Health Care Payment and Learning Action Network released its 2018 report on alternative payment methodologies, estimating the number of healthcare payments tied to value and quality at 34 percent among public and private payers, up 17 percent from the previous year. The federal government, the largest payer for healthcare services, has been a key force behind this continued shift, touting value-based care as one of their major initiatives. They’ve proposed to revamp the Medicare Shared Savings Program, pushing more Accountable Care Organizations to take on increased levels of risk faster. They have also collected reports from eligible clinicians participating in the first performance year of the Merit-based Incentive Payment System, awarding positive payment adjustments to 93 percent of them.
2019 Prediction: The shift toward value-based care will continue, but providers will run into a critical issue—data. Needing to better predict costs, measure outcomes, and coordinate care with other providers to estimate and maximize future payments, they’ll turn to their EHR systems. Though these contain treasure troves of data, effective data sharing between EHR systems is lacking. In 2019, expect advances from technologies and standards such as Fast Healthcare Interoperability Resources (FHIR) to establish common data formats and support interoperability between legacy healthcare systems, providing a lingua franca between healthcare systems. The journey towards interoperability is decades long, but next year expect significant advances.
More data, more problems.
As providers struggle to manage and share their own data, consumers continue generating more and more of it. Back in January, Apple released their Health Records app, which allows users to store their medical history, lab results, medications, and more within a clean, mobile interface. Yet difficulties persist in connecting and streamlining data to make a central repository such as the Health Records app generate meaningful results. Apple made even more waves when, later in the year, it released its Apple Watch 4 with FDA-cleared ECG and other heart monitoring capabilities, allowing its wearers to collect their own ECG in just 30 seconds and help predict atrial fibrillation. Innovations like these, along with other wearables from step counters like FitBit to Omron’s wireless blood pressure monitor, give patients a huge advantage over owning their own data. But advances in the interoperability of health data aren’t keeping up. The result? More data, more data silos, and a persistent need for ways to securely share meaningful takeaways from all this data between patients and their caretakers and providers.
2019 Prediction: Efforts to integrate patient data into EHRs via FHIR and other technologies will expand dramatically. More user-generated data is resulting in the growth of patients playing a more proactive and informed role in their own care and journey, but patients and providers will demand automated and secure ways to communicate and share that data on an ongoing basis. This is critical to help providers more accurately diagnose and prescribe treatment plants and help patients communicate symptoms more easily. In the process, wellness devices will hit peak proliferation, complicating rather than improving healthcare.
As most health care professionals know, meaningful change and innovation doesn’t happen overnight. At long last it appears that movement in 2018 could lead to significant advances in 2019, from improved access to care, to further adoption of value-based care, and advances in the ability to not only collect but share medical data more seamlessly. Structural, technological and cultural changes are empowering patients to take on more ownership of their personal health care journey, and that is a good thing for both patients and providers.
