Top 10 trends shaping the health industry in 2015

We know more patients than ever are covered by health insurance. We know emerging technologies, consumer demand and economic pressures are shifting healthcare into new models — models that will engage patients and put them back at the center of care. But how much will these forces noticeably change the healthcare landscape this year?

PricewaterhouseCoopers' Health Research Institute surveyed 1,000 U.S. adults, experts and clients to find out. They took a pulse on the top health industry issues for the coming year and presented their findings in a webinar last Thursday.

Here are the top 10 issues of 2015, which were outlined in the webinar by Karla Anderson, partner, Pharmaceutical Life Sciences Practice, HRI Leader Ceci Connolly and HRI Director Ben Isgur.

 

1. Do-it-yourself healthcare. This year, the intersection of consumer desire and technological advancements will put "D.I.Y. healthcare" at the top of the agenda, PwC predicts. "Increasingly, consumers are taking charge of more of their own care," says Ms. Connolly. Technology companies are ready to help this happen with the development of apps and mobile devices to track health metrics such as vital signs, medication adherence or even urinalysis. Based on HRI survey results, physicians are also starting to accept the technology. Nearly half of physician respondents said they would be comfortable using data from a mobile device to determine if a patient should be seen in person or prescribed medication, and 90 percent felt the apps and mobile devices would be important to their practice in the next five years, according to PwC's HRI. "It's a great opportunity for some of the new entrants who are developing some of these new products," Ms. Connolly says. "They may also want to partner with traditional healthcare organizations such as providers to collaborate on the development and commercialization of some of these technologies."

2. Making the leap from mobile app to medical device. The mhealth app space is getting more and more crowded. The FDA will likely review more mhealth apps this year than ever before, Ms. Connolly said. Regulatory approval could give some apps a competitive edge in a crowded sector. The rush of new apps also means consumers will need a way to sort through all the available tools. "Consumers and providers looking out at this vast new world of products and apps available to them may benefit from something called a formulary, or app library, or pharmacy," Ms. Connolly says. Jefferson, La.-based Ochsner Health System is one of the few systems in the U.S. that has already implemented its own app formulary. Dubbed the "O Bar," it is a curated group of apps and devices for patients. Physicians are able to even write "prescriptions" for apps to help give patients apps for information and education, according to Ms. Connolly.

3. Balancing privacy and convenience. Approximately five million patients had their personal records compromised from data breaches last summer alone, Mr. Isgur says. These EHRs, which offer personal, medical, financial and insurance information, can go for up to $1,300 on the black market. "Healthcare organizations are going to have to keep an eye on both internal and external threats," Mr. Isgur says. Yet as healthcare organizations strive to make data private, they must also consider their consumer, who could benefit from convenient data access. The healthcare industry can learn a lot from the financial and retail sectors on how to balance convenience and privacy with data, according to Mr. Isgur. Collaborations with experts across industries may help healthcare organizations develop better security strategies.

4. High-cost patients spark cost-saving innovations. "There is a very, very small percentage of people that cost our health system a lot of money," Mr. Isgur says. The sickest 1 percent of patients generates 20 percent of U.S. healthcare spending, he notes, and dual eligibles are especially costly. Outpatient care that might cost $11,000 for the average Medicare patient each year costs roughly $23,000 for patients who are eligible for both Medicare and Medicaid. "We also know there's a laser focus in most healthcare organizations to try to reduce costs," Mr. Isgur says. To do that, many organizations are trying to look at those populations and develop innovative care models. This year we will likely see health systems employ a variety of strategies, including delivering care in new settings, through telehealth and retail clinics, high-tech solutions like wearables and apps, and low-tech solutions like making sure diabetic patients have refrigerators to store their insulin.

5. Justifying the price of specialty medications. Increasing stress on the healthcare system is leading many insurers and healthcare systems to control drug costs by limiting access to high-priced, specialty medications, Ms. Anderson says. Though cost has been an issue for many years, she expects insurers to raise the bar in 2015 for both patients and providers to access to these medications. "From the patient perspective, we've seen an increase in financial responsibility that continues year over year, and frankly is not changing," she says. "It's getting more significant as insurers move to coinsurance and larger copayments, looking for the patient to have more of a contribution to the cost of their drugs, more of a conscious decision about the need for the drug." Patients will increasingly be a factor in decision making for drugs, she predicts. "Correspondingly, from the physician perspective, [insurers are] really looking for physicians to present a much more detailed, clinical profile of the patient to justify medical necessity, and in some cases, that's extending all the way to the request for genomic data."

6. Open everything to everyone. Ms. Anderson says there is a shift beyond making data transparent solely for the sake of remaining compliant. Instead, manufacturers, regulatory agencies and prescribers are transforming the way data is shared with a greater sense of collaboration. For instance, pharmaceutical and medical device manufacturers are contributing clinical trial data sets to Project Data Sphere, The Yale University Open Data Access Project and other programs, according to PwC's presentation. Ms. Anderson says she believes that a great deal of clinical data is never published based on the outcomes of different trials, initiatives or registries. "This movement to publish sort of the good and the bad and make things more transparent, I think, is clearly something we think is a top issue for this year," she says.

7. Getting to know the newly insured. More than 10 million adults have gained health coverage through the Patient Protection and Affordable Care Act, according to PwC's presentation. Ms. Connolly says the insurance industry and provider community are trying to learn about this group in a short period of time. Additionally, primary care physicians, surgeons and other specialists have seen measurable increases in the proportion of Medicaid patients in expansion states, according to PwC. Ms. Connolly says hospitals and health systems in the states that have expanded Medicaid are seeing significantly different types of revenue figures, which are evidence of an increase in admissions and a reduction in uncompensated care debt. As far as implications, it makes sense for providers to contract broadly with insurers and help uninsured and underinsured enroll in coverage, she says.

8. Physician extenders see an expanded role in patient care. Mr. Isgur says in 2015, they see extenders — such as nurses, physician assistants, pharmacists and others — having an expanded role in patient care. He says many states have looked at this, and by the end of 2014, more than half of states were looking at scope of practice issues and who was going to do what as far as clinical duties. He says a larger number of extenders also is expected. Over the next five years, the supply of primary care nurse practitioners and physician assistants is expected to increase by 30 percent and 58 percent respectively, he says. "States will have to again visit and revisit their scope of practice laws," Mr. Isgur says. One implication of this trend, he says, is that extenders initially may not slow growth in the cost of care as much as people think due to the demand for extenders, resulting in an increase in the cost of wages. However, that is expected to level out, he says.

9. Redefining health and well-being for millennials. Ms. Anderson says as baby boomers retire, employers, insurers and health systems are looking for new ways to engage, attract and retain millennials. "Employers will have to really pivot to better meet the expectations of this group of millennials…," she says. "It will require them to reorient strategies from the concept of wellness to one of well-being." By 2030, millennials will make up 75 percent of the U.S. workforce, according to the PwC presentation.

10. Partner to win. Ms. Anderson says in this new hypercompetitive environment, people are thinking differently about how they collaborate and with whom they collaborate. According to the PwC presentation, successful companies that want to thrive "will work together on innovative products and services." Ms. Anderson says an analysis of the Fortune 50 healthcare companies found that about 40 percent pursued new healthcare partnerships last year. "It's no longer enough to partner at a peripheral level…You really have to think critically about who you partner with," she says.

 

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