From the fate of the ACA insurance markets to a new president-elect's healthcare policies, 2016 was no doubt The Year of Uncertainty for the healthcare industry. One of the big questions is how the ACA will stand up to a GOP-led Oval Office and Congress. Alongside debate relating to the fate of the ACA markets came questions over how Medicare reimbursement may change under MACRA and how will the Cancer Moonshot effort take off.
But the ACA markets was only one of the major changes across the world of healthcare in 2016. Telehealth opened up access for behavioral services and the Cancer Moonshot initiative injected an entrepreneurial spirit into big health data and precision medicine efforts.
In the spirit of such a transformative year, we present the 2016 Dive Awards for the healthcare industry. These awards are a byproduct of months of work and research: We have been planning these awards since January, solicited suggestions for nominees from readers in August, then consulted industry insiders to help us narrow down the nominees. Ultimately, the winners were chosen by the editors of Healthcare Dive. Here are our 10 winners for 2016:
Organization of the year
Winner: White House
During its last year, President Obama’s administration made several strides in healthcare, particularly in the fields of precision medicine and cancer research and development. It also worked with more states to help them expand Medicaid and strongly advocated for more and better usage of health technology.
“One thing this administration did that enjoys broad bi-partisan support is emphasize primary care," says Krista Drobac, executive director of the Alliance for Connected Care.
Despite the flaws opponents have pointed to in the ACA, Obama’s signature healthcare law has significantly reduced the U.S. uninsured rate, which in turn has allowed many to receive care for preexisting conditions. Also, the administration increased the focus on veteran’s care, and data transparency from federal healthcare agencies.
Other nominees: Uber, CMS, IBM Watson
Administrator of the year
Winner: CMS acting Administrator Andy Slavitt
One of the reasons health policy was so exciting this year was due to the efforts from CMS acting Administrator Andy Slavitt. Committed to listening to the industry stakeholders and pushing for an open CMS staff, many felt Slavitt’s passion for his work come through various speeches and his infamous Twitter feed.
Slavitt and the CMS at large seemed genuinely interested in working to recapture the “hearts and minds” of physicians. The comments section for MACRA helps illustrate this point, though it did scale up its page length.
"Slavitt has been the rare government official who engages with his Twitter audience instead of speaking at them," Chilmark Research’s Brian Eastwood says. "He has used Twitter to become the administration's honest face of healthcare reform, addressing its successes as well as its challenges. When he has spoken, people have listened."
Other nominees: Barack Obama, Marilyn Tavenner, Mark Bertolini
Transformation of the year
Winner: Payment reform
Bundled payment demos. MACRA. An additional $140 million into Medicare primary-care payments. As regulators push value-based payment reform, the year 2016 saw no shortage in initiatives to drive the industry there.
“I would say payment reform is going to be the transformation of the next five years,” says Drobac. “Right now, everyone is working to figure out how to make this work and CMMI has done a good job seeding all of the ideas since it opened its doors in 2010. Now the transformation is in the process of happening.”
Other nominees: Theranos, ACA insurance exchanges, interoperability
Disruption of the year
Winner: Cancer moonshot
How to adequately tackle cancer has been a mystery researchers and healthcare providers have struggled to solve. With the launch of the Vice President Joe Biden’s “cancer moonshot” initiative earlier this year, 19 different projects were initiated, including a Department of Defense longitudinal study aimed at analysing any new relationships between biological markers and cancers. Another 27 projects will be rolled out over the next year or so.
"More and more research seems to be less about the stereotypical scientist in a lab and more about the data engineer that's going to create new algorithms and new ways to analyze data and find actionable information.”
PricewaterhouseCooper Health Research Institute
The initiative has been the most comprehensive attack on cancer, shedding a new light on the potential of analyzing and sharing genomic data. The National Cancer Institute's new Genomic Data Commons, for example, uses data gathered from different programs and researchers across the world, and includes DNA sequencing information.
“When you look at priorities that they put together around how to reduce the time for cures and speed up the research process, so much of it relates back to data analytics and connecting with consumers around the use of their data,” PricewaterhouseCoopers' Health Research Institute’s Ben Isgur says. “I think what we're finding out is that
Other nominees: Cybersecurity, population health, National Patient ID, precision medicine
Feud of the year
Pending insurer consolidation caught the eyes of antitrust regulators this year.
(Aetna, Humana, Anthem, and Cigna) proposed plans to merge, which were challenged by the Justice Department and some states with two separate lawsuits, citing reduced competition, increased costs to consumers and hamper innovation.
The antitrust lawsuits prompted additional controversy around the mergers, bringing to light issues with the plans such as bickering between Anthem and Cigna as well as accusations from the DOJ and Aetna-Humana of attempting to obstruct the legal challenge and “serious delay and misconduct.” respectively.
Humana and Aetna withdrew certain ACA offerings this year, while Anthem may be planning to do the same for 2018 following poor a unsatisfactory Q3 2016 earnings report and Cigna suspended its plans to expand its ACA participation. Their moves raised some questions.
“What was frustrating as an industry observer and a general citizen was the insurers trying to use the failure to approve their mergers as a rationale for leaving the ACA marketplaces,” Eastwood says. “I think a lot of them are crying foul because they all of the sudden have to cover sick people and they're losing money and they're sad now.”
Other nominees: Theranos, Advocate-NorthShore v FTC
Job of the year
With increased efforts around population health management and the major physician payment shift with the release of MACRA, nurses, known as the backbone of the healthcare system, have taken the spotlight. The industry has become increasingly aware of the nationwide impending shortage with this position, which is now in high demand in several states.
“All roads that lead toward population health and paying for value over volume and wellness and prevention over acute care lead back to nurses,” Isgur says. “They're the linchpin of that, so it's great to see the recognition of that part of our health industry workforce.”
Other nominees: Pharmacists, CIO, Chief of staff, Psychiatrist
Best Development for Patients
Winner: Behavioral telehealth services
Telehealth services are nothing new but when you marry them with behavioral health services, you open up a powerful door to healthcare access for individuals. That’s why we think the best development for patients this year has been behavioral telehealth services.
“We all know behavioral health is a very underrepresented component of the care continuum and seeing that make its way into telehealth and new models of care delivery is a good sign.”
“It brings together two things that most patients for the market really need: One is a use case for telehealth beyond one-off low acuity services and also access to behavioral health services that are woefully lacking in a lot of healthcare markets,” Eastwood says.
Other nominees: Transit partnerships, Online appointment scheduling, Push for interoperability
Obsession of the year: ACA insurance markets
During the ACA’s sixth year, the marketplaces faced numerous challenges and the 2016 presidential election drew some additional attention to the future of the federal healthcare law and its offerings. In response to concerns, the Department of Health and Human Services made some changes to the ACA marketplace this year, such as restricting short-term health plans to less than three months to strengthen the risk pool, and requiring significant documentation to gain coverage during a special enrollment period.
Health insurance companies attributed substantial financial losses to their ACA plans in their 2016 earnings reports, with many of them reducing their participation to the point where consumers now have more insurer monopolies than ever before. Also, the percentage of physicians recently surveyed by Sermo who were participating in the marketplace plans dropped by 4% this year.
Premiums for 2017 coverage went up by 25% on average across all states using HealthCare.gov, which fueled Republicans’ arguments to repeal and replace the ACA. They now control the White House and Congress, so the next move is theirs.
Other nominees: Cybersecurity, M&A, Opioid epidemic, Pokemon Go
Health tech to watch
Digital health and wearables are hot topics right now. Digital health has seen a record number of investments into the space recently. But is the fire going to burn for a long time or cool as tech companies struggle to find their place in the clinical community? That’s why digital health/wearables are on our watchlist for next year.
“For this market to have a tangible impact on healthcare, it's going to need to find its way to bridge the divide between the mass market fitness devices and even low grade clinical devices,” says Eastwood. “Where Fitbit is starting to get more involved is with corporate wellness and that might be an inroad for them to start proving some clinical efficacy but we also saw that study earlier this year about wearable devices not necessarily leading to weight loss so it's one of those markets I want to succeed but it's not quite getting there yet.”
Other nominees: EpiPen, Internet of Things, reanimated limbs, Apple’s healthcare plans
Tweet of the year
10 years from now, the work we are launching today on prevention, care coordination & taking care of people at home could change Medicare.— Andy Slavitt (@ASlavitt) July 17, 2016
The healthcare community is a vocal and there’s no lack of ideas being shared on Twitter any given hour. There were so many good candidates for this category but ultimately, we went to Healthcare Twitter’s breakout star of the year: Andy Slavitt.
Throughout the year, Slavitt has shared interesting, succinct views from the White House on where he sees the industry heading and engaging supporters and opponents on the forum alike. This particular tweet in particular showcases his enthusiasm, determination and humility.