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In this commentary, an industry insider shares his 2016 predictions for healthcare. Do you agree?
Last year was certainly a notable one for healthcare, with many big changes taking place. In the payer world, consolidation was the name of the game, with the “big five” set to become the “big three,” assuming the Anthem/Cigna and Aetna/Humana deals close early next year.
StephensAfter many fits and starts, the long-awaited ICD-10 transition occurred in 2015 without much incident, with the Centers for Medicare and Medicaid Services (CMS) announcing that it will allow a one-year grace period for code specificity.
And, it was a big year for data analytics. The launch of the Apple Watch brought health monitoring capabilities into the hands of many consumers, making it easier for them to share this data with their doctors. I anticipate that in 2016, however, people will realize that the Apple Watch isn’t cutting it in terms of tracking health data and that the use of biometric data, retail clinic data and the like will explode instead.
Given the changing healthcare landscape, I predict the following for 2016:
There will be no more uncertainty around Accountable Care Organizations (ACOs)
By next year, we will know as an industry that the ACO model is not working. Existing ACOs will realize they are not seeing savings from the current model, payments will fall flat and 50%of these entities will lose money as they take on increased risk. As a result, less than a dozen ACOs will actually move into the Next Generation ACO model. Instead, we will see higher participation than ever in Medicare Advantage programs as many of these organizations withdraw from Medicare’s ACO program and turn to Medicare Advantage as a better alternative. The goals of such programs are largely the same as the original goals of ACOs. They also offer several benefits, including payment benchmarks that are scheduled to grow at the same rate as fee-for-service Medicare and a tendency toward in-network utilization.
We will feel the impact of health plan consolidation
After all the consolidation among health plans in 2015, the Blues are the only ones left untouched. I foresee that the government will change tax exemptions for Blues in 2016. Once all the big health plans have consolidated, they will start going after hospitals to build integrated delivery networks. There will be an acceleration of the “Kaiserization” of the industry. As the industry continues to figure out the efficiency gains, the risk piece of the ACA will play a key role.
There will be big gains for “alternative” care access points
Speaking of hospitals, they will increasingly shut down in 2016 due to constrained construction budgets, and corner clinics will replace some physician practices and primary care physicians. A recent Healthline survey found that when faced with a routine illness in the last year, about 20% of patients sought care at an urgent care clinic, and 13% used a retail health clinic (e.g., CVS Minute Clinic, etc.), demonstrating that these options offer consumers a viable care alternative.
More employers are also including telehealth services as part of their health benefits packages, recognizing the value and cost-management opportunities this channel brings. In the coming year, I expect telehealth to really take off as consumers seek new, more convenient ways of getting routine medical care and are more willing to take advantage of their employers’ offerings. The Healthline survey found that nearly 9% of consumers surveyed had used a telehealth service for a minor illness at some point since these services became commercially available. Ninety percent of those who had used telehealth felt their experience was the same or better than that at a doctor's office consultation. Surprisingly, 45%of telehealth users reported that they were unaware of these types of services just two to three years ago.
Electronic health record (EHR) consolidation and innovation
EHRs will continue to evolve in 2016. The EHR giants will gobble up additional market share, further widening the gap between them and the other vendors. However, following this year’s explosion of health data into the cloud, cloud-based EHRs will see increased momentum compared to previous years.
Additionally, provider dissatisfaction with EHRs will increase. This will lead to more disruption, driving new innovations to solve the challenges facing EHR users. For example, the The Health Information Technology for Economic and Clinical Health (HITECH) Act, the Affordable Care Act and meaningful use have led to an explosion of electronic patient data in recent years. Providers put significant effort into contributing patient data to EHRs but don’t see the value coming back. This generates a high level of frustration.
EHR vendors will increasingly recognize the need for analytics to make sense of all this data and will begin to embed new capabilities such as natural language processing (NLP) into their technology. In order to be effective, NLP must go beyond recognizing explicit mentions of certain entities to truly understanding unstructured data in free-form narrative text. Tools that help clinicians extract this critical information, especially for risk adjustment, will have a significant impact on healthcare system efficiency, cost savings and patient outcomes in 2016.
Dean Stephens is the CEO of Talix,a provider of patient risk management solutions.