Infographic: Healthcare Predictions

Healthcare policy has long been a moving target, but it’s hard to remember a time when more change was cycling through the industry. Now, more than half a decade since the passing of the Affordable Care Act (ACA), the focus has shifted from expanding access to health insurance to reforming the delivery of healthcare. In particular, policymakers have embarked on a series of experiments and initiatives to transition from the traditional fee-for-service (FFS) system to a payment-for-value delivery system, with key attention to cost containment and quality improvement. We are in the first generation of pursuing approaches better than FFS, and expect the industry’s shift toward value-based care (VBC) to accelerate and continue to impact providers, patients, vendors, and payers in different ways. Here are the most important healthcare predictions for the future.

1.      Technology will be increasingly important

It’s not really news to say that healthcare providers are looking for tools to inform their decision making. Such technology is essential to collect data for everything from clinical decision making to quality reporting for payment determination. Predictive analytics hold power to look at past patients in order to select the best treatment for current patients. Automated database tools such as patient registries also hold promise to advance care by easing the reporting burden on physicians while still maintaining the collection of important data.

2.      Physician support in risk agreements must increase

Simply setting up a VBC payment arrangement involves some level of upfront risk. However, there is increasing pressure for providers to move beyond one-sided risk bearing arrangements, in which they have the opportunity to share savings, to two-sided risk models in which they’re also at risk for losses. Many large payers are turning their attention to value-based payment models and risk-based contracts with their network providers. Accountable care organization (ACO) models, in which providers take responsibility for quality and cost of care for patients, are gaining momentum for private and public payers.

3.      Networks will continue to narrow

No longer is the focus on network size alone. Instead, the movement is toward trimming networks to hold fewer, but higher quality, providers. Fitting with the trend of providers bearing more risk, there’s tighter payer-provider collaboration that makes the push toward higher quality just as important for payers.

Increasingly, payers are using quality and cost-efficiency data to identify the best hospitals, post-acute care providers, and specialists to build their networks. The open network and the fragmented care that came with it is becoming a thing of the past. This new integrative approach could very well aid in the transition from rewarding more care under FFS to rewarding better care under a value-based system.

Providers are tasked with adopting the numerous changes resulting from healthcare reform, which add data collection and reporting requirements for these new value-based arrangements to their duties of furnishing high-quality care. Building closely managed and well integrated networks of high quality providers will continue to be essential. Skilled nursing facilities, large physician practices, and post-acute facilities should be thinking hard about these predictions and how they fit into the coming changes.