For many, the start of a new year brings renewed energy and optimism around resolutions and self-improvement. It is also a time for performance appraisals and goal setting for many businesses and their employees—a time to look back over the previous year and celebrate successes as well as identify areas for improvement. This year, in addition to my personal resolutions, I am focusing on what I’d like to see happen in 2015 that I think could move the health care industry forward and help surpass stakeholder expectations for delivering on value.
Some of last year’s big stories underscored system discontent across the stakeholder spectrum. Headlines like “Out-of-pocket spending continues to burden consumers,” “Hospital Value-Based Purchasing Program has not affected hospital quality performance” and “ICD-10 delayed: What’s next for stakeholders?” rattled the health care industry. As Deloitte surveys have found year after year, too many physicians, employers and consumers grade the US health care system a “C” on its performance. This is not good enough.
At the same time, there was some good news in health care last year. Certainly the continued slow growth in health care spending was one, as was the robust enrollment in health care marketplaces and Medicaid, which helped reduce the rate of uninsurance. Hospitals reduced readmissions across the country.
So in the spirit of the new year and setting expectations for the months ahead, here are some expectations I’d like to see met in 2015:
Value-based care initiatives become overwhelmingly successful
I would love to hear about how accountable care organizations (ACO) are working to improve quality, delight patients and slow the growth in health care spending. I would like to learn what the secret is behind the success stories. Is it analytics? Clinical integration? Patient engagement? My guess is that it may be all of the above and possibly more, but it would be very exciting to see delivery on the promise of value-based care, especially now that 89 more ACOs signed on to the Medicare Shared Savings Program.
Physician payments reformed; Congress passes permanent solution
We most likely will see a “patch” to the sustainable growth rate problem in Medicare; it is certainly what we have seen year after year. Last year, Congress got pretty close to a fundamental change not only to the formula but to physician payment policies. There would have been more incentives for physicians to provide excellent care by working in teams. Although the legislation was supported by both parties in both chambers, it fell by the wayside when it came time to find the budget cuts to offset the increases in spending associated with overturning the update formula.
National health care spending continues trend of slow growth
In 2012, spending grew only 4.1 percent over 2011. It slowed even more in 2013, at 3.6 percent over 2012. Many expected spending growth to start picking up as we emerged from the recession, but the continued slow growth has persisted. Experts have attributed the slower growth to different reasons (e.g., the rise in out-of-pocket spending, value-based care initiatives), but I think the jury is still out. The bottom line is that slow growth is good for consumers, employers and taxpayers.
Obesity rate drops; public health efforts show progress
It would be great to see rates of obesity turn around and fewer people experiencing chronic disease. For example, I would love to see the Million Hearts™ initiative deliver on the promise of saving lives and reducing morbidity and mortality. Success might come from consumer engagement efforts, physician focus on exercise and diet discussions with patients or even wider use of wearables. Effective disease management and workplace wellness programs might also lead to positive results.
Next generation of health care tools target consumer behavior
We have excellent platforms that help consumers find restaurants, flights and hotels. Health care is a lot more complicated and people think about it differently than other services. New tools could help consumers choose health plans (e.g., through the insurance marketplaces and private exchanges) and to find doctors, low-cost scans and tests and good deals on prescription drugs. Developers are working on these tools already, but it would be great to see consumer adoption increase. Then we may see an increase in respondents who say they have the programs, online tools and incentives that help them monitor their health and/or make health care decisions.
Supreme Court rules on health insurance subsidies in the federal and state marketplaces; Administration and new Congress work together on health issues
This spring, the US Supreme Court will hear King v. Burwell, a major case that could impact the availability of subsidies through the federally facilitated marketplace (FFM). The plaintiffs in King v. Burwell challenge the government’s authority to issue tax subsidies through the FFM and argue that the ACA only allows the government to provide subsidies to individuals who purchase insurance through a state-based marketplace. While I don’t pretend to be an expert on the legal nuances of the case, I do know that the ruling will make a difference to the millions who are getting access to care this way and to the health plans, providers and life sciences companies who are seeing more customers with this type of coverage.
The midterm elections stirred the pot around Washington. A new Congress with both chambers held by the same party is likely to mean that more bills make it to the president’s desk. But, it’s too early to tell what such legislation might look like. It’s my hope that both parties can come to agreement on some of the major issues facing health care.
Health care makes enormous strides in Ebola outbreak
Last year, the headlines were riddled with concern, heartbreak, a bit of panic and many accusations surrounding the Ebola outbreak in the US and abroad. This year, despite recent flare ups causing worry about more infections to come, I hope that the many efforts surrounding the control and prevention of Ebola pay off and that we begin to see Ebola drop off the news wires. This could come quickly in the new year as policymakers, scientists, researchers and many other stakeholders watch with bated breath as early vaccine trials are completed.
ICD-10 implementation goes off without a hitch in October
Hospitals, states and health plans have worked hard to put new systems into place through training and running simulations. It might be best for policymakers and others to stay the course. I recognize this has been challenging for some physician practices, but ICD-10 could help create a platform for higher quality information that helps stakeholders better understand health care and solve its problems.
New technologies, drugs and products help solve health care’s toughest problems
I saw many promising ideas at TEDMED (see the September 23, 2014 Health Care Current) and heard of many more at Singularity University’s Exponential Medicine conference last month. Deloitte’s surveys of US physicians and consumers are finding that the market is demanding these products, and consumers and physicians are beginning to catch on to the value of mHealth. These ideas have great potential, and I hope many of them catch fire.
Health care industry moves closer to interoperability
Early last year, I attended a briefing on health IT that featured hospital chief information officers. I was struck by how often the theme of interoperability came up. There has been an enormous investment in building up the health IT infrastructure, and health care could benefit from technology that facilitates sharing and communicating information across systems and settings.
If all these expectations come to fruition, it might do a lot to shift course toward a better health care system. I look forward to a year of policy and research, where we continue to learn from the success stories as well as the wrong turns and setbacks.