Here are some of the top health care trends in 2013:
- Medicare / Medicaid expansion and managed care
- Health insurance exchanges
- Medicare cost reduction
- Comparative effectiveness
- Focus on reducing fraud and waste
- Provider consolidation
- Employer activism
- Health plan transformation
- Value-based pricing
- Information driven health decision-making
By all accounts, 2013 will be a big year in the health care industry. It’s already a highly regulated industry and that environment expands with continued implementation of health reform as mandated in the Affordable Care Act.
As a review, health reform includes the following key steps:
- Expand Medicaid to allow more people at the lowest income levels to qualify for coverage.
- Encourage employers to offer health insurance.
- Provide credits to purchase private health insurance coverage to moderate income Americans who do not qualify for Medicaid.
- Streamline the purchase of health insurance through the establishment of Health Insurance Exchanges.
- Strengthen consumer protections and require transparency.
- Impose protections to guard against unreasonable rate increases.
- Encourage primary and preventive care.
- Require most Americans to purchase health insurance.
Many of the consumer protections have already been implemented, but perhaps the biggest impact in 2013 will come from the scheduled availability of health insurance exchanges when open enrollment begins on October 1st. The earlier Supreme Court decision stipulated that the Medicaid expansion is now an option for states, not a requirement. Much of the conversation will center on Medicaid eligibility and expansion. States currently are determining whether they will accept federal funds for expanding the coverage of their Medicaid programs. Many feel that doing so would create additional budgetary pressures that would be difficult, if not impossible to manage. If the states choose to operate their own exchanges, will they operate them in competition or in tandem with private exchanges? Regardless, future Federal & State budget reform in 2013 will target ways to reduce healthcare costs. Not doing so will create far bigger budget problems down the road. What this means to the effectiveness of health reform is anyone’s guess, but we know the additional cost constraints will also call for increased provider and health plan accountability and value.
The Obama Administration has made important progress in reducing healthcare fraud and waste. As testament, the government recovered a record-breaking $4.1 billion in 2011. Those recovery programs will continue to expand in 2013, placing more pressures on providers to manage compliance.
Employees will be front and center as significant health plan transformation takes place. There will be increased sensitivity to pricing and efforts to learn what drives behavior. Employers may increase employee cost sharing as a way to decrease the rise in health insurance premiums. Those that do not offer the required minimum coverage will need to decide whether to drop coverage and pay a penalty or to increase their health insurance benefit levels and costs.
Comparative effectiveness research will grow in importance as recommendations are used to improve care outcomes and drive down the variability in costs. Health plans will increasingly be competing on value not price. As the number of shared risk and bundled payment programs proliferate, providers will be trying to figure out where they fit in the new ecosystem. This will drive new consolidations and relationships.
We will begin to move past the tipping point with regard to using health information technology. As the implementation of electronic medical records grows and their meaningful utilization improves, more and more data will be available to aid decision-making. Big data and data analytics will become increasingly important enablers to manage the explosion of administrative and clinical data. Healthcare will evolve to increasingly being information driven.
By all predictions, 2013 will be an interesting year!