The Top Five 2019 Healthcare Trends

his article is based on the January 2019 webinar “Healthcare Outlook for 2019” by Bobbi Brown, MBA, and Stephen Grossbart, PhD.

在2018年中期选举期间，候选人面对的是修补破损的医疗体系的大胆主张。那么，新一届国会在改善医疗保健和修复陷入僵局的政治体系方面做了什么呢?Beyond political maneuvering, 2018 saw material changes in the business of healthcare, including the increased pace of mergers and acquisitions as well as new measures from CMS to support transparency, interoperability, and a continued shift tovalue-basedpayments. These changes have significant ramifications for health systems in 2019 as the pace of change continues to increase.

卫生系统必须不断适应其社区、人口、政治和报销结构的变化。了解当前的气候和即将到来的医疗保健趋势可以帮助他们跟上重要的变化，并为未来做好准备，以保持财务上的可行性。本文分析了2018年医疗保健领域最大变化的影响，并预测了2019年医疗保健趋势，卫生系统应该关注这些变化。

The Politics of Healthcare

Healthcare continues to be an important, but divisive political topic. Not surprisingly,41 percent of eligible voters称医保是2018年中期选举的关键议题。In 2008, when the ACA became law,only 46 percent of voters supported single payer healthcare. That number has grown significantly to 59 percent approval in early 2018. While Medicare-for-all legislation is unlikely to pass both the House and Senate in its current form, there is a shift in public opinion with a solid majority now in favor.

Similarly,Medicaid is expanding. During the 2018 midterm elections, three states had ballot proposals to expand Medicaid, and two other states replaced governors who had blocked legislative attempts to expand Medicaid, resulting in a total of five new states that will expand Medicaid. Overall, the U.S. will likely increase Medicaid coverage to as many as 76 million enrollees by 2020.

Many states are also passing laws that make it easier for residents to access affordable healthcare. To that end, it seems Congress won’t repeal it–for now. Even with a Republican-majority House and Senate, there wasn’t enough support to repeal the ACA, so the ACA and the federal exchange should continue to thrive in 2019. Enrollment was down slightly in 2018 compared to 2017, but the numbers are still high. During the 2018 open enrollment period,8.4 million people enrolled(down from 8.7 million in 2017).

However, while people are still signing up for insurance through the federal healthcare exchange, legal challenges to strike down the ACA still loom.A Texas judge ruledin 2018 that the entire healthcare law is unconstitutional because Congress had voted to remove the penalty for not having health insurance. According to the ruling, this effectively killed the constitutionality of the law because the Supreme Court had ruled that the original law (and penalty) was constitutional because Congress had the taxing authority to impose that fine. The judge’s 2018 ruling was quickly followed by legal analysts on both sides of the political aisle saying the judge’s reasoning was flawed, so it’s unlikely this ruling will stand. Regardless of the outcome, the ACA appears to be here to stay for the foreseeable future unless the Supreme Court steps in and makes changes.

Transparency

While there’s partisan divide about the ACA, both parties agree on the importance of transparency. As Figure 1 illustrates, most states are not doing well in this arena. The maps provide transparency and quality scores for each state. Grey colored states on both maps indicate a failing grade, while blue states indicate an “A” for either quality or transparency.

Price transparency in healthcare is another big issue to watch for in 2019. Prior to January 1, 2019, California was the only state that required hospitals to post their prices online for consumers to view. As of January 1, 2019, CMS requires all hospitals to post prices online. However, prices don’t provide the whole story as patients’ costs remain a mystery. For example, if a patient has a hip replacement surgery at an outpatient center versus in a hospital as an inpatient his costs are going to vary considerably and include a wide range of variables. To aid consumers in understanding the billing process, Maryland state hosts a website where total cost is available for some procedures. The site shows the hospital costs and a potential total cost per condition, along with some quality metrics related to that condition for individual hospitals. This is a good example of how states can help improve transparency for consumers, enabling them to make informed choices about their healthcare.

Telehealth

另一个得到强有力政治支持的医疗保健倡议是远程医疗。That support likely comes from the fact that, according to HIT Consultant,Accenture conducted a 2018 surveyshowing that 78 percent of consumers are interested in receiving virtual health services. In 2019,Physician Fee Schedule regulation expanded coveragefor telehealth and virtual care. Thirty-four states and the District of Columbia now require private insurers to cover telehealth the same way they would cover in-office services.

The Business of Healthcare: 2019 Healthcare Trends

As healthcare grows and changes, new business models are taking shape. One of those models is personalization of healthcare services. Consumers are taking advantage of personalized healthcare options that provide a concierge model of service, accommodating the care they want at the time and location that’s convenient, such as the expansion of telehealth services. New models also means new market entrants and shifting strategies are driving changes in the healthcare landscape, withAmazon, Berkshire Hathaway, and JPMorgan’s foray into the healthcare spaceat the forefront. They’re not the only ones, however. Companies are seemingly entering the healthcare market from all directions and industries; Google is hiring physicians, including former executives ofGeisinger Clinicand theCleveland Clinic;Apple is investingin their Wellness Monitoring App; and even Uber is getting in on the action with thelaunch of Uber Health帮助增加患者接触的机会。

Mergers and acquisitions are the norm with partnerships forming everywhere. For example,CVS is working with Aetnato combine 10,000 stores, 1100 clinics, and 22 million enrollees. TheCEO of CVS, Larry Merlo, said about the move, “We are hard at work creating a plan to differentiate CVS Health in these patient journeys with the goal of making them simpler and more personalized while making care more actionable.”Cigna and Express Scripts combinedto create insurer and pharmacy benefit company, andUnitedHealth Group’s OptumCare and other insurance companies are buying physician practices试图控制医疗系统的第一次投入。

卫生系统的伙伴关系和合并的清单似乎无穷无尽。Meanwhile, many hospitals have closed their doors–a total of21 in 2018alone. While hospitals are closing, existing health systems are expanding their facilities. According to theAmerican Hospital Association’s (AHA) 2019 Hospital Statisticsreport, 71 percent of respondents said their hospitals will be acquiring off-site outpatient locations. Looking at volume trends reported by the AHA, it’s clear that inpatient admissions are trending down, while outpatient care centers are increasing, which points to a change in the way healthcare is delivered.

Bridging Healthcare Disparities

According toNational Research Council, the United States is among the lowest in terms of life expectancy out of 17 of countries with similarly high income. Health disparities take part of the blame. Variation in life expectancy across the county is dramatic. Access to healthcare services, education, early childhood development, and work conditions vary greatly. New York City is a perfect example of these disparities. In apresentation at the Institute for Healthcare Improvement in December 2018, Don Berwickstated that people who live on the upper east side of Manhattan have a life expectancy that is 10 years longer than those who live five miles north in the south Bronx. A breakdown of this shows that life expectancy declines by six months for every minute someone travels on the subway or 2.3 years for every mile driven.

解决这些复杂的差异是具有挑战性的，但一些组织正在尝试这样做。For example,Rush University Medical Centerin Chicago is taking ownership of the disparities. The organization’sstated goal就是努力提高预期寿命，不仅是学生和员工，还有附近的社区。为了实现这一目标，他们正在招聘和发展当地人才，并将最低工资提高到大约每小时22美元，他们认为这是支持健康的最低工资水平。他们还在当地采购产品，而不是在全国范围内采购，他们在社区投资的目标是改善居民的健康质量，增加周围社区的预期寿命。

This visual below fromthe Democracy Collaborativeprovides more details about Rush’s aim to address healthcare disparities:

The Shift to Value-Based Care

CMS is working to shift healthcare delivery from a fee-based system to a value-based system, which means the payment structure for Medicare payments continues to change. Most of the value-based programs CMS offers have been in place for several years and hospitals that participate are showing results in reduced readmissions. According to theMedPac report out in June of 2018, as the readmission rate declined, mortality rate and ED/observation rates were steady, but there was two billion dollars in annual savings, showing that the shift to value-based payments is making headway.

Accountable Care Space

As predicted,the accountable care space grew in 2018而且可能会继续增长。ACO的目标是通过采用真正的基于性能的模型来承担真正的风险，该模型在ACO表现良好时提供好处，但如果不表现则会评估罚款。This CMS model for ACOs,Pathways to Success, revolves around bundled payments and has five goals: accountability, competition, continued quality, integrity, and beneficiary engagement. This last goal is exciting. It means ACOs can talk directly to beneficiaries to offer incentives for care. United Healthcare has a value-based arrangement—a program it refers to as the intersection of health plus care.

United Healthcare reports that the 15 million members who received care under a value-based arrangement experienced improved health and better care at lower costs, illustrated in Figure 3 below.

Episodes of Care

Episodes of Care havetaken healthcare organizations on a wild ride. These are bundled Medicare payments that started out as voluntary, then were mandatory, but arenow again voluntary. The new voluntary episodes of care bundle, which began in October of 2018, is called捆绑支付改善护理(BPCI)高级。有1547家医师组织和医院注册了BPCI，其中包括质量评分作为项目的一部分。

Some examples of bundling payments include major joint replacement, congestive heart failure, and sepsis. This program gives health systems an opportunity to get their feet wet, so to speak, and try out an episodes of care model before going all in.

Looking to the Future: 2019 Healthcare Trends

随着所有这些变化的发生，卫生系统在2019年保持领先地位有几个关键因素。卫生系统应该清楚地了解其目标，并根据当前对卫生保健领域的了解制定战略计划。When it comes to ACOs, bundles, and risk-based contracts, health system leaders should be ready for a growingdataburden and make sure there are analysts on board who know how to analyze claims data. Building capacity to integrate claims and clinical data is also critical. Another trend that’s worthy of following is collaboration with community partners to improve healthcare delivery and reduce disparities.

卫生系统必须足够灵活，以适应行业的变化，包括新的医疗业务模式、合并和收购以及报销结构。了解这一前景和新的期望可以帮助它们在未来的医疗保健中保持可行性。

A poll of a 2019 Healthcare Trends webinar attendees showed that nearly half of attendees believe that consolidation and changing business models will be the top healthcare story in 2019, with big market share gains in new care delivery models and consumerism coming in second and third, respectively. No matter what happens in 2019 and beyond, one thing is certain: healthcare organizations will have to change and adapt in order to meet the challenges of the evolving healthcare landscape.

Additional Reading

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

1. Emergency Department Quality Improvement: Transforming the Delivery of Care
2. Transforming Healthcare Analytics: Five Critical Steps
3. The Missing Ingredient in Healthcare Analytics: The Executive Sponsor
4. Addressing Healthcare Waste Through Centralization
5. A Framework for High-Reliability Organizations in Healthcare