The Top Three 2020 Healthcare Trends and How to Prepare

This report is based on a 2019 webinar given by Stephen Grossbart, PhD, Senior Vice President and Chief Quality Officer, Health Catalyst, titled, “The Biggest Healthcare Trends of 2019 and What’s to Come in 2020.”

After a year full of change and many topics competing for the headlines in 2019, politics and reform, theAffordable Care Act(ACA), prescription drug access and pricing, and price transparency were major areas of focus politically. As healthcare and politics are deeply intertwined, we know that any changes in our political landscape have a direct impact on healthcare.

随着医疗保健组织争相应对2019年起的变化，他们需要向前看，并为2020年的变化做好准备，这些变化可能会立即影响程序定价方案、报销率和患者满意度。卫生系统比以往任何时候都有更多机会利用数据和技术为所有患者提供最佳护理，无论他们生活在哪里。

Top Healthcare Trends from 2019

# 1的趋势。The Affordable Care Act

The ACA was enacted in March 2010 and was still one of the top 2019 healthcare trends. Although some courts have fought the legislation, it has yet to be repealed entirely. For example, in December 2018, theTexas District Courtruled that the ACA was unconstitutional. In May 2019, theTrump administrationand justice department, which is historically responsible for defending a federal act or statute in the courts, chose to support the repeal of the ACA. The case reached the Fifth Circuit Court of Appeals, which heardoral argumentsin July 2019.

Of course, no change will be enacted until 2020 when the Supreme Court hears the case. However, if the Supreme Court votes to repeal the ACA, the effects will be far-reaching for patients and health systems, as21 million Americanswill lose insurance coverage.

With an unsuccessful attempt to repeal the ACA, a gridlock in Congress, and the absence of constructive legislative action, the Trump administration still made big waves that deeply impacted health organizations, payers, and patients through executive orders:

1. Lowering the cost of short-term insurance plans.
2. Reducing federal financial support for insurance exchanges.
3. Reductions in Medicaid spending.
4. Expanded use of health savings accounts.
5. 禁止那些拥有非法移民身份的人进入保险交易所(这正在法庭审查中)。

趋势# 2。Medicaid Expansion

Medicaid扩张是2019年辩论的热门话题，并将持续到2020年。Although Medicaid expansion legislation was passed in 2018 and took effect in 2019, referendums and legislation are still pending in many places throughout the United States:

• 37 statesand the District of Columbia provide Medicaid expanded coverage under the ACA.
• Legislation is still pending in Kansas, North Carolina, and Wyoming.
• Referendums for expansion are expected on the 2020 ballot in at least four states.

医疗补助扩大法案对医疗机构和病人产生了严重影响，因为医疗补助扩大意味着比以前有更多的人获得医疗保健。Health systems need to be prepared to care for this new influx of patients without compromising quality and also ensuring they meet CMS standards of care in order to receivereimbursements.

Medicaid expansion allowed people in remote communities, such as throughout the Mountain West, to access care that was previously unavailable. As a result, critical care hospitals and smaller healthcare organizations started merging and contracting specialty services with other organizations. For example, small hospitals throughout southern Utah, southeast Idaho, and southern Wyoming withUniversity of Utah HealthandIntermountain Healthcare为社区内的病人提供专业护理。

趋势# 3。Prescription Drug Prices

As prescription drug prices skyrocket, and pharmaceutical companies and politicians continue to debate who should pay, a new bipartisan bill appears to offer at least some of the answers.

The White House endorsed the Senate’s bipartisanPrescription Drug Pricing Reduction Act, sponsored by Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore), in November 2019. Unlike the House’s titled theElijah E. Cummings Lower Drug Costs Now Act, the Senate Bill does not give theDepartment of Health and Human Services(HHS), the government body with jurisdiction over public health, the ability to negotiate drug prices or target private insurance.

Although thePrescription Drug Pricing Reduction Act该法案为医疗保险D部分的年度自付支出设定了3100美元的上限，从2022年开始，其主要目标是为支付人创建激励机制，以管理医疗保险D部分福利旅程的所有阶段的成本。如果国会通过该法案，医疗保险D部分受益人的自付费用将大大减少，理想情况下，支付者将与制药公司谈判降低药价，从而导致更低、更可负担的药价和有效的药价谈判和管理。

Trend #4. Price Transparency

Price transparency is a trending concept in today’s healthcare landscape. President Trump’s executive order in June 2019 called for increased called for increased pricing transparency in healthcare so that consumers could understand the full cost of a procedure or service and have the ability to shop around and make the most informed decision.

The executive order calls for HHS to publish prices that “reflect what people actually pay” and requires healthcare providers and payers to discloseout-of-pocket costs. With increased information available to consumers, payers and providers are incentivized to improve quality and cost, driving down healthcare prices without compromising the level of care.

What to Expect: Three 2020 Healthcare Trends

As we reflect on the many revolutions that changed the healthcare climate, it’s time to look forward. With pending legislation, health systems must prepare for the changes to come in 2020.

# 1的趋势。Consumerism—One of The Biggest Disruptors in Healthcare

As price transparency increases and consumers—and CMS—demand quality care for less, healthcare organizations need new ways to succeed within theVBC landscape. Alternative payment methods—including ACOs, shared savings, shared risk and bundled payments, and population-based at-risk contracts—are just some examples of new payment models that link cost and reimbursements to quality as the fee-for-service model continues to diminish.

新消费主义医疗方法的另一个方面是并购。随着来自私营和公共部门的公司联合起来解决医疗保健的最大问题，医疗系统应该问问自己，他们是否准备好在这个新的环境中竞争。Data shows that healthcare providers are not currently meeting theirconsumers’ highest priorities(Figure 1).

消费者驱动的医疗保健领域的另一部分是通过虚拟医疗或远程医疗进行访问。医疗保健组织应该提供或考虑提供容易获得的医疗保健咨询(如虚拟医疗保健和远程医疗)，这些咨询也强调提供方便和容易安排的高质量医疗。

As the push for virtual healthcare continues, so does the pressure for health systems to develop these programs, which requires a major overhaul for some organizations. Health systems need have the following capabilities:

• Enough providers with the scheduling capacity to care for patients via telehealth.
• 医院、诊所和其他卫生系统之间的合作，制定合同，解决支付、责任和交通问题，如果供应商要提供医疗服务。
• The infrastructure to avoid technological errors.

Although implementing virtual healthcare and telemedicine programs is challenging, many health systems are proving they’re up to the task:

• Jefferson Health2019年，美国东北部一个由14家医院组成的系统实现了10万人次的远程医疗访问。
• Stanford Children’s Health该公司位于旧金山湾区，2019年在初级和专业护理中实现了3500次远程医疗访问，目前为1型糖尿病和单心室患者提供家庭监视器。
• St John’s, a hospital in Rochester, New York, offers rehabilitation consults for post-discharge surgical patients via mobile health care and has 700 providers currently trained to provide quality healthcare through technology.

趋势# 2。Financial Performance Indicates the Ability of Healthcare Organizations to Survive

While there have been many notable mergers in the past few years—for example, the merger of HCA Healthcare and Mission Health, andMercy Medical Center joining Cleveland Clinic目前还不清楚这些新成立的公司将如何影响卫生系统和保险公司的未来。

私营企业也在医疗保健领域发挥着前所未有的作用。Companies likeAmazonandSam’s Clubare taking aggressive tactics to solve these complex healthcare challenges rather than relying on traditional methods. For example, both companies now offer virtual clinical and home visits for their employees. Google is hiring physicians from and to develop new healthcare solutions that could possibly threaten current healthcare organizations by taking patients away from traditional hospitals and clinics.

In addition to mergers and private sector activity, dramatic changes in healthcare costs occurred in 2019—an increase in family coverage plans, increases in overall insurance costs, worker/employer share, etc.—and those changes are likely to continue well into 2020 (Figure 2).

Employers also had to deal with the new1.9 million new beneficiaries2019年被纳入医疗保险优势，占医疗保险总人数的34%。这些增加了雇主和医疗保健组织的成本负担，因为他们努力为日益增长的人口提供保健，而财政资源有限。

趋势# 3。Social Issues

As the business of providing healthcare becomes more complex, so does the process of treating individual patients. Instead of looking through a myopic lens that only allows a provider to see a patient with an illness, clinicians and their multidisciplinary teams are now collecting socioeconomic information as part of the care process. Where a patient resides, employment, family situation, etc. all affect an individual’s health and clinicians should include this information throughout thecare process.

Social Determinants of Health

Social determinants of health (SDoH) impact mortality, morbidity, life expectancy, healthcare expenditures, and health status and functional wellbeing, to name a few. They also cause major disparities in health and healthcare.

The data clinics, health plans, and hospitals are collecting today is far richer than it used to be and can highlight inequality. Data shows, for example, a stark disparity when it comes to healthcare cost being a deterrent to getting care. Anywhere from 10 percent to 22 percent, depending on race and ethnicity, did not see a doctor because of the cost, and anywhere between 19 percent and 35 percent delayed needed medical care because of the cost (Figure 3).

Thesedisparitieslead to situations where patients is prevented from following medical advice due to cost. For example, a diabetic patient will stop taking insulin or use less insulin than they need to survive because of the high cost of this prescription drug.

The percentage of patients with a usual source of care ranges from 75 to 87, depending on ethnicity. Those who have seen a doctor in the past 12 months or had a healthcare visit in past 12 months ranges from 75 percent to 85 percent, again, depending on ethnicity. Lastly, this disparity also appears among those who have seen a dentist in the last 12 months; between 54 percent and 68 percent (Figure 4).

With source of care andhealth visit dataclearly illustrating the need for better access, health systems have the insight to improve care across underserved race and ethnicity categories.

The Opioid Crisis

As the fight to combat , so does the legislation to overcome it—theSubstance Use Disorder (SUD) Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Actwas passed in 2018. Thebenefitsof this legislation will continue throughout 2020:

• Expands treatment of SUDs.
• Provides funding for residential treatment programs for pregnant and postpartum women.
• Authorizes CDC grants, states, and localities to improve their prescription drug monitoring programs.
• 扩大使用以阿片类药物为重点的远程保健服务。
• Helps stop illicit opioids from entering the country.

Another promising development to help combat the opioid epidemic is the additional number of codes for on opioid use disorder and the telemedicine parity law, passed in 36 states and District of Columbia. Telehealth allows people who live in hard-to-reach places to access the same opioid addiction recovery services that are offered in an urban area. The new telemedicine parity law requires private insurance companies to cover telehealth the same way they cover in-person visits, making opioid disorder support services more affordable.

How Can Health Systems Prepare for 2020 Healthcare Trends?

2019 was a tumultuous year for healthcare. Health systems should adjust to the changes and also prepare for 2020 by considering key questions:

• What will health organizations do if the ACA is repealed?
• Are health systems ready for, and practicing, price transparency?
• How do prescription drug prices impact a health system and its patients?
• 卫生组织能否获取和分析其数据以支持风险?
• Do health organizations collaborate and work with community organizations to collect race, ethnicity, and language data to identify care disparities?

The time to prepare for change in healthcare legislation, healthcare access and delivery, and payment methods is now—health systems need a clear goal and a strategic plan, based on their current knowledge, that will help them get there.

As health organizations continue to evolve in an everchanging landscape, digital health, alternative payment models, and better data, including social determinants of health, are key pieces to the puzzle. Health systems have opportunities to improve like never before; new types of organizations are entering the healthcare industry with new ideas, technology is changing the method of delivery, and patients are demanding price transparency.

The only way for health systems to remain successful, and flexible, is to be willing to try new ways of healthcare delivery and to never lose sight of the reason the organization exists—to provide the care to each patient, when, where, and how they need it.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

1. The Top Five 2019 Healthcare Trends
2. Healthcare Quality Improvement: A Foundational Business Strategy
3. Today’s Top Five Healthcare Payer Financial Opportunities
4. Removing Barriers to Clinician Engagement: Partnerships in Improvement Work
5. Healthcare Analytics for Payers: How to Thrive Through Shifting Financial Risk

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