As we start off 2018, let’s dust off the crystal ball and make some healthcare predictions. What can you expect for healthcare this year? Here are my seven predictions for the coming year.
The overarching driver for 2018 will be the same as for 2017: uncertainty. Instability in the insurance marketplace coupled with on-going activities in Washington and state capitals will present real challenges when it comes to short-term tactics and long-term strategic planning. Aggressive organizations will continue to merge and consolidate, creating ever larger health systems. CVS, Aetna, UnitedHealthcare and others will begin to leverage the investments they have made in providing direct care, adding new forms of competition and further destabilizing traditional providers. Given the conservative nature of most healthcare organizations, the great majority will seek to hedge their position and await further shakeouts of the market. As always, profitability will be a key strategy, driven primarily by expense reductions and a focus on revenue cycle enhancements. The more adventurous will also continue to pursue new ways to diversify revenue.
2. What’s old is new: revenue cycle management
Revenue cycle management is a hardy perennial favorite and for good reasons. Providers leave too much money “on the table.” Patients are responsible for an increasing portion of payments. Bad debt remains an issue. Provider coding and billing (which also drives some quality metrics) remain ripe for improvements. Expect to see an increasing role for technology in all phases of revenue cycle from schedule maximization to pre-payment to shortening the collections cycle. Predictive analytics and clinical decision support will continue to gain ground when it comes to coding and documentation improvement efforts (which in turn lead to better reimbursement).
3. Practical artificial intelligence
While some may dream of HAL from the movie 2001: A Space Odyssey, the real payoffs from artificial intelligence in 2018 will come in two forms: predictive analytics and Siri-like voice-recognition. Predictive analytics has been gaining traction the last few years fueled by ever larger data sets (like EMRs) and advanced algorithms. Far from being science fiction, these techniques are already used in other industries and will have diverse applications in healthcare. Predictions about future performance by providers, clinical outcomes for patients, and operations and finance will increasingly drive planning and day-to-day delivery of healthcare. The emergence in the consumer market of low cost, high-reliability voice recognition like Siri will enable a second generation of voice-recognition. While voice-to-text transcription will dominate, expect to see more voice-driven navigation to smooth workflows and reduce “screen time” for busy clinicians, while providing some relief from professional burnout.
4. Patient engagement and population health with a fee-for-service flair
Engaging patients as consumers to enhance loyalty and improve the health of populations will remain key goals for healthcare providers, insurers and increasingly the life sciences like pharma. Other industries have demonstrated that these strategies can build brand loyalty and change purchasing behavior. In theory, the same should be true for patients where the goal is to make them “sticky” to their healthcare provider and partner with them to change health behaviors. The last few years witnessed a sprint to “do” population health, which largely consisted of implementing population health analytics. Success has been mixed due to several factors including over-reliance on technology, underestimation of the process changes and a general lack of understanding of marketing and behavioral economic principles, which underlie success in other industries.
While value-based care will continue to rise as a proportion of reimbursement, expect to see a renewed emphasis on using data, technology and services to provide engagement and population health that focuses on more traditional fee-for-service opportunities. Identifying and appropriately filling gaps in care is both good medicine and good business in the near-term. It also allows organizations to learn and prepare for the time when VBC will predominate.
5. Virtual care = real care
Telemedicine and other virtualizing tech will play an increasingly important role in healthcare. An aging population with a growing disease burden, coupled with provider shortages, are creating a substantial demand-supply imbalance. Clinical studies continue to demonstrate the utility and effectiveness of telemedicine for both routine and emergency care. Whether it’s a command and control center monitoring hundreds of critical-care beds, a tele-stroke program connecting the ER physician with a neurologist in his office to diagnose and treat a stroke in progress, or a tele-psych program that lets a single psychiatrist provide medical management to hundreds of patients over a large geographical area, there is no doubt that virtual care is real and here to stay.
6. APIs rise, FHIR hype peaks
2017 was the year healthcare flipped from “what are these APIs you speak of?” to “FHIR will solve world hunger!” That’s progress of a kind. It is clear healthcare needs to leave behind 30-year technology – like HL7 based integration—and adopt the same approach as the rest of the digital economy. The rise of API-enabled applications is beginning to impact healthcare and will likely lead to transformations like those seen in banking, telecommunications and retail.
However, the combination of APIs being “new” to healthcare and a lack of mature offerings has led to hype around how good, how far and how fast this transformation will be. There’s plenty of “happy talk” about the impact of FHIR and vendor-specific APIs. But, speak to individuals who really know APIs or have attempted anything beyond simple applications and it quickly becomes clear there are real gaps and drawbacks to the current approaches. The best cure for this mediocrity: market competition that lets “1000 APIs bloom” to produce ever-better performance and lower costs.
7. Change is inevitable, success is not
The forces driving change in the U.S. healthcare system are enormous and unstoppable. Per capita, Americans typically spend twice the money for half the results compared to other successful western healthcare systems. As a percentage of GDP, healthcare spending is reaching unstainable levels. An aging population and increasing disease burden will only drive this higher. The epidemic of addiction and declining life-expectancy for some sub-populations are the hallmarks of a failing health system. The best prediction for 2018 and beyond is that while change will be inevitable, success will not. Those who seek to balance short-term tactics with long-term strategy, position themselves to experiment and fail, and pursue approaches that leverage technology while respecting the limits of said tech will likely be the winners.
Looking back at my predictions immediately after the 2016 election is both humbling and a reminder that predicting the future requires a bit of hutzpah and a bit of recklessness! It’s also an essential ingredient in imagining a better future and making it come to pass.
Dr. Dave Levin has been a physician executive and entrepreneur for more than 30 years. He is a former Chief Medical Information Officer for the Cleveland Clinic and serves in a variety of leadership and advisory roles for healthcare IT companies, health systems and investors. You can follow him @DaveLevinMD or email DaveLevinMD@gmail.com.