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Top Four Health Care Trends through 2020

In our complex and ever-changing health care ecosystem, it takes time to make new ideas a reality. With technology advancements introducing a constant stream of new possibilities, and the 2020 election year on the horizon, conversations are heating up around “what’s next?” for health care.  To help your team strategize how to get ahead of the market and continue to evolve the patient experience, Slalom’s Health Care team developed our list of the top four policy, technology, and service design trends to watch through 2020

1. States exercising their power

States have considerably more power to design health care policies and programs than compared to the recent past.  With that, we’ve seen an influx of proposals from states to re-invent the way they finance and administer health care for their constituents.  Not every proposal will ultimately be approved or implemented, but the volume – and notable innovation – shows momentum for states exerting their influence now, before the 2020 election introduces the potential for unknown changes.

One of the most notable state proposals came from California, in which the state government wanted to set medical reimbursement rates for all insurance carriers to curb costs.  The policy was unable to pass a key committee in the state, but that didn’t stop it from sparking a conversation about innovating alternatives to a single payer health care system that still address rising health care costs.

There has also been a recent influx of Section 1115 Medicaid demonstration waivers, spurred by CMS’s adjusted guidance in January 2018 that allows states to implement work requirements. As of June 7, 2018, CMS approved four states’ work requirement waivers while seven states’ waivers are pending.  Kentucky, the first state waiver to be submitted and approved, requires Medicaid enrollees who are able-bodied, not pregnant, and working-age to either work a minimum of 80 hours per month (and provide supporting documentation as evidence), or take part in community engagement activities like volunteering, job training, or education. Not all programs are set up this way, as the specifics of each waiver differ by state and are designed to meet their local needs.

Given the relative flexibility that states have today to design health care policies, it’s unlikely state-based innovation will slow leading up to 2020.  Therefore businesses, especially those that operate in multiple states, need to keep up with how current and proposed programs might impact them once approved and implemented.

2. Accountability to produce outcomes

Value-based care will continue to grow through 2020 as the mechanism for holding providers accountable for improving patient health outcomes.  2019 will be a big year for providers in Medicare value-based care programs.  For the first time, participants in MACRA’s Quality Payment Programs (MIPS and APMs) will receive financial bonuses for reaching quality targets.  A CMS assessment is underway on how to add cost containment targets to the list of potential financial bonuses in the future.  Another first in 2019: providers in Accountable Care Organizations (ACOs) will pay financial penalties for not reaching quality targets.  Modern Healthcare reported that 82% of the 561 ACOs currently operating do so without any financial risk, and when polled, 71% of them say they may disband the ACO rather than take on the risk.

On the pharmaceutical front, drug manufacturers and distributors are being held accountable for their role in enabling the opioid epidemic, arguably today’s biggest health crisis.  Hundreds of lawsuits have been filed across the country.  Many of them are aimed at drug manufacturers for falsely advertising addictive properties; Some are aimed at drug distributors for filling prescriptions for controlled substances despite having alleged knowledge they were being used illicitly.  Regardless of how these lawsuits play out, drug companies are seen with increased accountability for doing the best thing for the patient and delivering outcomes.

This heightened level of accountability leads to providers and drug companies adding rigor to their operations and internal auditing.  Businesses will continue to invest in their internal performance tracking and compliance auditing to ensure their products and services are in the best interest of the patient by improving efficacy, cost, and/or patient experience.

3. Investments in collaboration tools

Clinician collaboration is key to both achieving quality targets and offering a great patient experience.  Medical groups and health systems are investing in technologies and tools like Artificial Intelligence (AI) and machine learning to advance their clinical team’s ability to use data to deliver precision medicine.  Leveraging AI and machine learning can lead to tremendous life-saving potential within interdisciplinary care teams for everything from preventive to quaternary care.   Aggregating data from multiple disciplines and training the technology to identify health risks accelerates diagnosis and care plan development, affording the care team more time to effectively collaborate and care for their patients.

An emerging technology on the market is the Salesforce Health Cloud, which enables holistic health care management by securely giving the full care team a single view of all patient data and the ability communicate with other members of the care team, request specialist consultations across the care network, assign tasks, and track progress on the patient’s care plan.  The Health Cloud also includes a direct communication line to the patient that integrates with their Electronic Health Record (EHR).  Through this integration, the technology automatically logs all patient touch-points, saving clinicians administrative time doing manual data entry.

Simplified, direct communication with the patient doesn’t just improve information access among clinicians, it also engages the patient as an active member of their own care team.  One way patients contribute is through remote monitoring, where there have been many new technology and tool announcements.  Remote monitoring allows patients to go about their day-to-day routine while sending their clinical team data via a mobile application (such as Apple’s personal health record) or wearable device (such as a Fitbit).  The patient’s care team monitors the incoming data from the hospital / office to ensure key vital signs and metrics are at healthy levels, and when they aren’t, they reach out to the patient to simply check-in, direct them to services, or adjust their care plan.

This level of clinician-patient partnership brings us to our fourth trend…

4. Empowering patients to take control of their health

Health care is taking a page out of other industries’ books to raise standards for patient experience and empowerment.  Providers are asking questions like: “How can we make scheduling an appointment feel more like online shopping?” and “How can we make waiting for an appointment in our waiting room feel more like waiting for a table at a restaurant?”

Other industries shape customer experience expectations that extend into health care too.  Patients want products and services that are:

  1. Personalized – Would I like this based on what I’ve purchased in the past?
  2. Cost-effective – What is the price? Can I afford it?
  3. Reviewed – How did other purchasers like it?
  4. Convenient – Will I receive this when I want/need it? Can I get it right now?

“On demand” isn’t just for TV anymore; we’re seeing health care becoming on demand too.  Patients can instantly access clinicians via telehealth smart phone applications.   And though it’s not quite instantaneous, pharmacy retailers now offer same-day prescription drug delivery, which is faster than traditional mail order delivery and more convenient than filling the prescription in person.

Patients are also empowered through options to “shop” for their treatment.  Patients can look up publicly-available facility quality rankings and crowd-sourced physician reviews to find their provider.  Conversations about making treatment prices more publicly available are gaining momentum as well with CMS’ proposal for hospitals to publish their prices and Massachusetts’ state-wide health care cost website.

These tools and service adjustments are all intended to improve patient engagement so the patient gains access their own information and feels more empowered to actively manage their own health and wellbeing.  And when the patient feels empowered, they’re more likely to trust their provider, return for follow-up services, and adhere to their care plan, all of which result in improved health outcomes and enhanced health literacy.

These are just four of the ways we see the health care industry innovating and changing in the near term.  How is your organization acting on these trends?  What other trends do you see?  Let’s have a conversation about how we’re designing a health care economy that serves and cares for all people.

Written by: Shannon Russell, Consultant, Slalom Consulting (shannon.russell@slalom.com)

With contributions from Slalom’s Health Care Thought Leadership Team, including:

Sarah Korf, Client Service Partner, Slalom Consulting
Ben Hwang, Consultant, Slalom Consulting
Kate Sweeney, Consultant, Slalom Consulting

 
 
 
 
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