The annual health issues report from PricewaterhouseCooper’s (PwC) Health Research Institute predicted the coming year will be one of “uncertainty and opportunity” in the industry, both because of the potential repeal of the Affordable Care Act and the continuing transition to value-based care.
“There are three main tactics that organizations will use to address this shift to value—they will adapt, they will innovate and they will build new programs and approaches to their work,” the PwC report said. “These activities will occur against a backdrop of uncertainty as the new administration’s approach to healthcare takes shape. But the industry also will continue to be rich with opportunity, as forces greater than politics carry on its transformation.”
Top issues identified by the report included:
1. Under a new administration, the fate of the ACA remains unclear
Trump promised to repeal the Affordable Care Act (ACA) as a candidate and while he’s softened on certain aspects—like keeping insurance protections for people with pre-existing conditions—the repeal of the law looks all but certain, with the debate more focused on how the repeal’s effects will be delayed to keep the individual insurance market from collapsing.
Those approaches will bring uncertainty, so PwC recommends health systems “scenario plan” to be prepared in case there are large numbers of people losing health insurance. Reaching out to the new Trump administration may also be worthwhile to explain the “links between the individual mandate and the size of premiums on the exchanges and between levels of uninsured and the balance sheets of hospitals and health systems.”
2. Pharma’s new strategic partner? Patients
The report said drug companies need to step up patient engagement efforts as the industry deals with increased scrutiny from regulators—and not just as a public relations move.
“Everybody wins when engagement takes place,” said Fran Kochman, director of advocacy and alliance development at GlaxoSmithKline “Pharmaceutical companies would learn more about how patients manage their medications, and insurers could appreciate that patients are more likely to be adherent and meet their outcomes. There’s a domino effect.”
3. Easing the training wheels off value-based payment
The gradual move towards value over volume could begin to speed up with the first reporting under the CMS’ new Quality Payment Program. Even though the agency offered “pick your pace” options for the 2017 performance year, it marks the end of providers only taking upside risk.
“HRI’s analysis found that providers may be more prepared to commit to downside risk than they realize,” the report said. “Strong actuarial capabilities can help accurately measure performance, while strong leadership to set priorities can accelerate the pace of change.”
Companies offering platforms and solutions aimed at reducing administrative burden may find opportunities as the QPP payment tracks are implemented, offering ways to help physicians who are “drowning in data.”
4. Insert your card here for healthcare
Higher deductibles means more patients have to pay more often when they visit providers, and that means using credit cards. To handle those payments while making sure the patient has a positive experience, the report recommended providers modernize its payments systems, including security to protect financial information.
5. A year of new partnerships and collaborations
The consolidation trend isn’t likely to slow down, but 2017 may “bring an uptick in alternative transactions, such as joint ventures, partnerships, strategic alliances and clinical affiliations,” according to the report.
For an example of how these strategies could allow greater flexibility without the significant risk of full ownership, PwC mentioned Pennsylvania-based Select Medical, which has formed six partnerships with hospitals for its inpatient rehabilitation and long-term acute care services.
“You can’t be Switzerland,” said David Chernow, Select Medical’s CEO. “You can’t be out there alone and expect to manage patient populations, improve quality and control costs. We know the future of value-based payment will necessitate us to be in the same boat.”
For the full list of health issues to watch out for in 2017, click here.