Ten Trends to Ponder for 2014

By Clive Riddle, December 20, 2013

These aren’t necessarily the top ten trends for the coming year, because the ranking of trends depends on the position of the stakeholder – in other words – in the eye of the beholder.  But below are ten trends worth pondering as one positions oneself for the year ahead:

Private sector co-opting of public healthcare policy.  Consider a number of the trends discussed below. What they have in common – an overarching theme – is that the private sector has co-opted public healthcare policy, and may have achieved a greater impact than the public sector in doing so. The ACA begat Medicare ACOs – but the commercial ACO arrangements are generating a groundswell of activity. The ACA’s centerpiece is the public exchange launch of 2014, but the private sector is paying an awful lot of attention to private exchanges. Ten years ago, HSAs and High Deductible Plans were policy driven – now they are market driven. The Stimulus drove Meaningful Use, but now that it’s become meaningful, the private sector is leveraging what to do with this new framework.

Commercial ACO Collaborations become commonplace. Soon health plans and provider networks may stop issuing press releases with each new collaboration because they are so commonplace, they just aren’t news anymore. Unlike their Medicare counterparts that are standardized arrangements, the commercial collaborations are customized, any one might argue about how many of them meet the definition of a true Accountable Care arrangement. Or perhaps they will simply erode the definition to the point where we end up calling them something else.

Private Exchanges Exceed Expectations While Public Exchanges Fall Short.  While public exchanges can drive much bigger numbers due to sheer numbers of the uninsured and underinsured, and the availability of subsidies, 2014 will find the level of impact and implications falling short of expectations as not as many of these population opt-in as expected, at least for now. This will also mean the dire predictions of ongoing glitches and budget shortfalls may not be as bad as predicted, because there will be fewer numbers for now compared to initial rosy projections. Meanwhile, private exchanges may very well exceed initial expectations for enrollment and levels of interest as 2014 takes shape.

Defined Contribution Drives Private Exchanges.  Defined contribution health plan arrangements were the buzzwords at the dawn of this millennium, but got left aside in the rush to account based and high deductible health plans in the consumerism movement. But now the stars are aligning for the return of the prodigal defined contribution son, as the driver of how most private exchanges are designed, and the driver of private sector interest in 2014 and beyond.

Is Everyone in a High Deductible Plan? There a lots a surveys with varying reported levels of HDHP penetration in the commercial sector – but this much can be agreed upon – all the percentages keep trending up… and up. Unfortunately, the account based plans that were supposed to accompany the HDHPs are missing in many employer sponsored plans, or at least the employer contribution is. Never the less, the trend for HDHP growth will continue.

Innovation, Transformation and Integration are the Words of the Year.  Like the old 80’s episodes of Pee-Wee’s Playhouse, with the word of the day that set off buzzers, Innovation, Transformation and Integration are the words for 2014… although they will in many cases, be words but not action at this point in time. But if your organization doesn’t yet have a Chief Innovation, Chief Innovation or Chief Integration Officer, look for them in 2014.

EHR Tipping Point Drives Innovation. Of course lots of physician practices still don’t have EHR. And a number who do aren’t all that interoperable. But still, the point has been reached where there’s gobs of stuff you can do with the level of electronic data and transmission that is now being generated – and this is going to continue to stimulate a plethora of new applications and solutions in a range of environments.

Analytics Extends Its Reach.  Analytics has become huge for so many sectors – healthcare may actually be a laggard. But make no mistake – analytics is where the action is in healthcare for 2014 if there is any hope in taming the beast of operational inefficiencies, resource management, and explosive costs.

The Further Evolution of Population Health.  Ten years ago the definition of Population Health was commonly held to be “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” and was more prevalent in policy and academic circles. 2014 finds the scope and role of population health expanding and evolving, with strong involvement from the private sector.

Consumer Engagement Just Needs More Consumers to Get Engaged. In 2014, we will see the tools are there – apps, websites, outreach programs, incentive programs, plan design, you-name-it. The challenge we find ourselves in for 2014, is a number of surveys continue to demonstrate that large blocks of consumers remain unengaged, uninformed and fairly clueless about the delivery or the business of healthcare.