By Todd Bennett, Director, Vertical Market, LexisNexis Health Care
As 2016 comes to a close, recollections from 2016 and predictions for 2017 will begin to fill up your email inbox and the pages of your favorite publications. While policy wonks in different domains wax poetically about foreign relations, the economy, and military spending, I wanted to pay homage to the healthcare industry by offering a few predictions of my own.
1.Don’t fret about POTUS. Despite the fiery speeches on either side of the aisle, the outcome of the election will prove to have, at most, an incremental impact on the course of the healthcare industry. Despite the disparity in approaches to healthcare challenges, both parties recognize the cost curve has barely nudged and systemic change is required. One end of the spectrum of healthcare options is a single payer system that eradicates commercial health insurance as we know it, and on the other end is a complete and total reversal of all things Obamacare. Despite the rhetoric, neither of these extreme options are actually what the Republican or Democratic platforms are espousing, suggesting options closer to the middle will prevail. Both parties recognize higher quality, more coordinated care, greater transparency into price and quality for patients, and a solid dose of free-market innovation will lower costs. Defining the right mix of these characteristics to incent and the approach to scale them across the country is what each party is looking for as a win, and until either party unlocks that definition, incremental change will be the norm.
2.Identity fraud out-popularizes identity theft. Now that most of our identities have been stolen — multiple times — investment in protection from identity fraud will be the new rage. While hackers have used 2016 and preceding years to steal your personal identity information, 2017 will give them the opportunity to use it. They will impersonate you and use your identity fraudulently to access unearned, unentitled benefits that they wouldn’t qualify for otherwise. Negative publicity for these breaches and identity fraud will continue to underscore a need for and investment in information security tools and talent. Investments that have previously focused on endpoint protection, encryption, and intrusion detection, will now begin to focus on tools that protect the next frontier of information security - the actual legitimate user. Training the legit users on the different techniques that social engineers can use to attempt to collect information about you is difficult. By the time you’ve learned one of their methods, they’ve come up with something even more surreptitious. Early adopters will fight back with automation with tools like attribute-based controls to detect the level of fraud associated with an identity. These automated guardians will run in the background every time you request sensitive information or log into a system to make it easier for appropriate users to enter an environment while detecting and protecting against impersonation, phishing, and social engineering.
3.Health systems integrate care delivery and financing on a large-scale. For several years now, providers have been consolidating across care settings and growing their ability to manage risk in the same way healthcare insurers do. Health systems have bought additional hospitals, medical groups, post-acute and urgent care settings, and many have set up provider-sponsored health plans to manage the risk of their self-insured, employed populations. These moves have acted as an effective primer for formerly traditional provider organizations learning to manage risk effectively. With mega-payer mergers getting denied and more anti-competitive scrutiny of large health system acquisitions, I predict the first large multi-regional health system will make moves to acquire or merge with a major regional or national health plan in 2017. In future years, as a small group of innovators commits to these large-scale investments, a pack of strong baby-Kaiser’s will be born and quickly aim to mature and cross-pollinate expertise in managing risk and delivering care. The emergence of these new organizations will demonstrate the acceptance of the ‘integrated care delivery and financing’ model and accelerate (incremental) policy changes to accelerate adoption.
4.Bundled payment programs will be successful. The importance and challenges of integration and coordination among care settings is highlighted in episodic or bundled payment programs like the Bundled Payment for Care Initiative (BPCI) and the Comprehensive Care for Joint Replacement (CJR) program. By linking providers who are caring for the same patient together for performance accountability and payment purposes, these linked providers now have an impetus to share information, to be informed about the care delivered in other care settings, and to follow evidence-based guidelines during and after procedures. My prediction is that the CJR and some of the less complex BPCI episodes will successfully demonstrate the programs’ effectiveness at reducing cost and quality variations in procedures that are too often plagued with high variability in these areas. Furthermore, the programs will confirm the positive impact of clinical integration across care settings, reinforcing findings from other initiatives like Accountable Care Organizations and Patient-Centered Medical Homes. By sharing the financial risk and accountability across practitioners in multiple care settings, these programs will accelerate large health system investments in post-acute care delivery organizations such as home health providers that can directly impact readmissions and the total cost of care.
Don’t be surprised if these four predictions come true. You’ve read articles, heard commentaries, and lived your professional lives in these topics through recent years, and 2017 will prove to be a continuation of the same - with eyes on real ways and big ways to make our system of care better with every program and new initiative that our healthcare organizations and policy crafters attempt.