The Year 2018 in a Nutshell: Major Stories that Defined Healthcare

Bold, exciting, and groundbreaking, only some of the adjectives that could be used to describe the news that governed healthcare in 2018. To say the least, 2018 was ripe with massive health IT mergers, deals, and some major government regulations. And with another year over the horizon, healthcare professionals are preparing themselves to dive into a new year. While 2018 pointed toward the advancement of value-based care, there’s some uncertainty on what 2019 will bring.

But before we get to the future, let’s take a moment to look at some of the stories that were under the spotlight in 2018:

1. Consolidation in healthcare

Consolidation in the healthcare sector has accelerated in the past few years, reshaping the way health systems, hospitals, and independent physicians across the country operate. According to Illinois-based Kaufman Hall, mergers and acquisitions involving acute care hospitals increased from 55% in the last seven years. Much like Dignity Health and Catholic Health, or Ascension and Presence, many health systems are considering financial and strategic mergers or acquisitions.

Be it CVS-Aetna or Cigna buying Express Scripts, healthcare organizations are all trying to bring something to the table and streamline their operations. A number of trends such as poor credit outlook, lack of access to capital, and the fact that technology and value-based investments are significant now, suggest that consolidation is likely to continue. Although a major question around consolidation remains: whether it would lead to better care delivery and reduced costs. Consolidation activities may help scale their operations and manage patient health in a better way, but loose affiliations could go wrong.

2. Tech giants surge into healthcare

One of the biggest news of 2018 was the joint venture formed by Amazon, Berkshire Hathaway, and JPMorgan Chase. Another big news was the appointment of Dr. Atul Gawande to lead this joint venture. Given the state of healthcare and the pace with which companies like Uber, Apple, Google were entering healthcare, this venture didn’t come as a shock.

Each of these companies come to the table with a different ability- groundbreaking innovation, consumer-focused approach, or the ability to handle data at a tremendous scale. And that’s the key- these companies have the proven ability to handle and manage big data in a way other people haven’t. So possibly, we are looking at some transformative research or tools that help people manage their healthcare data and make it accessible in a way that will be useful. Healthcare could do with some innovation.

3. The progress of value-based care

2018 was a big year for value-based care. According to a report from the Health Care Payment Learning and Action Network, 34% of healthcare payments were tied to value-based care in 2017. This is an increase of no less than 23% over two years.

Additionally, CMS recently finalized an overhaul of the Medicare Shared Savings Program (MSSP), confirming what everyone was expecting: ACOs will have to assume downside financial risk. The new ACOs will have only two years to operate without assuming risk, a significant trim from six years under MSSP and three years for new, low-revenue ACOs.

CMS also launched Integrated Care for Kids, meant to improve child health, create sustainable Alternative Payment Models (APMs), and reduce avoidable inpatient stays and out-of-home placement. Early in the year, CMS Innovation Center announced the Bundled Payments for Care Improvement Advanced (BPCI Advanced) model, a new voluntary episode-based payment model that will test bundled payments for 32 clinical episodes, 29 inpatient and three outpatient episodes.

CMS proposed a rule late in December that allows payment adjustments to be made to Medicare Advantage plans in 2020 to reflect the total number of conditions each patient has. This would be in addition to viewing each condition individually in the MA model. The model will add variables that count the number of conditions a beneficiary may have along with certain technical updates that calibrate the model with more recent data.

4. Employers rattle healthcare

It’s not just Amazon- it’s just one example where employers took charge with an active role. In a survey by National Business Group on Health of 170 companies, it was revealed that employers projected an increase of 5% in their health benefits costs, for the sixth year in a row. This would bring the amount to $14,800 per employee in 2019. Also, companies like GM are looking to sign direct contracts for healthcare or simply invest in primary care themselves, much like Amazon in Seattle.

The survey also found that more companies are working on shifting costs by driving delivery system changes using accountable care organizations, direct contracting, or high-performance networks. There are also significant hopes from Health Transformation Alliance, a co-op of 47 companies including American Express, IBM, and Lincoln Financial. Collectively, these organizations spend more than $25 billion a year to provide coverage to over 6 million lives.

With the HTA, these companies aim to improve employee wellbeing and unite on patient-centric care. In only two years, HTA was able to save its members $800 million in pharmaceutical costs and is now planning to address chronic conditions.

5. Promoting healthcare interoperability

In the modifications in the rules associated with the Inpatient Prospective Payment System and Long-term Care Hospital Prospective Payment System announced in April, CMS renamed its “Meaningful Use” program to “Promoting Interoperability” to reflect its emphasis on achieving interoperability.

CMS hopes to make the program more flexible and less burdensome, in part by adding "measures that require the exchange of health information between providers and patients, and incentivize providers to make it easier for patients to obtain their medical records electronically," the announcement states. Specifically, it is replacing six measures with four:  

1. E-prescribing
2. Health information exchange
3. Provider-to-provider exchange
4. Public health and clinical data exchange

6. AI becomes mainstream in healthcare

A consumerism-inspired, patient-centric healthcare is going to be prevalent- if not today, then tomorrow. And most likely, it’s going to be an automated, smarter healthcare- where automation can save healthcare over $8 billion. The 2015 CAQH Index shows healthcare needlessly spends more than $8 billion every year on manual work for simple procedures- including mailing checks and claims and contacting patients to verify their health insurance.

Starting off simple, AI-based voice assistants are making great strides in a variety of industries, including healthcare. More than 51 million Americans have a device such as Amazon Alexa or Google Home, and although they use it mostly for simple tasks, the technology has so much potential.

Hospital and healthcare providers have found that voice assistants can help increase the efficiency of care delivery and improve the patient experience. One promise is that it would reduce the strain on the patient as the AI-assisted voice messages make day-to-day tasks easier. Another reason why voice assistants have been able to make such an impact is their popularity. Apple Siri, Google Home and Assistant, Microsoft Cortana, and Amazon Alexa are closer to household names now. Patients are able to check on their appointments, get reminded of their medications, and have answers to questions such as “can I get a nurse,” “when do I take my medicines?”

The technology may be new, but voice assistants have the possibility to change how patients interact with their care team, and they hold immense promise.

7. Financial stability for hospitals a concern

Along with patient safety, financial stability was one of the biggest concerns for hospitals this year. Hospitals are worried about an increase in uncompensated care, which could have drastic impacts on their financial stability. Declining government reimbursments, rising operational costs, and shifting financial risk has made it difficult for providers to generate enough capital to cover overhead costs and grow or sustain care delivery.

With value-based care, healthcare organizations will have to prioritize a number of capital investments both inside and outside a hospital setting to mitigate financial risk. As per Moody’s Investor Service, the operating cash flow would be flat, or worse, decline by up to 1% in the next year. This is compared to the 2%-4% contraction it predicted for 2018. The outlook toward financial stability still looks dicey.

8. Data breaches in healthcare

Despite advancements in healthcare, the alarming trend of data breaches in healthcare is nowhere near the end. According to HealthcareInfoSecurity, there have been 229 data breaches affecting 6.1 million individuals since the start of 2018.

It’s understandable why healthcare is at risk of data breaches: provider organizations keep records of very valuable information. Additionally, the healthcare sector is widely regarded as having rather weak security. Here are some breaches in healthcare that were recorded by Q2 in 2018, sourced from Becker’s Hospital Review:

• UnityPoint Health: 1,421,107 individuals affected in a hacking/IT incident
• California Department of Developmental Services: 582,174 individuals affected in a theft incident
• Bartlett, Tenn.-based MSK Group: 566,236 individuals affected in a hacking/IT incident
• Baltimore-based LifeBridge Health: 538,127 individuals affected in a hacking/IT incident
• SSM Health St. Mary's Hospital-Jefferson City (Mo.): 301,000 individuals affected in an improper disposal incident

With data in healthcare on the rise, organizations must be vigilant and should incorporate some practices that will enable full visibility into how their data is being accessed and used. Data breaches have nothing less than costly consequences on the organization as well as the individual.

While these are nothing short of great, we know that it doesn’t end here. There are so many stones that healthcare is yet to turn in its transformation. There needs to be an increased focus on making healthcare efficient in terms how we’re delivering the services. The care we deliver to patients has to be more proactive than reactive. The physicians should be provided with better technology to help them unhate their computers. All in all, making sure we are focusing on keeping all people healthy has to be the priority, and not putting out fires as they come.

Here’s to a new year, hoping we come closer to our goal of providing a healthcare accessible to all people, all the time.

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Join Team Innovaccer this HIMSS 19 at booth #2715 at Orange County Convention Center in Orlando, FL February 11-15, 2019 to hear how you can deliver more patient-centric care and become a part of the leaders of value-based care.

This blog has originally been authored by Abhinav Shashank.