Volatility is expected in 2020 for the U.S., whether its related to politics, federal and state policy or healthcare.
Everyone knows that change is an industry constant in American Healthcare. But the experts at Advis work hard to stay ahead of the curve. Not all change is foreseeable. But if you know where to look, sometimes you can see what’s coming in time to make a difference to your bottom line. Our experts expect to see changes from payment structures, service delivery and growth in technology in healthcare.
1. Payers will recognize the importance of the interrelation between healthcare outcomes and addressing the social determinants of health.
We will begin to see payments to providers addressing the social determinants of health. As a first step in this direction, United Healthcare and the AMA presented a set of ICD-10 codes that would expand existing diagnostic codes to include social determinants of health. Consequently, hospitals would be reimbursed for those services rendered. Recognizing the social determinants of health further serves to institutionalize the hospital as the preeminent community safety net.
2. Site Neutrality is leveling the playing field.
Promoting site neutrality in an effort to level the playing field between hospitals and other healthcare providers will continue to cause headaches in hospitals. Specifically, with United Healthcare’s recent push for outpatient surgical services outside of the hospital, and Anthem’s push for imaging and MRI services in ambulatory settings, the trend to get away from the hospital will continue to accelerate in 2020. It is going to continue to accelerate for years to come.
3. Transparency trends persevere, forcing us into API and Cloud Based Systems.
The government continues to force transparency trends onto the industry. CMS will require standardized data formatting via API or cloud residing database use to allow open access to price transparency data. Patient-friendly price transparency tools that calculate individualized out-of-pocket cost estimates will become the norm. “There’s an App for that” is the mantra of digital culture. Transparency rules will not apply on a per hospital basis; instead, they will be developed by software companies using the open API mandated by CMS. Hospitals that do not comply with exact data specifications will be at a severe disadvantage within the marketplace.
4. Physician Groups will continue to expand market share.
In the past, physicians were part of small practices or largely self-employed. Over the past 20 years, individual practices or even two-physician practices have decreased significantly. Today, most physicians are employed by large healthcare organizations. Most physicians work in large group practice settings. As both payers and public continue to demand efficient, immediate, and cost-effective care, physician group practice will continue to grow larger. Large physician groups like DMG and Oak Street Health are going to see the continued expansion provided they remain responsive to value-based care. Whoever and whatever can provide quality patient care at significantly lower costs than hospitals is poised to grow larger.
5. C-suites will shrink.
Currently, the United States spends more than twice as much on healthcare as other high income, developed countries. According to the Center for American Progress, in 2019 payers and providers will spend 496 billion dollars on billing and insurance related administrative costs alone. In fact, the average salary for hospital administrators is $237,000; for an insurance chief executive officer it’s $584,000; and for a hospital CEO it’s $386,000. How do these salaries compare to those in the actual medical profession/ With the people with all the education and loans to pay? According to the New York Times, the average salary for a general practitioner is $185,000. The average salary for a surgeon is $306,000. Layers and layers of healthcare administration must collapse as demand for efficient, low overhead patient care increases. There’s no other way. Hospitals and academic medical centers have to find ways to trim the high costs of administration.
6. Psychedelics and Marijuana will become mainstream in healthcare.
Maybe Baby Boomers just want to relive their youth. Or maybe they’re on to something. Either way, with Medical Marijuana having gained almost universal acceptance (and recreational marijuana not far behind), Psychedelics now represent the final frontier for experimental behavioral science. As a result of recent studies successfully treating several psychiatric diagnoses, from depression to autism and substance abuse disorders, with psychedelics, combined with the recognition of the benefits of psychedelics and marijuana for behavioral health by several federal agencies, we predict seeing more of these substances utilized by conventional medicine and psychiatric care in the days and years to come. Numerous patients report benefits and attending physicians are encouraged by the results. Experimentation regarding the relationship between psychedelics and behavioral health will continue apace.
7. Pharmacists will join the primary care team across the nation.
Some states have already recognized patient care by pharmacists and are mandating reimbursement for these services. Wellness and prevention are a significant part of primary care. Many people in the US suffer because of a dearth of preventative care. However, there’s a light at the end of the tunnel. Pharmacists are trained in preventative care and medication management. Increasingly they’re bridging the gap between the patient and circumstances where primary care is lacking or falls short. Improper medication usage is one of the reasons hospital readmissions are at an all-time high. Moreover, integrative pharmacies help reduce primary care provider burnout. Along with optimizing compliance with hospitals and medication management, the industry will see pharmacists emerge as a widely recognized and accepted part of the primary care team. With more states and payers recognizing the importance of the pharmacist to direct patient care, payers will increasingly allow for the reimbursement of their services.
8. The inpatient SNF will morph into a completely transformed venue of care.
The Skilled Nursing Facility as we know it today will disappear. SNFs will disappear to allow room for service provision in a patient’s home, or on an ambulatory basis, with the use of technology, telemedicine, and efficient SNF teams that travel to the patient. We know the service population is continuing to grow; but the push away from inpatient SNFs is unstoppable. Inevitably, this changing and highly fluid situation is going to evolve into a whole new model of care. That new model may allow SNFs to continue as the risk bearer and quarterback for services, or they may be entirely written out of the picture.
9. Healthcare consumers will more and more gravitate toward Telemedicine and Internet Apps for their Healthcare.
With the internet bombarding us with trendy, efficient, and useful ways to meet our healthcare service needs, hospitals will need to jump into telemedicine and App utilization to avoid market share loss. Startups like Hims and Roman for erectile dysfunction, Nurx for prescribing oral contraception, Cove for migraines, and Zero to quit smoking capitalize on the younger consumer’s internet-based marketing habits. Internet based healthcare services provide a solution for American health care frustrations. They provide a cheaper, more accessible means of primary care. These apps can connect users to a licensed professional who can then prescribe needed medications with no appointment or clinic visit required. Apps utilizing facetime, text messaging, and webcam monitoring efficiently and effectively diagnose symptoms and prescribe medications to patients at drastically reduced costs. These apps also work with a user’s insurance and can work for people lacking insurance. In the future, there will be an App for that… and the future is now.
10. Birthing Centers will replace traditional inpatient Labor & Delivery Units.
Birthing centers provide a more comfortable and holistic approach to childbirth. Here the well-being of the mother can be the primary focus of the institution; the mother’s desires and needs are front and center. But birthing centers have also proven to lead better delivery outcomes. Birthing centers target women with low-risk pregnancies. The costs are 50% lower than in hospitals. They improve maternity care. They are better equipped to meet patient needs during the pregnancy and birthing stages. And birthing centers support maternity bundled payment models feasible for both payers and beneficiaries. These centers are also responsive to managed Medicaid, which is why we will continue to see hospitals increasingly develop birthing centers in an effort to provide better service and control costs.