Healthcare continues to feel the pain of reform in 2016
In September, I found myself holed up in a hotel in San Jose, CA for a couple of days for Health 2.0 where, in between what seemed like hundreds of venture capital pitches, the depth of industry disruption suddenly dawned on me.
No doubt, the healthcare industry will likely be very different by end of president-elect Donald Trump's first term. There will certainly be plenty of stories to follow regarding the development of the industry under his watch but the disruption I felt in September extended beyond regulatory implications over the industry. While I hate to use the overly used word "disruption," it still best describes what I realized: The industry is battling within itself for control.
Coming from a health IT journalism background, I was aware physicians weren't too keen on programs such as Meaningful Use. They felt it pushed, rather than guided, them to use technology that wasn't widely adopted in the first place. For one part, these legacy systems weren't initially designed to talk to each other. Physicians and health systems found themselves stuck between regulations and health IT vendors. One was asking health systems to share patient data while the other made it nearly impossible to do so.
However, as these systems have been widely adopted, it's finally time for physicians, regulators and vendors to work together to develop a system working toward the ever-buzzy "interoperability."
National Coordinator for Health IT Dr. Vindell Washington recently told Healthcare Dive that he himself was struck with the scale of complexity of the health IT landscape. That said, as Chilmark Research recently noted in its year-end review, interoperability is still largely hampered by culture, not lack of technology.
IT challenges aside, actors within the industry are shaking out winners on the other side of healthcare reform. As James Surowiecki notes in The New Yorker, physicians have traditionally protected their own financial interests. Citing Paul Starr's "The Social Transformation of American Medicine", Surowiecki notes the AMA attempted to tamp down prepaid medical groups in the early 20th century, as such organizations were seen as a threat to doctors' pocketbooks.
Today, we see a different set of actors trying to wrestle control and/or money from the physician's grasp. Take, for example, the trend toward retail and primary care clinics. Only 90 or so retail clinics were in operation and about one in 10 consumers had been to one in 2006, as PricewaterhouseCoopers' recently noted.
As healthcare access and transparency has generally been a thorn in the side for the patient, companies such as Wal-Mart and CVS Health looked to these clinics as an easy revenue stream. Providers, as well as insurers, eventually took note as they realized they were getting cut out of some financial action. Providers such as Sutter Health began partnering with CVS Health to enter the space and offer varying levels of care access plans for different levels of acuity, while Mount Sinai recently partnered with insurer Oscar to enter the primary care clinic space.
Today, more than 3,000 retail clinics have been propped up across the U.S., with one in three consumers having visited one. This drift highlights the continued move to more convenience in healthcare access as well as price transparency for patients.
Trends toward potentially emerging healthcare markets are wide and vast. From concierge care and transportation partnerships to digital health wearables, there's a lot of innovation in the space. But clinical adoption for many of these innovations have yet to stick.
Whether it's because these innovations are seen as threat to the power of the profession or not, I can not say – but what strikes me is as the shift to value-based and preventative services continue, I expect more vendors will enter the space to make a run for some of the $3 trillion market that is the healthcare industry.
Most individuals I spoke with this year noted they see behavioral health services to be a growing market. Capturing wellness and nutritional data for patients to create a whole picture for physicians have been an emerging discussion I've been having with sources. Yet, with disparate vendors and health data points of interest, the need for interoperability and predictive data analytics will largely be needed if the perceived outcomes of healthier patients and timely interventions are to operate smoothly.
I imagine there may be resistance to new trends and companies coming into the space as that cedes power and money from the ruling healthcare class, though to what degree is yet to be seen. Unfortunately, it's hard to update the telling of history as it's currently being told. Healthcare is a complex system with a lot of moving parts and no doubt the vendors, physicians, payers and other industry stakeholders will be acting to protect their own investments and self-interest as we exit 2016 and head into 2017.
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