It’s become an annual exercise to predict where a given industry is going in the year ahead, and healthcare delivery and health IT has become no different, so why fight it?
It’s a parlor game few can resist. At the ONC Annual Meeting that wrapped Dec. 1 in Washington, D.C., a panel was asked to predict 2018 in one word. Panelists ranged from Boston Children’s Hospital to Cigna to AMA to Mt. Sinai.
The answers? “Community.” “Nodes.” “Empowerment.” “Connected.”
Won’t argue with the positivity, but after a tumultuous 2017, it’s likely worth a measured approach to where the industry will go in several key areas.
Here’s our take on what will be most impactful.
Data blocking for real
Speaking of ONC, the spring of 2018 is targeted for the agency’s first issuance of its data blocking rule. Fueled by the 21st Century Cures law, this is regulation with teeth, meaning enforcement. The language will move from bad actors to data hoarders, for real.
Telehealth rings loud
With literally a dozen telehealth expansion bills introduced in Congress in 2017, most of which are foundering as the new D.C. learns to crawl, expect more bill consolidation such as this year’s Senate Chronic Care Act, and for Congress to continue to champion real telehealth expansion, abetted by provider and patient surveys, with expansion along geographic, specialty medicine and reimbursement lines, all as CMS continues to do its share via the annual fee schedule.
Mid-terms: House in play, Senate status quo
With only eight GOP Senate seats in play, compared to 25 for Democrats, a flip in the Senate could be a long shot. No wonder the hype is around the House, where all 435 members are on the ballot, and where Democrats would need to flip 25 seats. The political winds between now and November 2018 are hard to predict, but the gerrymandering following the last House vote isn’t. Still, the Alabama senate result, despite such a flawed GOP candidate, is impacting expectations for both chambers.
Doc-friendly payment models
How friendly? CMS has made a point of provider-centric reform, not to mention patient-consumers, and a big clue resided in the agency’s RFI on new payment models. Expect movement on episodes of care allowing providers to bid on same, and for beneficiaries to realize their own incentives.
MIPS actually worked
Despite the sturm und drang, MIPS will have better than expected submission and positive payment adjustments. Once past the clutter, the actual reporting isn’t that hard, if you can reconcile toward any clinical relevance. (We still prefer MedPAC’s MIPS plan.) Despite scathing reactions like this from an MGMA survey of 750 practices, mostly 1-20 docs, almost half of them plan to report a full set of measures to get into the exceptional bonus pool.
Apple takes a bite
Apple will follow other consumer-facing retail hopefuls with its own plunge into healthcare. Apple is moving from consumer wellness into the B2B space, with toolkits for research and an ever-widening array of sensors. With plenty of cash and a reputation for nimbleness, Apple is already using AI for facial recognition and improved photos. Look for the company to find ways to pivot all this into healthcare or also find a suitor.
EHR limitations become crystal clear
Now that meaningful use dollars have ended in Medicare and many health systems have spent hundreds of millions on their EHR systems, they’re recognizing that this technology may document patient visits and billing data, but is pretty limited in aggregating, analyzing and using data for VBC. More providers will turn to add-on PHM solutions to help them perform the cost and utilization analytics, outcomes reporting, referral management and other tasks they need to manage risk-based contracts.
VBC will focus on rising risk
Healthcare providers engaged in the early stages of value-based care are beginning to realize that focusing on the highest utilizers can leave them vulnerable to eventual losses. The ‘rising risk’ group – including pre-diabetics, those with hypertension, and those with kidney disease – often don’t know their health risks are a ticking time bomb. As VBC becomes more mature, expect to see more providers focusing on this group to manage utilization and costs.
Social determinants will come of age
Although providers have begun to realize that the ‘social determinants of health’ could account for 80% of their patients’ health, they quickly found that getting this type of data was easier said than done. In 2018, more vendors will come to the fore to offer ways to integrate social determinants data with claims and EHR data for a more complete picture of patient health.
Patient engagement will move beyond portals
So far, providers have barely gotten their feet wet in the difficult task of engaging patients in their care and health. Patient portals were a way to meet Meaningful Use but provide little meaningful engagement. In 2018, we predict that more providers will use PHM solutions to create outreach programs to patients who have care gaps, and bring them in for more proactive care.
Healthcare and health IT will remain subject to M&A, regulatory/political and innovation forces that will continue to disrupt. The 10 factors above deserve attention over the next 12 months. Did we leave anything out? Over-state? Let us know what you think.
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