A Look at the Year Ahead

We enter 2019 on the heels of a midterm election that saw Democrats take control of the U.S. House of Representatives and Medicaid expansion approved via referenda in three states where governors opposed the move. Surveys just prior to the election indicated that healthcare was the number one issue for voters of all political persuasions across the country, beating out hot topics like the economy, immigration, trade and others.

Prognosticators seem to anticipate little change in policy because Republicans still control the Senate and the Presidency. Democrats are likely, however, to use their newfound ability to hold hearings as a tool for shedding light on the high cost of drugs, the underlying causes of the opioid crisis, and other issues.

On the local front, voters in Nebraska, Idaho, and Utah approved referenda to expand Medicaid as allowed under the Affordable Care Act. In addition, the election of Democratic governors in Maine, Kansas and Wisconsin increased the chance of Medicaid expansion in those states.

While not political, a federal judge in Texas recently ruled the Affordable Care Act (ACA) unconstitutional based on tax law changes that eliminated the penalty for not purchasing health insurance. The judge ruled that the penalty was inseverable, and therefore the elimination of the penalty invalidated the entire law. There is considerable skepticism among legal analysts that the ruling will stand as is. The same judge subsequently issued a stay, effectively delaying any implementation of the ruling until all legal steps have been exhausted.

Once again, technology is top of mind for many in healthcare moving into 2019. In The Healthcare Executive Group’s (HCEG) survey of leading issues anticipated in 2019, leveraging data and analytics to improve decision-making by providers and payers came out number one. Organizations that can’t collect, analyze and act on data in 2019 will be left behind, it’s as simple as that. Then there are technologies that are patient-facing such as telemedicine. Medicare is adding codes to reimburse for telemedicine services with several analysts projecting significant growth in its use, driven by the need to increase access, reduce cost and improve patient satisfaction. Remote monitoring of patients is included in the new reimbursements, which extends the reach of traditional medicine into the home, resulting in improved patient outcomes among Medicare members.

According to health research conducted by PwC, more than half of patients surveyed indicated they’d be in favor of using mobile devices or wearables to share medical monitoring information with physicians. Don’t forget Artificial Intelligence, which is certainly making its presence known in healthcare, primarily in precision medicine with additional applications on the horizon. As use of technology grows we’ll get a better idea of where its application provides the most benefit.

The number of payers participating in ACA exchanges and Medicare Advantage is also on the rise. According to the Kaiser Family Foundation (KFF), going into 2019, 608 counties are gaining at least one insurer, while only five counties nationwide will lose an insurer. KFF also found that the number of plans being offered in Medicare Advantage increased by 417 and there is a net gain of nine insurers participating in 2019. Medicare Advantage is proving to be highly profitable for those insurers, and Baby Boomers turning 65 are enrolling in MA plans at an increasing rate.

Other topics gaining steam heading into 2019 include improving the customer experience (on the payer side), continued growth in value-based payment agreements, increasing access to mental health services, continued consolidation among and between payers, providers, PBMs, national retailers, etc., and increasing competition and/or disruption from non-traditional players in the market (e.g. big tech companies such as Amazon, Google, Apple, etc.).

2018 was a year full of challenge and change. 2019 looks to bring more of the same.


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