PwC’s Top Health Industry Issues for 2013

By Claire Thayer, January 14, 2013

Last week, PwC’s Health Research Institute outlined their 10 Top Health Industry Issues to watch out for in 2013. Here’s a summary of their Top Ten issues culminated from recent survey of 1,000 consumers:

1.    States on the frontlines of Affordable Care Act implementation

Over the next year, state officials must decide how to run insurance exchanges, whether to expand Medicaid coverage, and what type of insurance market regulation is needed. The biggest challenge states may face in 2013 will be information technology.

2.    Consumer revolution in health coverage

Consumers’ rising voice on how they spend their healthcare dollars, coupled with state insurance exchanges, is prompting the health industry to compete on attributes similar to the retail industry: convenience, price and transparency. 

3.    Medtech industry braces for excise tax impact

A 2.3 percent excise tax on medical device companies takes effect on January 1, 2013, representing potentially $29.1 billion to the federal government over the next 10 years.

4.    Caring for the nation’s most vulnerable: dual eligibles

Dual eligibles – people who qualify for both Medicare and Medicaid – make up many of the 16 million people the ACA will add to Medicaid rolls by 2019.  The cost of care for duals is skyrocketing – much of it wasted due to a lack of care coordination between the two programs – and 70 percent of state Medicaid spending on duals goes to long-term care support services, such as nursing homes. 

5.    Bring your own mobile device: convenience at a cost

Doctors and nurses are bringing their own mobile devices to work, but many hospitals do not yet have a secure enough environment to protect sensitive patient information.  Sixty-nine percent of consumers surveyed said they are concerned about the privacy of their medical information if providers were able to access it on their mobile devices. 

6.    Goodbye cost reduction, hello transformation

With reimbursement resetting under the ACA and pressure from the federal budget crisis and price-conscious consumers, hospitals are scrambling to further reduce their costs.  HRI research found that 40 percent of consumers postponed care in 2012 because of the costs. 

7.    Customer ratings hit the pocketbooks of healthcare companies

Paying for performance will take on new meaning in 2013 as consumer reviews generate penalties and bonuses for hospitals and insurers. This could mean a bonus payout of more than $3 billion for insurers and a hold back of $850 million for providers in 2013.

8.    Meeting the new expectations of pharma value

Physicians, once the primary arbiters of pharma value, now have less say in payment decisions than insurers and large providers. The final hurdle in the long, expensive path to drug and device development is not regulatory approval, but rather reimbursement. 

9.    Bigger than benefits: employers rethink their role in healthcare

For nearly 70 years, employer-based coverage has been a cornerstone of U.S. healthcare - but healthcare and employers may not be inseparable.  With the Supreme Court ruling to uphold the ACA and the re-election of the President, employers have an opportunity to re-examine their long term role in providing healthcare coverage and explore alternative approaches provided by state and/or private exchanges.

10.    The building blocks of population health management

Medicare's accountable care organization and patient-centered medical home initiatives laid a foundation for improving population health, but other collaborations are fueling growth in population health management. 

For more details and to download the full report, visit: www.pwc.com/us/tophealthissues