Changes in healthcare 2019

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This was replaced by many and relentless changes and rollbacks of orders that had been signed by President Obama, as well as similar Cabinet-level Secretary changes from the previous administration. In addition, many federally enforced or determined issues were passed back to the states to decide on or to enforce, which was another campaign promise by President Trump.

The legislative branch, which includes the House of Representatives and Senate and is collectively known as Congress, has been in a lawmaking gridlock, even with Republican control, and is now headed into a greater holdup as control of the House has moved back to the Democrats. Such gridlock could allow greater movement or flexibility given to the states to act on more local interests related to healthcare. Similar shifts in policy determinations are happening regarding abortion, opioid and illegal drug use, tobacco and e-cigarettes, medical marijuana, drug pricing, soda taxes, and sales tax exemptions.

In addition, health insurance structure and design have been identified as key issues by the new Congress. Voters across the United States are addressing increasing important healthcare issues through state ballot initiatives that are likely to continue into The judiciary branch, which includes the US Supreme Court and the Federal Judiciary Center, continues to play a role in interpreting the ACA and related executive branch actions, as well as state ballot initiatives.

Given the midterm election results and the preparations already underway for the presidential election that would affect the ACA renewal review, the courts should expect appeals to the Supreme Court to quickly work their way through the judiciary system.

There is currently no lack of issues related to the US economy, including worldwide trade tensions and drug pricing. Economists expect total healthcare spending to increase by 5. The US pharmaceutical industry will continue to be buoyed by the tax reform passed in November that helped to free up more money for investment in pharmaceutical research and development.

Innovations will continue to emerge in , including promising gene-editing technique products. Of note, although the United States is moving away from universal healthcare, some countries in Asia ie, India, Oman and Africa eg, South Africa, Nigeria will seek to expand their public health insurance systems.

Finally, pharmaceutical economic growth is expected to rise by 5. Many medical technology rivalries are competing, especially with China, with tariff battles that have resulted in part from trade disputes or intellectual property issues, including medical imaging equipment, medical supply consumables, and some drugs. Finally, economic impacts emanating from unresolved issues in , such as the opioid crisis, and continuing federal versus state battles regarding the ACA, could have greater economic effects in to , depending on their resolution.

The rise of healthcare costs far faster than inflation has been a major driver for healthcare reform in the United States. The healthcare spending was expected to increase by 5. This unsustainable spending and the year-over-year increase remain critical issues for CMS, as well as for individuals in commercial plans and self-funded employers. Various measures will be used for each domain, and these are subject to change. Value-based models change the incentives to focus on value by rewarding better outcomes and lower spending.

Historically, medical treatment services were paid or reimbursed in a fee-for-service environment; basically, every episode of a consultation visit, doctor appointment, surgical procedure, or hospital stay was treated as a siloed event for the purpose of payment for services rendered.

Transitioning from volume-based to value-based payment in healthcare has been slow in the commercial and public sectors. Healthcare organizations, such as Kaiser Permanente, Geisinger Health System, and the Cleveland Clinic, have tested the use of value-based models to assume more financial risk while controlling spending.

Each value-based care model fits different employers' situations and workers, so choosing the right model will depend on the organization's capabilities, market position, financial situation, and company goals. New health economic tools are being developed to help self-insured employers to assess and determine value, improve their risk management, and make better decisions for healthcare coverage as a purchaser.

Much-needed medical and economic marketing techniques by manufacturers have to be revamped. Integrated care across the continuum of care delivery from acute care to maintenance or home-based services has emerged as a central clinical and economic area for improved efficiency in the US healthcare.

Workforce- and population-centered care settings will likely contribute to stakeholder role shifts in terms of where care is provided, such as hospitals functioning as community health systems, retailers as convenient care clinics, and insurers as partners with community-based providers. These shifts can be seen through the continued expansion of employer-based on-site and near-site clinics to at least one-third of self-insured employers that is likely to grow more rapidly through alternative retail or convenient care clinics.

Such approaches to deal with access to care also have a strong care-efficiency component that may lower the total cost of care. Whether through employer-owned on-site clinics or through community-based routine convenient care clinics, consumers will likely have greater options to access care and primarily at none to lower out-of-pocket costs. This can benefit the employer-sponsored plan or third-party insurers, as well as the consumer.

New efficiencies in acute or chronic care delivery will likely be offering savings beyond network access, as care systems deploy more efficient services and levels of care through an increasingly more consistent integrated system of care.

The drive to a lowest-cost site with the same or better outcomes is emerging through this more competitive market structure. Role changes among or between direct care or third-party payer stakeholders will become more obvious in and into the next decade.

Recently completed mergers in late by CVS Health with Aetna and CIGNA with Express Scripts illustrate such trends, along with a new willingness for collaboration across stakeholders in a patient-centered approach for optimal clinical and financial outcomes. Other firms are likely to become even more interested in mergers, as pressure to optimize healthcare delivery and utilization efficiency increases.

Preventive health efforts are also increasingly more valued, especially those associated with fewer episodes of acute care. As employers and CMS align to seek value, addressing the spectrum of care becomes an obvious need. For example, diseases can be more readily prevented with the use of effective vaccines for influenza or varicella and herpes zoster strains, as well as for curing diseases, such as diabetes, for which they are still being studied.

Harnessing technology across medical devices, diagnostics, and drugs will become more obvious in through the early part of the next decade. For years, there has been pressure on various segments of healthcare to consolidate and drive more business efficiencies, while remaining competitive with their drug purchasers. Beyond the typical within-sector or horizontal-sector mergers, we now see some vertical-sector integrations in healthcare. Employers as purchasers of care had also applied pressure on middlemen, along with inefficiencies in the healthcare supply chain.

Those collaborations, coupled with existing employer advocacy coalitions, sought purchasing power, as well as disruption. Business coalitions sought change in the way healthcare was being paid for, and in what and where healthcare was going to be delivered for their members. Pressure by employers on third parties and care-delivery organizations ie, hospitals and retailers continued through and is expected to continue into the next decade.

At the surface, much of healthcare looks like an iceberg, because many unseen changes below the water are likely in the midst of being incorporated into new or upcoming contracts, plan designs, and structures of healthcare coverage.

Such changes underneath the surface look headed toward sustained change over the next several years, regardless of what happens in Washington, DC. Also, changes are not likely to be an explosion of a disruption of healthcare, but rather more like bubbles popping up from beneath the surface that signal that change is in place, which will come too late for those in the less-informed segments of the supply chain of healthcare.

The combination of purchasing prowess, drive for efficiencies, and restructuring of insurance coverages is also likely to affect medical technology pricing. For example, the pricing of biologic and specialty drugs is already under political and managed care scrutiny, but structural changes in employer commercial health plans make that moot and can threaten drug utilization more quickly.

Cross-sector consolidation or expansion may become a greater vehicle to achieve disruption or reduce unnecessary costs factored in healthcare pricing. Adding to that pricing and efficiencies trend is the arrival of Silicon Valley information technology IT firms and start-ups that are seeking disruption in healthcare as a unique business opportunity.

Amazon, Apple, Google, Microsoft, and others have established footholds that are likely to disrupt the existing drug supply chain, while establishing new and highly efficient systems that can also affect the economics and experience of healthcare for consumers. This is a win-win situation as a result of improving economic performance or member experience for such IT as employers themselves who have become frustrated with the entrenched and costly status quo within the existing healthcare system.

Expect more rapid and sustained changes to emerge in that address a wide variety of commercial employer insurance market issues that have not yet been resolved. In addition, expect the pace of change to pick up as a result of the way IT firms innovate, as well as the rapid pace established by President Trump to make change happen.

The pace of technological change we have seen has been remarkable, relentless, and amazing compared with the status quo. Today, a broad concept known as the Internet of Things IoT links objects to the Internet and facilitates data and insights that have never been available before.

An IoT network of physical objects contains embedded technology to communicate and sense or interact with their internal states or the external environment. An IoT also describes a world where just about anything can be connected and communicate in an intelligent fashion.

In other words, with the IoT, the physical world is becoming one big information system, a concept that many of us may not have thought of or are concerned about now. The IoT could ensure safety and efficiency in cold chain supply chains for biologic or specialty drug manufacturing or patient shipments, and already are doing so to some extent. The IoT could provide drug information on demand for consumers or providers at home or at a point of service.

A new array of terms defines what makes up the IoT and is also instructive about where healthcare may be headed by harnessing such a network, where almost anything can be connected and communicate in an intelligent fashion. Adapted from SAS Institute. With a plethora of uses and global access to information now available about healthcare, including personal data, big concerns have arisen about cybersecurity. Cybersecurity, also known as IT security, is the protection of computers, networks, programs, and data from unauthorized access or attacks that are aimed at exploitation.

The major areas in cybersecurity include application security, information security, disaster recovery planning, and network security. Similar breach notification provisions implemented and enforced by the Federal Trade Commission, apply to vendors of personal health records and their third party service providers, pursuant to section of the HITECH Act.

Nearly every week we hear or read about another breach or issue with cybersecurity of our healthcare information. The news releases are independent of legal filings or settled cases in court. HIPAA violations and data breaches are increasingly common and large, resulting in record-setting fines and settlements. Although intended to provide expanded legal protection for genetic information, several loopholes in GINA remain. Because such information covers a broad use of data from life insurance to employment beyond healthcare, GINA's promise of being a civil rights bill has not come to fruition.

Statute coverage versus real-world use of such data is often contradictory, and genetic tests can have unanticipated consequences, such as increased insurance premiums.

Awareness and understanding of the law are fine, but the ever-changing technologies and applications of their ensuing results make keeping the law or consumer expectations in sync very difficult. Changes in disease management paradigms will continue to emerge in , as drug manufacturers experience a blockbuster revival. Once considered high-risk drugs, recent first-in-class medicines such as the RNA-based therapy patisiran, the novel gene therapy voretigene neparvovec-rzyl, and the chimeric antigen receptor CAR T-cell gene therapies tisagenlecleucel and axicabtagene ciloleucel, are not going to be alone.

New treatments for blood disorders, such as anemia and RNA interference in patients with hemophilia, are being developed. In immunology, treatments for rheumatoid arthritis and plaque psoriasis are coming, along with gene therapies for various neurodegenerative diseases such as Duchenne muscular dystrophy.

Oncology will continue to see the addition of more small-molecule drugs, in addition to biotechnology drugs that pursue niche cancer indications that will lead to broader use, such as the class of the programmed-cell death-1 inhibitors. The pharmaceutical industry has been expanding its technology solutions to enhance discovery, development, and supply chain efficiencies through harnessing the IoT.

Simple mechanization 1. Supply chains exist around the world, and we have limited capacity to communicate fast enough as humans. We, humans, are the emerging biologic-limiting condition of pharmaceutical operations. For autoimmune diseases, biologic drugs bring promise and problems, benefits and risks, including side effects. The body may attack itself, or our immune system may be suppressed, which may lead to other illnesses.

Major autoimmune diseases in the United States include psoriasis the most prevalent , rheumatoid arthritis, ulcerative colitis, and Crohn's disease the least prevalent. Today, health plans still prefer to focus their management on spending on biologics, which has become increasingly ineffective from an annual trend perspective of plan sponsors.

Treatment guidelines or protocols that extend from screening diagnostics through treatment to ongoing monitoring expand the drug-device-diagnostic triad. For example, drugs combined with drug-delivery devices that cross over benefit coverage lines create havoc in third-party management that is focused solely on claim management. Home use device development broadens the lines of devices outside of acute care settings too.

Increasing the connectivity of devices across the spectrum of care will add to the market growth for consumer-level devices that may be paid for by the consumer outside of typical plan coverage. Such market dynamics, coupled with technological innovations, will add another level of pressure on traditional plan management by all third-party payers and purchasers. Personalized medicine as a new standard of care in healthcare, such as immunotherapy and targeted therapies in oncology, illustrates the solutions represented by the new blockbuster drugs.

For example, CAR T-cell therapies are novel innovations with high response rates in patients with relapsed disease, representing a personalized approach to cancer immunotherapy.

But this comes with problems—the hallmark of CAR T-cell therapy toxicity is cytokine release syndrome, an inflammatory response that results from supraphysiologic T-cell activation. As part of improving regulatory processes and new drug approvals, FDA Commissioner Scott Gottlieb, MD, has cleared a backlog of applications and expedited access to drugs in the United States in The approvals will include medical devices, diagnostics, and generic, brand-name, and biosimilar drugs.

Dr Gottlieb has prioritized expediting the process of reviewing generic drugs to help lower drug prices. Access to gene-based technologies and their efficacy as a therapeutic solution to rare diseases will emerge as key issues in for most stakeholders, because of the associated excessive costs and the promise of success in a broad mix of rare conditions. A variety of devices have also benefited from the FDA initiatives, including traditional stand-alone or drug combination devices.

Expanded bioprinting applications now include medical devices and drugs. Change does not always come fast and is usually preceded by basic developments, with continued improvements that drive innovation over time. This also holds true in healthcare. Much of what is reaching the pharmaceutical market today has been in the works for years and has become mature enough for utilization by healthcare providers and consumers.

As a result, is shaping up to be a significant transitional year in healthcare, which will see even more change in All healthcare supply chain stakeholders are likely to be affected in some way in Stakeholders hanging onto the status quo will be subsumed by the veracity and velocity of consumer- or purchaser-driven changes.

By , the questions will likely focus more on how much change has happened, and how fast it occurred. The author would like to thank John Santilli, of Access Market Intelligence, for his assistance with drafts of this manuscript. Dr Vogenberg has no conflicts of interest to report.

Am Health Drug Benefits. Randy Vogenberg. Author information Copyright and License information Disclaimer. Consumerism and Populism There are 3 related terms that are reflected in US consumers and politics today that deserve mention, because they underpin many of the trends and contradictions seen in the following discussion. Post-ACA and Midterm Electoral Landscape All 3 branches of the US federal government ie, executive, legislative, and judiciary are engaged in issues that were discussed along the campaign trail in the midterm elections.

Harnessing technology to aid the management of healthcare costs remains a standard strategy for states as purchasers and payers of care. How that plays out in the marketplace remains to be seen from the perspectives of economic and healthcare outcomes improvement. The FDA has launched pathways toward faster approvals for generic or biosimilar drugs, as well as digitized medicine ie, drugs, devices, diagnostics and precision medicine, including approvals for niche or rare conditions or for applications with nonspecialty drugs.

The rapid growth, administration, and breadth of use of personalized medicines are challenging traditional insurance administration processes beyond the costs of care only.

Artificial intelligence, cloud computing, and blockchain healthcare applications are poised to grow rapidly in and beyond. Such computing ease and innovation have already begun to challenge the existing safeguards for personal health data, while also facilitating increased insights gleaned from available data, at a faster pace. As a result of the increasing use, applications for, and storage of data, cybersecurity has emerged to be even more important than before for healthcare providers and healthcare systems that are entrusted with that personal information under the HIPAA Health Insurance Portability and Accountability Act and the Health Information Technology for Economic and Clinical Health Act.

Containing the legal flow of data and the chain of control beyond the patient as a user of these data are becoming more complex. This flow of data represents a positive development, by enabling patients to become more engaged in their treatments, as well as a negative step, as the technologic innovations offer ever increasingly easier or simpler transfers of data that can be susceptible to hacking.

Not all aspects of the coming industry trends in healthcare are covered here. Instead, we identified a high-level context of trends that are likely to emerge or grow to maturation. The amount and pace of change in most aspects of healthcare mirror other sectors of the economy, but these were not readily apparent until the passage of the ACA in refocused attention on this economic sector.

Transparency has been elevated as consumerism marches forward in the face of steadily increasing healthcare costs. Nonetheless, full transparency regarding all the costs of care remains difficult to achieve or to act on to facilitate further changes.

State responses to the shifting of federal controls over decision-making boundaries have emboldened state legislatures to act when Congress has been unable to do so. From alternative benefit plan options, hospital closures, marijuana access, and opioid treatment legislation to healthcare infrastructure issues, states have increasingly acted when the federal government has allowed them. Federal policy proposals or regulatory changes have already reshaped the commercial insurance landscape for , while allowing longer-term change to emerge at a more incremental pace through federal programs managed by CMS.

Commercial markets continue to be favored for the introduction of innovation, while CMS moves to make its changes where and how it can in Medicare and Medicaid.

Finally, the wild card of a presidential election remains to be played out, but change will certainly happen. Whomever occupies the White House and holds congressional majorities certainly will have a critical influence on healthcare trends for late and beyond.

Dr Vogenberg and Mr Santilli have no conflicts of interest to report. Am Health Drug Benefits. Randy Vogenberg. Author information Copyright and License information Disclaimer. Market Trends Are Increasingly Dynamic Consumerism and transparency in healthcare have been trending for the past few years but will likely take on added significance in Cost of care Access to care Quality of care Downside risk arrangements Decrease in rural hospitals or healthcare CMS monitoring shifts Increased OOP costs Expanding home and telehealth Transparency promoted for patient use More HSA-eligible plans and high-deductible health plans Evolving pharmacy-based primary care services Social determinants of health incorporated into health-system reimbursement.

Open in a separate window. Downside Risk Arrangements Healthcare providers continue to make progress in adopting value-based care payment models. State-Level Trends Are Increasingly Important The multiyear shifting of federal controls over select healthcare-related decision-making has emboldened state legislatures to act when Congress has been unable to do so.

Conclusion Not all aspects of the coming industry trends in healthcare are covered here. Contributor Information F. References 1. LaPointe J. Value-based contracts with risk 3 to 5 years away for providers. March 19, Accessed August 26, June 25, Ramesh T, Gee E. Center for American Progress. Rural hospital closures reduce access to emergency care.

Center for American Progress; September 9, Accessed October 23, Social determinants of health. Copy Download. Social determinants of health incorporated into health-system reimbursement.

Allow for more health plan alternatives to traditional or ACA-eligible plans. Expanding home and telehealth: telemedicine and telepharmacy.

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Getty Images. Donut hole An expensive element of the Medicare Part D prescription drug benefit requires enrollees with high prescription costs to pay more for their medicines after they reach a certain level of spending in one year. Better information Medicare is updating the handbook it sends to beneficiaries every fall. More telemedicine Medicare is steadily broadening the availability of telehealth programs that let patients confer with a doctor or nurse via telephone or the internet.

In-home help Medicare Advantage plans also will have the option to pay for assistance from home health aides, who can help beneficiaries with their daily activities including dressing, eating and personal care. Leaving AARP. Got it! Please don't show me this again for 90 days. Cancel Continue. Thank You. Your email address is now confirmed. It will help prevent avoidable hospitalizations and readmissions while reducing unsustainable health costs. These updates would reduce barriers to accessing information and coordinating care that traditionally keep providers from accessing key information that could help identify potential opioid misuse.

Vatsala Pathy, VP of Policy at Collective Medical, wrote a MedCity News article discussing where these proposed changes may fall short when it comes to physicians making life-changing decisions—including a lack of comprehensive data and ease of accessibility to this data. An ACEP found that 47 percent of emergency physicians had reported being assaulted at work in the 12 months before the survey. This bill would require the Department of Labor to address workplace violence and create an occupational safety and health standard that would require certain employers to develop and implement plans for protecting staff.

ACEP released a public letter of support for H. Housing insecurity or homelessness has become a big focus across the nation—and particularly in California. Senate Bill went into effect on July 1, This state bill placed several new requirements on California hospitals for homeless patients.

These requirements include more robust discharge plans, on-demand meals and clothing, coordination with community providers, logging hospital encounters, and ensuring safe discharges.