According to Heraclitus, a Greek philosopher, “change is the only constant in life”. While 2017 hardly represents a lifetime, this will be a year of profound change in healthcare. Look all around, the winds of change are blowing. We have surveyed the landscape and here a few of the topics and observations that captured our attention.
The Healthcare Law of the Land – Accountable Care Act (ACA) or Obamacare, whatever your preferred name for the current healthcare law, there will be change. In a recent report, NPR noted that there several possible plans on the table, the Cassidy-Collins plan, the Republican Study Committee plan, A Better Way plan penned by House Republicans in a 2016 campaign document led by House Speaker Paul Ryan, and President Trump's administration officials’ plan. Who knows which way this will go? Either way there are sure to be some surprises along the way.
MACRA, MIPS and Bundled Payments - Quality AND Value are Job #1 – Say Medicare Access and CHIP Reauthorization Act (MACRA), Merit-Based Incentive Payment System (MIPS), and bundled payments, and you are using synonyms that are meant to stand for healthcare quality and value in short. Seeing so many of the prior CMS programs converge has taken a while, but many believe that our industry is on the right track. Consider the similarities between the three: MACRA, designed to reward clinical quality versus volume; MIPS, reimbursing physician performance based on quality, resource use, clinical practice improvement activities and meaningful use of an electronic health record (EHR) system; and bundled payments to incentivize healthcare stakeholders and others to work together for best health outcomes and lower costs. Looking at these three programs together and seeing how closely they align seems almost revolutionary. Funny thing is, sometimes the simplest of concepts are those that are the hardest to envision and execute.
Analytics, the Need is Still Paramount - Very few population health management (PHM) stakeholders question the need for a comprehensive data set and the analytics to navigate the choppy waters to value-based care. Despite years discussing connectivity and integration, these topics too are still relevant. According to a KPMG Survey in December 2016, 44% of respondents at payer and provider sites have a population health platform in place that is both effective and efficient; another 24% are in the process of implementing a population health program near term. Most of the rest of the respondents say they do not require this sort of system, and another 10% simply do not plan to implement a PHM solution. Therefore, the challenge is not in merely possessing a system or the analytical tools, the real work comes in knowing how to use the system you have in place. Once you have clinical integration, business and clinical intelligence and a robust technology platform, driving operational and clinical impact based on the analytics is how real change will be driven.
Prescription Drug Prices Continue to Soar – You know about the EpiPen and HIV drug price hike controversies, but did you know that almost 20% of the country’s healthcare spend is for prescription drugs and these expenditures are growing faster than any other part of the healthcare dollar? According to the Office of the Assistant Secretary for Planning and Evaluation, a department of the U.S. Department of Health & Human Services, part of the growth may be attributed to population growth, but other, larger factors are that the numbers of medications per person are increasing and the use of expensive, specialty drugs is also driving up costs.
New Channels Increase Access to Care for Many – Lack of access to good care for some has long been talked about as a blunder on the US healthcare system. While this topic continues to be of concern, urgent care centers and freestanding emergency centers play important roles in making care more accessible. While the two types of centers play very different roles, both offer the benefit of reduced wait times to see a clinician. According to the Urgent Care Association of America (UCAOA), “…more Americans have health insurance than any time in the past five years”. Further, the UCAOA estimates the number of urgent care facilities has increased +23% for the two-year period, 2014 to 2016. Though we did not find the same statistics for freestanding emergency centers, the number of stand-alone emergency centers seems to be multiplying as well. While there are surely changes on the horizon given the shift in Federal policy related to the Accountable Care Act (ACA), in the meantime, it is good to know that for people that need healthcare sooner versus later, we all have more choice now than ever before.
Healthcare Data Security Should be Everyone’s Concern – The Identity Theft Resource Center reported that the number of data breaches tracked in 2016 were 40% higher than those reported in 2015. Healthcare, just behind the business sector in terms of the number of total breaches, reported 377 incidents, representing 34.5% of the overall total number of breaches for the five categories tracked by the center including the business, education, government/military, banking/credit/financial and health/medical sectors. In healthcare, since close to half of all data breaches are the result of insider threats and frequently unintentional, we all must stay vigilant. As our eQHealth security expert says, “Think before you click, there is a lot to lose”.
In closing, eQHealth Solutions provides a technology platform that can improve the effectiveness of your value-based care delivery and has a team of statisticians that can help you use analytics to determine the clinical and operation initiatives needed to drive impact in your system. For more information, click here. We have shared with you a few of the topics that grabbed our attention. A penny for your thoughts, what healthcare issue is top of your mind for 2017? Join the conversation, write back and let us know.