TrendSoup: Ten Key Healthcare Business Trends for 2013

By Clive Riddle, December 19, 2012

There may not be a point to ranking the components in a collection of the top trends to impact the business of healthcare in 2013. It can be difficult to say what specific trend singularly will be the most important – beauty may be in the eye of the stakeholder. It would seem that top tier trends all converge and have some degree of effect on each other – kind of like the ingredients of a soup.

So here’s what this chef sees as the ingredient list – in no particular order – of the 2013 TrendSoup for the business of healthcare:

Exchanging Confusion with Public Health Insurance Exchanges

It is not too daring to predict a good deal of confusion will reign for all stakeholders involved with public health insurance exchanges during 2013, as everyone scrambles to prepare for HIX implementation in 2014. Guidance won’t be able to get produced fast enough; guidance won’t anticipate all the scenarios, and a monumental level of decisions and development must be delved into. It won’t be for the faint of heart.

Employer embrace of Defined Contribution Approach

Interest in private HIXs took off during 2012, and even though public HIXs were validated by SCOTUS and the November elections, it is clear that public and private exchanges can co-exist, and that mid-size and large employers are intrigued by utilizing private HIXs to facilitate a switch to defined contributions for health benefits, particularly for those still involved with retiree benefits.

Medicaid Matters: Implications for local Medicaid Plans

Size Matters. Therefore in healthcare, Medicaid Matters. Starting in 2014, the formerly uninsured will shift in sizeable numbers into the Medicaid system. Much attention has been given to the implications for national Medicaid plans – WellPoint acquired Amerigroup – all eyes are on the implications for Centene or Molina. But the real impact, and larger implications, may be spread over the blanket of local, publicly run Medicaid plans throughout the country. The question is – how will the Medicaid Surge transform the local plans?

Early Successes and Failures of Medicare ACOs

With any major new model of care delivery and payments, comes the buildup and the teardown.  So much has already been said about the hopes, dreams and aspirations for what ACOs can do for healthcare. In 2013, enough early experience will exist for Medicare ACOs, that the inevitable examples of big failures will emerge, with pundits and naysayers gleefully parading out their case studies, proclaiming that ACOs are a big bust. Similarly, there will be big successes that will emerge, with pundits and cheerleaders cheerfully parading them out as well.

Employer and Health Plan Embrace of Commercial Accountable Care Arrangements

The real ACO action around the country may be in how major national and regional health plans are investing in building and securing accountable care arrangements with provider organizations for commercial populations. Already a big deal in 2012 – the level of activity will continue to increase in 2013.

Integrated Healthcare Momentum

A greater  number of healthcare systems will either expand their integration efforts, or initiate such steps, with a particular emphasis on medical home development, accountable care arrangements, full system EHR, and some level of administrative capability to function as a payer, while not typically going so far as a licensed commercial health plan.

Hybridization of Employer Worksite Clinics

Onsite workplace clinics continue to gain in popularity among very large employers, to fulfill a number of objectives – reducing costs, improving access, reducing time off work for appointments, implementing a medical home, and many other strategies. But the concept appeals to a wide number of employers that can’t swing implementation due to their size, physical campus logistics, corporate capital constraints or a variety of other issues. 2013 will find development of more hybrid arrangements, such as shared sites between multiple employers or employer coalitions, TPA or health plan sponsored sites for large clients, mobile clinics rotating between sites and other arrangements.

The Convergence of EHR critical mass, readmissions and analytics

A much wider swath of the provider universe now orbits around EHR. Among other EHR implications, 2013 will find many more provider organizations mining their newfound trove of electronic data to conduct analytics, particularly for readmissions management strategies.

Medication Adherence Becomes a Bigger Target

Whether as part of wellness incentive programs, disease management programs, hospital readmissions management, or other care management initiatives; the realization will become even clearer in 2013 that medication adherence may the largest, lowest hanging fruit for stakeholders to focus on, with a wide range of approaches emerging to better address this long-standing issue.

Explosion of mHealth and Emergence of Breakthrough Apps

There’s an explosion of any kind of app, so it follows there’s an ongoing explosion of available healthcare apps. What will also shakeout in 2013 is that a handful of these mHealth apps will gain traction, go mainstream, and will be coming to an iPad near you, this New Year.

Comments

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