1. Value-based care will continue to grow.
The Centers for Medicare and Medicaid Services (CMS), which has led the charge on value-based care (VBC) reimbursement, pulled back a bit last year. CMS eliminated two new bundled payment programs and excluded many physicians from its Merit-Based Incentive Payment System (MIPS). Nonetheless, MIPS continues to move forward, as does CMS' Alternative Payment Model (APM) track for accountable care organizations (ACOs) and other risk-bearing groups.
Private payers are also hustling down the VBC path. Aetna, which has long invested in ACOs and private label plans for large healthcare systems, forecasts that 75 percent of its spending will be in VBC arrangements by 2020. Cigna aims to increase VBC payments to 90 percent of its spending this year. Payers are already seeing results: Blue Shield of California, for example, attributes $325 million in savings from 2010 to 2015 to its ACO strategy, and other plans have seen reductions in hospital costs. The healthcare industry should expect more, not less, VBC reimbursement in 2018.
2. Industry consolidation will continue.
The transition to VBC has caused many hospitals and healthcare systems to invest extensively in health IT infrastructure. Meanwhile, as more procedures have moved to the outpatient side, acute care hospitals have felt pressure to grow their market share. The need to improve care delivery and increase access to capital and patients has motivated many healthcare systems to merge. While the government has blocked a few of these mergers, the overall pace of consolidation has quickened, doubling between 2011 and 2015. Last year, foreshadowing what's to come, hospital chains Dignity Health and Catholic Health Initiatives announced one of the biggest provider mergers ever.
A similar development is happening on the payer side. The Justice Department stopped the proposed Humana-Aetna and Anthem-Cigna mergers last year, but Humana later agreed to buy home care/long-term care operator Kindred Healthcare, and Aetna was acquired by CVS Health. While some observers saw the latter deal as a defensive move by CVS against the potential entry of Amazon into the pharmacy business, the insurer and the pharmacy chain promised to use their combined clout to lower the cost and improve the quality of care-the definition of VBC. One certainty is that the consolidation of both providers and insurers, both among themselves and with other parties, will continue, with some novel arrangements in the forecast.
3. Interoperability will grow in new ways.
The national project to connect disparate electronic health records (EHRs) so that doctors can easily exchange patient data still has a long way to go. Some progress was made last year, with the growth in direct secure messaging and the announcement that the Carequality Interoperability Framework had electronically connected more than half of all providers for the exchange of documents. But it remains very difficult for clinicians to search these documents for the information they need, because the data doesn't automatically flow into the proper fields in their EHRs. It also remains difficult for patients to download their records from providers' multiple EHRs to make use of that data.
What is starting to change this is a rapidly maturing HL7 standards framework known as Fast Healthcare Interoperability Resources (FHIR). Using Internet standards to create plug-ins to EHRs, FHIR offers the potential to connect EHRs at the level of discrete data, to expand an EHR's functionality by providing access to outside applications, and to allow consumers to use their own EHR data in FHIR-based apps. Epic, Cerner and Allscripts-three of the largest EHR vendors-are encouraging developers to build these new apps, and some are taking them up on the offer. For example, Zynx Health recently introduced a FHIR-enabled API, to make it easier for third-party solution developers and providers to consume our evidence-based clinical content, in the context of their own solutions using the EHR SMART on FHIR standards. Expect more apps of this kind, as well as more FHIR-enabled EHRs, in 2018.
4. Telehealth will become routine.
With smartphones near-ubiquitous and the use of FaceTime widespread, consumers are becoming more comfortable with the idea of virtual visits to providers. All states now allow remote diagnosis and treatment of patients who have not previously seen a physician in person, and 32 states require insurers to cover telehealth. While several national telehealth services still dominate the space, more and more healthcare systems are expanding into telehealth, using services such as American Well, Doctor on Demand and MDLive, their own physicians, or a combination of providers.
Most virtual visits are still confined to simple acute problems, but a wider range of consults is becoming possible. Consumers can already use their phones to send photos of skin conditions to dermatologists. Some observers believe that devices that work with smartphone apps, such as portable stethoscopes and EKG systems, may become part of telehealth. Irrespective of whether physicians are willing to accept the data from such devices, the low cost, convenience, and consumer acceptance of telehealth are likely to make it a standard care option in the near future.
5. The future is here now.
Eric Topol, MD, a nationally known cardiologist and geneticist who serves as director of the Scripps Translational Science Institute, recently predicted that between 50 percent and 70 percent of office visits would become redundant, replaced by remote monitoring, digital health records, mHealth apps, and virtual house calls. He also projected that consumers would one day be able do most of their lab and imaging tests using devices that communicate with smartphones. Software on the phones would suggest diagnoses and treatments, using the test results and vital signs measured on the mobile devices. Other mHealth apps would provide self-care reminders to patients with chronic conditions. Topol noted that in many instances, this approach will replace face-to-face doctor visits for simple acute problems and follow-up visits.
The rapid growth in telemedicine and mHealth is already starting to make some of this possible. Many consumers now own wearable devices such as Apple Watches and FitBits. Although those items are being used mainly for wellness and fitness, FDA-approved mobile devices for measuring heart rhythms and helping patients with diabetes manage their conditions are also available. Some patients with serious conditions like congestive heart failure use home monitoring devices.
However, physicians are still hesitant to rely on data from mobile devices and their related apps. Some of the data are inaccurate, and clinicians need better ways of screening the data to distinguish the important signals from the noise. Moreover, in a fee-for-service payment system, doctors are not reimbursed for this type of patient monitoring. Under the VBC payment model, this is expected to change.
Automated diagnoses require the use of artificial intelligence (AI). Despite the recent growth of AI in healthcare, cognitive computing-a branch of AI-is still in the stage of providing clinical decision support to doctors, not making medical decisions for patients. In the near-term, AI and machine learning will be increasingly used to predict health risks in population health management, to scan the medical literature, and to help hospitals cope with local infection trends.
Source: Health IT Outcomes (View full article)
Posted by Dan Corcoran on January 11, 2018 08:27 AM
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