Hosts Share What They See on the 2019 Horizon
We are not immune to getting caught up in predictions. They may not all come true but it does put perspective on what others think are important in the healthcare and health IT industries. Our radio hosts are always looking forward and talking to those on the forefront. So who better to ask what they will be looking for in 2019. And thanks for tuning in!
Looking deeply into my crystal ball I can see that 2019 has a few surprises headed our way. The transition in healthcare reimbursement from “fee for service” to “pay for value” will rear its head early in January. The initial public release of MIPS scores will allow those impacted clinicians to be viewed on a 0 – 100 point scale. You can bet that numerous consumer websites will employ technology to allow anyone to enter a zip code, desired provider specialty, and be rewarded with a Google map showing provider names, locations, and scores. Professional reputation will become part of the mix as this unfolds. 2019 will also see the rollout of the first wave of legitimate blockchain healthcare use cases. Work has been going on behind the scenes for such uses as the pharmaceutical supply chain, professional credentialing, and hopefully, interoperability. Time will tell on the last use case but there is no doubt, the times they are a changing.
Patient engagement will be a major focus for healthcare organizations in 2019, as providers look for new and effective ways to engage patients in the billing and payments experience. As a result, more opportunities for digital engagement will arise, since patients will be drawn to healthcare payment experiences that deliver the convenience they’ve come to expect – including patient check-in, online payment adoption, frictionless digital wallets, automatic payments and paperless billing. The benefit to providers is a reduction in billing costs and faster time to payment as patients adopt self-service payment tools and electronic billing. Additionally, personalization in the payment experience will be more common in 2019, as healthcare organizations look to cater to the unique and specific needs of individual patients, instead of relying on a one-size-fits-all mentality. We can expect to see greater variety and personalization when it comes to billing messaging and payment options.
I predict we will see more DevOps methodologies adopted within healthcare systems. As we see more and more healthcare organizations adopting cloud-native services, we are seeing a shift in the role of the System Administrator in healthcare. Now they are learning DevOps methodologies, including Continuous Integration-Continuous Deployment (CI-CD), adoption of serverless technologies, containers and Kubernetes, and Blue-Green deployment. CI-CD is a DevOps best practice for your app development team wanting to deliver code changes reliably and rapidly. Blue/Green is a DevOps methodology to reduce downtime by creating two identical production environments called Blue and Green, where only one (Blue) is live and serving all the production traffic. The other (Green) is where you prepare, test and deploy new versions of your app or software. Once you have deployed successfully to Green, Blue is made idle. In addition to reducing downtime, it reduces risk because if anything happens to the Green live environment, you simply switch back to the latest version of the other, in this case Blue. DevOps automation can provide automated safeguards and compliance checks to healthcare orgs in the public cloud.
I predict that “consumerism” will continue to rise in importance in healthcare and disrupt health system, physician practice and corporate strategies unlike ever before. Patients are making more informed decisions as well as they are demanding more from technology and our research from the Health Innovation Think Tank shows how patients factor cost above access, trust and even brand now. This is a significant shift from 10 years ago and it puts patients/ consumers more in the driver seat for their healthcare. We have published key findings recently where as in 2005, 80% of patients cared about their hospital’s brand/expertise but in 2015, only 42% rated brand/expertise above cost and access.
Our Think Tank research also shows that patients are demanding more when it comes to telemedicine, “video visits” and virtual care. They want secure video and chat functionality with their own primary care physician, not a random care provider.
These are all signs that patients/consumers are becoming more educated about their healthcare and certainly their healthcare costs.
While most of this is completely understandable, we all must pay attention to the shifts in sentiments and then reflect on our organizational strategies to ensure we are all successfully navigating the consumerization of healthcare.
Dr. Nick van Terheyden
2018 was a tumultuous year for so many areas of our world and no more so than in healthcare. Declining life expectancy in the US for the 2nd year in a row, opioid crisis continues to kill 130 people day in the US, medical bankruptcy continues to impact many in the US for both insured and uninsured, and 1 in 3 Americans delay medical treatments due to costs. In fact the US Healthcare system has been in crisis for half a century! Sobering statistics.
So what will 2019 bring – could we see an end to the crisis and a move towards affordable coverage of basic healthcare for everyone. My prediction is we will see small #incremental steps towards this aim thanks to new entrants who have been thoughtful about their approach and strategy and not only want to but also have the necessary resources to actually bring about change. Some are returning like Google/Verily and Microsoft, others are newer but committed like Apple and Amazon (or MAGA for short) and yet more are combining forces to create new partnerships to bring efficiencies like Aetna and CVS, FedEx and Walgreens, Cigna and ExpressScripts, and Walmart and Humana. The overriding data point that get shared often but bears repeating:
- Over 80% of Americans live within 10 miles of a pharmacy and
- 90% of Americans live within 15 minutes of a Walmart
But to be clear the changes from this will be small but shine a welcome spotlight on a healthcare system that is working as designed, and that design needs to change. But my personal request is for #Ubuntu (A Nguni Bantu term) or put another way use the amazing power of consolidation, talent and resources to do good.
2019 is going to be the year of the voice in healthcare. We’ve seen inklings of this in 2018, but 2019 we’re going to see voice everywhere. Whether it’s voice controlling your EHR to patient scheduling appointments using a voice assistant to using your voice with advanced analytics to diagnose your condition and much more, we’re going to see voice-enabled applications springing up everywhere. Don’t believe me, ask Alexa, Google, or Siri what they think. That’s right. You’ve already experienced voice in your life. Now you’ll see it everywhere in healthcare.
Oh, the promise of 2019! The year will bring with it a much-needed update to HIPAA. We’ll also see the “Amazon effect” take hold of healthcare by bringing the focus of value-based care back the consumer as a patient. Consumerism will touch all facets of healthcare, especially the home health space, which has not been a huge consideration in the past year. Comcast, Google, and Amazon elevating their visibility and disruption talents will change this, along with the EHR market. Smaller EHR vendors will collaborate or dwindle. AI, again primarily in the home health space, will change how we care for out-of-hospital populations, especially medically-fragile children and chronically-ill aging populations. Device manufacturers will have to get on board with security strategies, much like their institutional counterparts. Finally, we’ll see collaborations between healthcare entities and the tech community yield valuable solutions for using actionable data, as opposed to big data for solving long-term issues in care delivery.
2019 will be the year where change is driven by frustration. We have three crises that are reaching a point that they can no longer be ignored – physician burnout, lack of interoperability, and high cost of care. Physicians have become much more vocal about the burdens placed on them – especially the administrative tasks that do not contribute directly to patient care. Their voice will only grow louder in 2019. Organizations will be looking to technology + process change to address the issue or risk losing physicians to organizations that are taking the issue more seriously. The lack of interoperability will be a big theme in 2019 and it won’t only be driven by patients wanting access to their data. Researchers, public health authorities and others will lend their voices to the rising tide in 2019. Unfortunately I think things will have to get a little worse before they get better. We’ve had a lot of talk in the past two years and we’ll start that way in 2019. It won’t be until regulations are threatened that we’ll see the industry take meaningful steps to address the issue. Finally, I think 2019 is when we will finally make progress on “bending the cost curve” in healthcare. We’ve downloaded a lot of costs to patients and employers. These two groups are the most motivated to lower the cost of care and we will start to see innovative technologies and approaches from these two camps around the cost of care. I see 2019 as the year when our frustrations in these three areas grow to the point where we’re finally going to start doing something about them.
The request for information concerning potential changes to HIPAA released by the Office for Civil Rights in late December will not result in any major rulemaking or other change in the Privacy or Security Rules, other than hopefully getting the long overdue Accounting of Disclosures updates. Instead, the questioning about how HIPAA can support and co-exist with value based care initiatives will drive introspective consideration of how HIPAA already aligns with and enables many goals of care coordination and sharing of information in ways that can lead to success. These benefits will result because the introspection will drive a deeper analysis of how HIPAA operates, which means individuals and organizations will begin to fully grasp current operations as opposed to assuming that an understanding is correct. The increase in knowledge and awareness will reduce the instances when HIPAA is thrown out as the reason for why coordination, access, or other sharing of data cannot occur. There is always hope that a desire to do the right thing and learn will be more prevalent.
My prediction for 2019 is that the federal government will continue to aggressively pursue healthcare fraud that will result in large recoveries. Holding individuals and entities accountable for fraud and abuse safeguards taxpayer funds while providing a good return on investment- for every dollar the government spent, it recovered $4. This is why maintaining an effective compliance program is more critical than ever to a healthcare organization’s risk mitigation efforts.
2019 will be a fascinating year on a number of fronts. Two that fancy my interest are healthcare costs and population health. In the cost arena, we may have finally crossed the line in the sand and see real pressure placed on pharmaceutical manufacturers, hospitals and others. The majority of this pressure will come from large self-insured employers, but I expect to see further legislation and rules making by the federal government, with states getting into the game as well. The main approach of employers will be the use of narrow networks and centers of excellence for the larger self-insured companies as well as the identification of high performing healthcare vendors such as those selected by the Health Value Awards. The key to not repeating the negative experience of narrow networks in the 90’s will be education of employees regarding variations in quality (assisted by using major high-quality brand-named players such as Mayo, The Cleveland Clinic, Geisinger etc.) combined with positive employee incentives, such as no out-of-pocket expenses or even paying the employees for utilizing the narrow network or selecting the preferred options ala The State of Utah Health Plan.
On the Population Health front, we’ll see real programs developed to attack the social determinants of health, the question will be how are they funded? Current approaches are utilizing short term models such as Health Plan Grants or limited hospital financing. The key to long term sustainability will be to remove the waste from the system and redirect those funds. Obviously, this will not be looked upon well by the majority of healthcare providers, but those that move up the risk ladder, particularly those moving to global capitation, will reap the rewards of an aggressive approach in this area if they can effectively manage their provider utilization while implementing these community-based programs.
I’m hoping that the focus on interoperability by CMS starts to pay-off in 2019, especially for patients. As organizations put an emphasis on upgrading their EHRs to meet those new requirements, I’m looking for some of the functionality that comes with those upgrades to enhance patients’ and clinicians’ access to centralized information. I also expect the level of consumerism in healthcare to continue it’s upward trajectory. This will come from more information about clinicians being made public in tandem with new payment models that require patient compliance to drive effectiveness.