The 2015 Healthcare Landscape - A Review of the Key Areas to Watch

In a Gallup poll reported on January 22, 2015, most people are concerned about “Healthcare costs” and “lack of money or low wages” as the two most important financial problems they face. Based upon this poll and our research, we believe there are four key areas to watch in 2015.

As the baby boom generation ages, more people will be living with chronic conditions and diseases. Medicare has cut physician reimbursements for traditional fee-for-service. However they have added a new reimbursement for chronic care management, hoping that physicians will spend more time with patients to resolve the underlying causes of chronic disease and related conditions. The goal for patients to gain healthier lifestyles will hopefully lead to lower costs. The two causes of chronic conditions most discussed are obesity and smoking. So what are the key areas to watch in 2015 as patients and physicians engage the system?

Patients

Many people will live well into their 80’s with chronic conditions, putting tremendous access and cost pressure on the U.S. health care system. Healthcare insurance is undergoing shifts which are not well understood by most healthcare delivery systems. While Obamacare and all of the hybrid types of insurance have given many more people access to the delivery systems, it is a highly subsidized financial arrangement benefiting the new participants. This financial burden on the existing payers and system is likely to be a very heated debate on the national political scene this year. The demographics of chronic condition management and the inherent need for the general populace to lead healthier lives will continue to dominate the news for patients in 2015.

Physicians and Other Healthcare Providers

Medicare is driving the change in payer culture as reimbursement rates are being cut for fee-for-service volume. Most providers feel very threatened by these changes; however the smartest delivery systems are integrating quality and cost efficiencies by emphasizing medical team coordination and patient (family) partnering. We anticipate more delivery systems will follow this trend in 2015. With all of the cost to train, employ and maintain providers to serve the system, it is likely that most physician and other healthcare practices will be owned or managed by larger hospital and healthcare companies. We expect this trend will continue to accelerate in 2015. Additionally, some of these hospitals and companies will be restructured to accommodate the new reality of Medicare, Medicaid and private insurance company reimbursements. The days of the “charge master” retail billing structure are fading, to be replaced in the future by a “reasonable and customary” fee structure based upon improved outcomes that is more palatable to payers. Providers will begin to lead the way toward better outcomes, and patients and the system will be rewarded accordingly.

Healthcare Technology

Currently, the healthcare technology infrastructures are “silos” of information, with each provider’s system capturing unique data related to that specialty product or service. The primary physician is in the best position to coordinate care; however systems typically don’t share data in an electronic form with other providers. Consequently everything is done with paper. As “outcome” teams are formed for patient care, the trend toward faster information integration within care teams is likely to occur in 2015.

Healthcare Finance

There are momentous shifts occurring in insurance and self-insurance among payers. Everybody wants to have “quality” healthcare, however few people are willing or able to pay for their high level of expectation of the delivery system. Consequently, there will be many more disappointed people in 2015 when coverages and premiums are negotiated for healthcare. Most of the exchanges and private insurers have limited provider access to gain cost advantages. Obviously, consumers need to live within a certain budget for these expenses. In our practices, we have seen a tendency for consumers to forego important coverages, or access to their physicians and other providers, in order to purchase affordable insurance. As more subsidized people have access to the system, there will increased rate pressure due to greater than anticipated chronic claim costs and required Obamacare coverages. This situation will lead to less access or more costly insurance for most payers in 2015. Certainly, healthcare finance and insurance will impact the political environment this year and for many years to come. Please contact us for our further research and development in these areas, and how these trends may affect you or your organization.