Continued Upheaval as Healthcare Reform Gains Traction
LOS ANGELES, CA — (Marketwired) — 01/08/14 — Despite 2013’s rocky start for insurance sign-ups and subsequent delays in enacting parts of the health insurance mandate, the pressures for providers and payers to adapt to healthcare reform will accelerate this year. Seismic shifts in the provider landscape will continue, with brisk deal-making by hospitals and health systems to gain economies of scale and expand their continuum of care, employers forging more direct arrangements with health systems, and non-traditional players extending their reach, according to The Camden Group’s 2014 Top 10 Trends in Healthcare.
“We are three years into the biggest healthcare overhaul in a half-century, and many providers are plainly struggling,” says Steven T. Valentine, president of The Camden Group. “2014 will be a pivotal year as cost-cutting and IT investments remain paramount, making new care and payment models work becomes critical, and public scrutiny on pricing, quality, and patient outcomes intensifies.”
In short, the going is going to get tougher this year, as evident by The Camden Group’s predictions of the major trends in 2014:
- Newly insured likely both a boon and a burden.
- From both exchanges and expanded Medicaid programs, the newly insured’s impact remains a major question mark. Potential issues that could emerge are a rise in providers’ bad debt, lower-than-expected enrollment that hurts payer profitability, very narrow networks and adverse selection through the insurance exchanges.
- Hospitals and physician groups that enjoy high prices, are operating at capacity and/or believe they can “ride it out” will likely choose to not participate, at least for the first year or two.
- With benefit design, economic incentives, and other changes that lower volume and reimbursement, hospitals will face revenue strain and greater labor strife as layoffs continue.
- The big will get bigger and broader.
- Discouraged by their lack of progress in transitioning to value-based care, many medical groups, IPAs, hospitals, and health systems will merge or be acquired.
- Health systems may merge with other systems to gain increased access points, greater critical mass, population health management knowledge, and a stronger presence in geographic areas or regions.
- Expect more vertical integration as providers build out post-acute care services and begin converting or repurposing facilities for skilled nursing, rehabilitation, step-down units, and transitional care units.
- As pricing and quality transparency increases, so will marketing and branding.
- Use of cost and quality profiles by public and private exchanges will take transparency and demands for it to new levels, beginning this year.
- Some employers, including Safeway, already have developed and now post pricing information for selected procedures on employee websites, and more will follow.
- Providers will go on the offensive, promoting access, experience and other strengths.
- Branding will rise in importance as hospitals, medical groups and systems continue consolidating while also collaborating with academic medical centers.
- Anticipate greater use of social media and marketing to the public, with tailoring to specific market segments, such as Medicaid, Medicare, ACOs, and self-funded employers.
- Large employers increasingly carve their own path.
- Expect expansion of existing and new models, including onsite clinics, like those at BMW, and more shifting to private insurance exchanges, following early adopters such as IBM, Kmart, and Walgreens.
- More will join Lowe’s and Walmart in direct contracting with “Centers of Excellence” such as the Cleveland Clinic, Geisinger, Virginia Mason, and Baylor Scott & White Health.
- Deploying and optimizing IT remains essential and elusive.
- Providers will focus attention and investment on IT rather than diagnostic and therapeutic equipment and facilities.
- The goal: Exploiting IT to improve care and lower costs is growing, with everything from telehealth, e-visits, and mobile apps to population health analytics and big data.
- A huge hurdle for many health systems and physician organizations that are growing through mergers and acquisitionsis how to move all to a common IT platform.