The political decision on whether to change or repeal the Affordable Care Act (ACA) is lining up to take center stage in healthcare news this year. However, issues such as drug costs, healthcare consumerism and a rise in technology - or telemedicine - are also making headlines.
The rapid growth in knowledge of the healthcare industry, heightened ability to find information, and rise in new ways of offering healthcare benefits, such as self-funded insurance, are causing demand for healthcare reform overall. As people begin to identify themselves as consumers of healthcare rather than patients of healthcare services, they are becoming increasingly more informed about their healthcare wishes and rights.
Here are a few trends to expect as politics impacts change and demand increases for more consumer-friendly healthcare services:
1. Changes to the ACA
The healthcare industry entered 2017 under a cloud of uncertainty. President Donald Trump pledged to repeal and replace the Affordable Care Act (ACA) during his campaign and scaled back many aspects of ACA with his first executive order after his inauguration.
The requirement under ACA for all citizens to carry health insurance is likely to be eliminated under any new healthcare bill but the Trump Administration has expressed support of many components of ACA, including allowing children under the age of 26 to stay on their parents’ insurance plans.
Despite the question marks, the uncertainty surrounding ACA doesn’t mean the healthcare industry will stagnate. For now, Americans are still required to have healthcare coverage in 2017 or be faced with a penalty.
2. Focus on Preventive Care
A survey by the Health Research Institute of PwC revealed healthcare consumers want more nutrition advice from their healthcare providers. This falls in line with the trend of people seeing themselves as proactive consumers of healthcare services rather than taking the reactive patient approach.
Healthcare consumers are interested in healthy diets, regular exercise, weight management, sufficient sleep, and regular check-ups to have a better chance for early detection of any health issues. The bottomline is they want to stay healthy to avoid being a recipient of healthcare.
When asked if they would take advantage of free nutrition and weight management advice from a variety of sources, 79% of respondents said they’d take advice from a doctor, as opposed to 38% from an employer. Taking such advice could have profound impact on the overall state of healthcare in the U.S., including lowering the cost of care.
Employers can be more engaged in healthcare cost management through incentives and services like care coordination to drive usage of preventive services that lower healthcare costs. Companies that embrace this trend with an increased focus on nutrition and prevention will benefit by reducing costly medical issues.
3. Rise in Care Coordination & Navigation
In 2017, we expect to see an increasing focus on interconnectivity, with patient-centered care as the ultimate goal. This will require a shift away from fragmented services with an increase in coordination between care providers and patients who act as partners in the healthcare journey.
Care coordination and navigation is an integrated approach to healthcare that provides consumers with a single point of contact -- called care coordinators -- for all medical care. Care coordinators are closely looped in to patient history and goals to seamlessly connect consumers with healthcare practitioners who can work with patients proactively on issues such as the best specialists to see, prescription medicine pricing, and preventive measures like nutrition.
The practice of care coordination and navigation has traditionally been suppressed by the fragmented nature of healthcare providers. However, with the increased demand of proactive healthcare services and advice, care coordination will become more common and expected by consumers.
4. Increase Usage of Telemedicine
Implementing technology into healthcare through practices such as telemedicine allows consumers to connect with certified physicians via computer, tablet, or smartphone. As telemedicine becomes more of the norm, patients will increasingly be able to “see” a doctor without leaving their home, lowering costs and increasing efficiency throughout the healthcare system.
What will this look like? It could mean anything from virtual reality medical training to drone delivery. In fact, many of these developments have already arrived. For example, U.S.-based start-up Zipline partnered with the Government of Rwanda last year to deliver blood products via drone. Web-based services like Doctor on Demand and One RX are also being used as consumers continue to take control of their healthcare.
5. Slower Growth for Drug Prices
The outrage over spikes in speciality pharmaceutical prices over the past several years and the pressure associated with it should help slow growth in 2017.
Particular attention has been paid to the costs of Hepatitis C drugs. Gilead Sciences new drug was approved for use by the FDA last year and priced at nearly $75,000, lower than the company’s competitors but still prohibitively expensive. That said, the lower price could be indicative of a downward trend for specialty drugs this year.
Even if drug prices fall, employers should remain on the lookout for ways to lower out-of-pocket costs, including prescription benefit management. Prescription programs ensure cost-effective and clinically appropriate drugs are being prescribed and used by the member. Implemented effectively, prescription programs can save between 5-10% on drug spend in the first year.
While there’s still uncertainty about the future of healthcare in the U.S. in 2017, there are steps you can take to prepare. At Apta Health, we empower employers to get the most out of their health benefit plans. Our extraordinary program combines the best solutions in the industry with cutting edge technology to reduce wasteful spending and drastically bend the trend of rising healthcare costs.
Contact us to discuss how to proactively manage your group health plan and reduce wasteful spending.