Ten Key Health Care Business Trends for 2011

by Clive Riddle, December 16, 2010

The time has come to start making a list, and checking it twice. What’s on your list of the trends that will shape how your organization proceeds through the new year? Here’s my take on some key trends that will affect the business of health care in 2011:

1. Impact of Health Reform Backlash:
A Republican House, negative public opinions and a Federal judge’s ruling on mandatingcoverage combine to have an influence on health care reform implementation in 2011.No- there isn’t a feasible way to repeal the Affordable Care Act in 2011, as a number ofRepublicans have called for. However, that doesn’t mean that various aspects of healthreform backlash won’t loom large in further development of implementing regulations,ongoing funding provisions, and how stakeholders react.

2. Medicaid Clout
As employment based health coverage shrank during the past decade, Medicaid grew,particularly once the recession kicked in. The Affordable Care Act turbo chargedprojected Medicaid enrollment for the coming years. Given that health care policy can beoften most effectively be dictated through the role as purchaser, Medicaid has increasingclout to impact policy in 2011 and beyond. Furthermore, the increased enrollment hasmade Medicaid the awakening giant for health plans and provider systems to deal with.Major health plans will increasingly look for Medicaid contracting, market expansionsand plan acquisition opportunities. Major providers will dedicate increased resourcestowards Medicaid delivery systems.

3. ACO Initiatives
No one is waiting to see how Medicare ACO pilots set forth under the Affordable CareAct will turn out. 2011 will witness continued rapid deployment of ACO developmentand operational initiatives in the commercial and Medicaid sectors.

4. ACO Naysayers
There will be a growing groundswell of warnings about getting involved with ACOs.Never has there been swooning in the marketplace over a hot new trend without theaccompanying follow-up of naysayers shortly thereafter attributing all the attention tohype, smoke and mirrors. Quite often, it can be for good reason. But by the end of 2011,we won’t know if that’s the case or not for ACOs.

5. Provider Payment Reform
The provider contracting environment will be subject to much greater change andupheaval in 2011. Whether driven by new delivery system initiatives such as ACOs,medical homes, and integration initiatives; general payment restructuring such as byepisode of care; or network restructuring initiatives such as narrow networks, 2011 willwitness significantly heightened activity.

6. Physician Integration
It isn’t just all about potential ACO development. Whether due to EHR/Meaningful Usepressures, economic pressures, perceptions of the future outlook for health care, and ahost of other factors, physicians in private practice will continue to integrate into largermedical groups, and or with health care systems at an increasing rate in 2011.

7. Wellness Incentives
Find some major employers in 2011 that aren’t deploying health risk assessments andfinancial incentives for employees to engage wellness and lifestyle health care issues,and they most likely are developing plans to do so. Those that are already involved willcontinue to roll out additional programs, particularly seeking how to reach into dependentengagement.

8. EHR Critical Mass
Broadband internet connectivity existed for sometime before it reached enough criticalmass for consumers nationwide to routinely start watching You Tube videos of twoyear olds biting their older brothers’ fingers. In 2011, there will be enough medicalgroups, hospitals, health plans and consumer portals to engage and transact a materialsegment of the consumer population with their health care, and the impact of this ongoingtransformation over time will be immense.

9. Survival of Consumer Driven Plans
HSAs and Consumer Driven Plans were written off by pundits as health care reformcoalesced during the past two years. But the plans are survivors, and reports keep comingout documenting moderate, steady growth, that over time, makes them an importantfactor in the health benefits equation.

10. Era of Uncertainty
There’s so much unknown country to drive through: how much will health carereform backlash affect reform implementation? What will be the specifics of variousimplementing regulations? Will the economy pick up steam or not? How are otherstakeholders going to behave in this environment? Often, with major uncertainties afoot,organizations can tend to hunker down for the time being. But with so much at stake,2011 will require driving forward without an up-to-date road-map.