Policy upheaval, tech giant disruption and megamergers: Healthcare Dive's 10 best stories of 2018
This year in healthcare was marked by sweeping changes, including seemingly constant vertical and horizontal consolidation, led by the $69 billion CVS grab of Aetna and Cigna's $67 billion acquisition of Express Scripts.
As 2018 wound down, a federal judge took an ax to the Affordable Care Act as the Trump administration kept up its efforts to undermine the law, with CMS expanding short-term health plans many say are built to subvert the ACA. Elimination of the individual mandate penalty, Medicaid expansion and rising premiums all likely contributed to declined enrollment on ACA exchanges as well.
The administration encouraged states to use waivers to expand controversial Medicaid work requirements and proposed site-neutral payments, rattling health systems of all sizes that were already struggling under ferocious operating headwinds. Hospitals cut back on services and invested heavily in lucrative outpatient facilities in an attempt to reclaim volume.
Tech companies Apple and Amazon pushed further into the space, with the former focusing on mobile health apps and the latter focusing on, well, almost everything.
But that's just scratching the surface. Here is a curated list of Healthcare Dive’s top stories from the last year.
Some smart observers saw a predecessor to these unions in UnitedHealth Group's Optum: a pharmacy benefit manager plus a care services unit that employs over 30,000 physicians, using data analytics to capitalize on consumerism and value-based care.
Our piece on Optum's solid foothold in the space, and its likelihood of staying ahead of the nascent competition, was Healthcare Dive's most-read article in 2018. Read More »
A novel Medicare Advantage rule giving payers more flexibility to sell supplemental benefits to chronically ill enrollees sparked a fair amount of interest in our readers.
The rule offered up a slate of new opportunities for insurers such as UnitedHealthcare and Humana that can now work with rideshare companies to provide transportation to medical appointments, air conditioners for beneficiaries with asthma and other measures around issues like food insecurity in a broad shift to recognizing social determinants of health. Read More »
Outside players such as Apple, Amazon and Google moved forward in their bids to disrupt healthcare in 2018. Apple rang in the New Year with its announcement that customers would now be able to access their medical records on the Health app following months of speculation and buzz.
The move looks to put access to personal, sensitive data back in the patients' hands, an objective a lot of the entrenched healthcare ecosystem can get behind as well. Heavy hitters on the EHR side (Epic, Cerner, athenahealth) and the provider side (Johns Hopkins, Cedars-Sinai, Geisinger) are taking place in the initiative. Read More »
Nurses have been advocating for more equitable nurse-to-patient staffing ratio for decades now, but 2018 was a particularly toasty hotbed of labor disputes around the issue.
Short-staffed, overworked and burned out nurses pose significant risks to health outcomes and workforce retention in hospitals. But hospital interests argue their narrowing margins won't allow them to survive under a hiring mandate, especially with nurse shortages and escalating operating headwinds.
At least 14 states have legislation addressing safe staffing currently, but California is the only one to implement a strict ratio at one nurse per every five patients. Looking to 2019, in Pennsylvania voters elected a governor who has voiced support for state legislation. Read More »
Employers ramped up their cost-containment creativity in 2018. One method? Cutting out the middleman and forging direct relationships with providers themselves, whether it's contracting with an accountable care organization to manage an entire employee population or a simple advocacy role to fight for payment reform.
Although only 6% of employers are doing so currently, 22% are considering solidifying some sort of provider relationship for next year according to a Willis Towers Watson survey. It's also likely the Amazon-J.P. Morgan-Berkshire Hathaway venture will look at direct contracting in its (still vague) mission to lower employer costs. Read More »
Amazon's B2B purchasing arm reached out and grabbed the healthcare supply chain this year, shaking a once-predictable business model.
Under intense operating headwinds, supply chain professionals looked to trim the fat from traditional distribution and supplier models in 2018. Some looked to Amazon Business, which generated more than a billion dollars in sales its first year alone by relying on its marketplace model, streamlined ordering and a "tail spend" strategy.
Healthcare Dive discussed this and more with global healthcare leader at Amazon Chris Holt in an exclusive interview that drove a lot of interest. Read More »
Value-based care was a buzzword over the past year, with providers, payers and healthcare execs across the board looking (or saying they're looking) for ways to cut costs and improve quality.
Although legal barriers stemming from the Anti-Kickback Statute and Stark Law persist, medical technology companies jumped on the bandwagon, with big names like GE, Philips and Medtronic coupling with hospitals to promote VBC initiatives. Read More »
The combination of the e-commerce giant, a 200-year-old multinational investment bank and Warren Buffet's redoubtable holding company joining forces to take on healthcare costs spooked investors in traditional industry players. The venture added a slew of big names to its C-suite, including Atul Gawande and Jack Stoddard for CEO and COO, respectively. Read More »
Anthem made big waves earlier this year when it released clinical guidelines that wouldn't require a nurse or an anesthesiologist to monitor anesthesia during cataract surgery.
February's move was one in a chain of cost-saving moves by the Indianapolis-based payer, including not reimbursing for some emergency department visits or imaging tests done in hospitals. Anthem's drive, ostensibly to move patients to more inexpensive outpatient facilities, set off a tsunami of provider criticism (and at least one lawsuit). Read More »
In August, CMS issued its final rule on the Inpatient Prospective Payment System, cementing an earlier proposal to push hospitals to make their standard charges available online (and solidifying data and price transparency as a focus of Trump's CMS).
Since the rule reduced reporting periods, eliminated reporting measures and struck the 25% threshold policy for long-term care hospitals, it was welcomed by health systems and hospital associations alike.
Though the rule didn't require hospitals to post any more information than they already had to, CMS issued a request for information that acknowledged the wide gaps in pricing the agency still has to address.
The agency will likely bring its interest in cost advocacy into 2019. Read More »
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