Corrective Lens Needed for 2020 Healthcare Vision

By Clive Riddle, December 19, 2019

How did two decades of the new Millennium already fall into the rear view mirror? Weren’t we just bracing healthcare organizations for all the fallout that was supposed to emanate from Y2K?

It’s a shame we don’t have corrective lens that can adjust for hindsight, as we attempt to seek 20/20 vision into 2020 and beyond. None the less, here’s seven quick takes on trends that should shape our new year:

1. Election Year Policy Angst - Its not just Democrat vs Trump policy proposals – it’s also what fallout is coming from the forever legal saga surrounding the ACA, congressional proposals, state proposals and ballot initiatives, and lobbying clout. A lot is at stake and a lot is uncertain.
2. Expanding Impact of Medicaid Expansion - While Medicaid Expansion policy falls under the above discussion, the impact of Medicaid Expansion is a category unto itself: the coverage disparities between states; the resulting funding disparities for hospitals; the health improvement metrics where expansion is firmly in place; the transformation of dominant product mix for health plans and much more.
3. One More Year for SDoH Before.. - Speaking of impact of Medicaid Expansion, growth of Social Determinant of Health initiatives were totally fueled from that source. Good vibes are abundant from the embrace of SDoH by plans and providers, which will continue to reach a crescendo. Then a year from now, as always happens with shiny new trends, naysayers and boo birds will start to emerge questioning the ROI.
4. Viral Value Based Payment - No end seems to be in sight for value based payment models and arrangements. They will continue to spread and mutate into new forms.
5. Health Technolytics - The rapid evolution of healthcare technology platforms, devices and analytics will continue to make healthcare organization analytic capabilities more powerful and impactful. Will the humans in the organization be able to keep pace?
6. Morphing Point of Care and Coverage - the lines drawn for where people get their care continue to blur with telehealth, retail sites, mergers of cross-industry forces, e-commerce and other disruptors. Where is this all headed? One thing is certain – disruption will abide.
7. Behind the Veil of Pricing Transparency - CMS hospital pricing transparency regulations will have more of an operational impact in 2020 – and what new pricing transparency initiatives lie ahead for other healthcare stakeholders? (see Election Year Policy Angst)

Is there a trend or issue for 2020 that could potentially have a significant impact for healthcare stakeholders that might be flying under some organizations’ radar? That’s the question posed in the current issue of MCOL ThoughtLeaders.  Some of the above takes are reflected in the ThoughtLeader panel’s responses. Here’s some key snippets they shared:

Patrick Horine, CEO, DNV GL Healthcare says “the push for more transparency of healthcare providers has reached an all-time high. The demands for transparency of pricing, coverage, costs, performance quality raises many challenging questions and concerns as to what should be shared.”

Hank Osowski, Managing Partner, Strategic Health Group tells us “there exists a curtain of uncertainty that is masking what could potentially be one of the most impactful and disruptive periods in the industry’s history. This uncertainty is driven by two dynamics which will help to determine our future: a ruling on the constitutionality of the Affordable Care Act (“ACA”) and the likely turmoil to be created by the elections of 2020. The healthcare industry may not be prepared for the disruption. “

Mark Lutes, Chairman, EpsteinBeckerGreen notes that “an important emerging trend is attention to serious illness management (“SIM”) in the subacute settings—ideally the home. The trend is embryonic yet terribly important — both from quality and cost perspectives. There are significant opportunities to improve patient satisfaction and to optimize the application of resources by focusing on the development of appropriate care models.”

Neal Hogan, Director, BDC Advisors, shared that “value based payment (which looks a lot more like the traditional fee-for-service model than risk) seems to be a signpost on the road to population health---if that is where our system is truly heading. We need to start matching the reality to the rhetoric so we can be clear about how to win in an era of consumerism and transparency.”

William DeMarco, Founder and President, Pendulum HealthCare Development Corporation, comments: “the issues that are under the radar for many organizations who see only one or two options, are the vast variety of CMS models which are emerging and reemerging in different forms that are altering reimbursement as well as delivery of care.”

And Lindsay Resnick, Executive Vice President, Wunderman Thompson Health, summarizes that we should “expect the healthcare community to step-up efforts in cross-industry collaboration. While we’ll continue to see vertical and horizontal M&A reshape the landscape, collaborative partnerships will thrive.”