Welcome to 2017. So far, so good, but it won't be quiet much longer for the healthcare industry. Obviously, the incoming Donald Trump administration casts a shadow of uncertainty on the Affordable Care Act, but the industry will have more than enough to deal with as the shift to value-based care continues. From MACRA implementation to Cancer Moonshot efforts, 2017 likely will be a banner year for an industry at a flashpoint of reform. Here are some of the storylines we'll be watching this year:
ACA repeal-and-delay impact
For years, Republicans have called for the ACA’s repeal. With a Republican-controlled White House and Congress, it looks like the GOP will finally be able to make good on that promise. The only problem is...there’s no consensus over what should replace the ACA.
Reports have noted it could be as long as four years before the GOP could implement a replacement. Hospitals may be none too happy over this development. Just yesterday, four medical organizations representing about 400,000 physicians and medical students urged Congress to "to maintain Americans’ access to comprehensive health benefits and ensure a stable insurance market in any health reform legislation they consider."
With at least 20 million Americans gaining coverage through the law and the Obama administration reporting record signups in last December, it will be necessary for Republicans to come up with a sound replacement. The Congressional Budget Office last month stated minimal insurance products that would "not provide enough financial protection against high medical costs to meet the broad definition of coverage" would not meet the office's past definition of "coverage." This notion of coverage and the GOP's plans – and the insurance industry's reaction – will be important to watch this year.
Will Medicare/Medicaid reform be on the table?
There's been a lot of talk about Medicare and Medicaid reform since Trump became president-elect. Trump's HHS Secretary pick Tom Price (R-GA) and House Speaker Paul Ryan (R-WI) have mentioned or alluded to GOP plans for the programs. As of July 2015, 55 million Americans were covered by Medicare, so there is no doubt reform for these programs could shake up the industry.
The shift to value-based care, greater access will continue
Preventive services, wellness and healthcare access are all the rage right now as the shift to value-based care continues to march on. These trends have seen a rise in retail and primary care clinics popping up all over the U.S. in hopes that convenient care can lead to healthier patients and behaviors and bend the healthcare cost curve.
Providers (such as MedStar Health and Sutter Health) and insurers (like Oscar) have in recent years set up shops and/or created partnerships to get into the ease-of-access game for patients to healthcare providers, and such access trends are likely to continue in 2017. Greater access could come in the form of online providers (which could affect the physical "doc-in-a-box" shops), and that leads us to our next trend to watch.
What shape digital health will take in 2017
Digital health is a large umbrella. From wearables to on-demand physician apps, digital health seems to include any and every innovation under the healthcare sun. Partnerships such as the recent Fitbit and Medtronic partnership could help wearables get over the healthcare hump by getting into the clinical space. However, it's a always a big bet to rely on consumers acting reliably with consumer medical devices and tracking data, so it will be interesting to see how this space takes shape. In addition, emerging technologies stakeholders such as blockchain, the Internet of Things and drones will continue to be watched in 2017. While they may not currently share widespread adoption, these technologies are seen as potential change agents for care delivery services and coordination.
MACRA back-end support
One of the biggest bipartisan healthcare reform stories last year came when CMS released its Quality Payment Program, the MACRA implementation rule. 2017 marks the beginning for affected providers to report data to the agency to affect their payments in 2019.
A recent HHS Office of Inspector General report identified two "vulnerabilities" the agency should address this year before the QPP payment adjustments hit provider in 2019. The watchdog recommended the agency provide "sufficient guidance and technical assistance to ensure clinicians are ready to participate" and develop "IT systems to support data reporting, scoring, and payment adjustment."
As we've seen, EHR data reporting and administrative duties can help lead to physician burnout. QPP was largely seen as an achievement for bipartisan policy support and that CMS listened to the concerns of physicians over the rule so data reporting will be important as to not lose confidence with physicians that may feel overwhelmed with administrative duties.
Risks taken from providers and insurers
It's always enjoyable to hear how companies can shake up their offices – and if and how those shakeups produce results. Look for more stories such as Aetna paying its employees up to $500 to sleep and Geisinger instituting a money-back guarantee.
It’s time to take cybersecurity more seriously
Last year, we predicted that cybersecurity concerns will grow in 2016 and in that regard, the year didn't let us down. Healthcare will be a continued target for hackers in 2017 and last year’s demonstrations on how effective ransomware attacks can be will likely encourage more attacks. The industry needs to look into more effective means of cybersecurity solutions.