Over the past decade, healthcare transformation has largely been spurred by value-based shifts in payer reimbursement models. Going into the new decade, regulatory changes will continue, but disruption is more likely to be fueled by technology advancements, new healthcare entrants, and a consumer/employer-centric mindset shift. Healthcare executives will need to prioritize the upskilling of their workforce to align with the digital health world. Below are four major trends to watch:
Major legislative disruption remains a possibility, but less likely.
2020 will likely be a relatively slow legislative year because the election does not take place until November. Whether major legislative disruption to the healthcare industry occurs will depend on the election outcome. Democratic presidential candidates such as senators Bernie Sanders and Elizabeth Warren have endorsed “Medicare For All” single-payer plans, whereas candidates former Vice President Joe Biden and former New York City Mayor Michael Bloomberg have endorsed building on the Affordable Care Act with a public option plan. Despite healthcare being a top priority for US voters, pursuing groundbreaking legislation would be impractical unless the next president’s political party also wins both the House and Senate.
The outcome of the election would also determine the fate of Trump administration policies on Medicaid, the ACA and price transparency. Regardless of outcome, there are a few consumer-focused issues with bipartisan support that could potentially be addressed. These include drug pricing reform, Medicare Part D changes and surprise billing.
Artificial intelligence permeates diagnostics, clinical practice and personalized medicine.
Artificial intelligence has already been working behind the scenes in healthcare to assist physicians in diagnosis and providing patient care. For example, AI has been used to help interpret MRI scans and detect possible cancer in imaging tests. Additionally, AI-based speech recognition and transcription can assist physicians in performing clinical documentation efficiently. Patients are also beginning to interact directly with AI-powered technology that collects upfront information about medical history, medications, allergies, symptoms and vitals during clinic visits. Finally, as providers, payers and pharma companies collaborate, and industry data interoperability and security issues are addressed, cognitive analytic platforms will emerge to combine genomic, clinical and lifestyle data to deliver actionable insights that bring more precision medicine into clinical practice.
Data interoperability drives a shift to consumer-centric personal health records.
Significant improvements in the exchange of patient clinical information are expected in the new decade, especially with the October 2019 release of the Fast Healthcare Interoperability Resources (FHIR) 4.0.1 standard by Health Level Seven International (HL7). Data interoperability enables the exchange of healthcare information between legacy healthcare systems, healthcare providers, and patients across a wide variety of devices, including computers, tablets and mobile phones. Under FHIR, developers can build technology and digital health applications that easily and securely integrate into existing systems. The emergence of patient consumer-centric digital health applications will drive a shift in focus from enterprise health records to personal health records. By the end of the decade, blockchain-based personal health records could become the foundation for ensuring access and ownership of individual health data.
Consumers and employers embrace do-it-yourself and digital healthcare.
Increased access to personal health data is empowering patients to make better decisions about their own healthcare and costs. With 181 million Americans covered by employer-sponsored insurance and the average employer-sponsored family insurance plan costing $20,576 in 2019, patients and employers are demanding more value, convenience, price transparency and affordability. For example, Amazon is piloting Amazon Care, a virtual primary care clinic with home health nurse options for employees in Seattle. Additionally, Apple Inc. has opened its own AC Wellness clinics near its headquarters.
Digital health startups and retailers are helping to fuel a comparison shopping consumer mindset. GoodRx, which enables consumers to shop for drugs and compare prices, is also launching GoodRx Care to provide physician virtual visits starting at $20 depending on the condition. Other virtual medicine subscription companies such as Roman, Hims, Curology, Nurx and Pill Club enable patients to have virtual physician visits followed with monthly prescription deliveries to the patient.
Through community health organization partnerships, Walmart has launched its first standalone Walmart Health center in Georgia where customers can access primary care, dental care, mental health services, labs, x-rays and wellness. Appointments range from $59 to $99 without insurance, and large insurance plans are accepted. Walmart Health also started offering 44 generic prescription drugs for just $4 each for a 30-day supply.
As the trends unfold, healthcare executives will need to ensure their organizations have the workforce competencies needed to navigate new innovation and changing care models. In September 2019, the PwC Health Research Institute surveyed 300 healthcare provider executives to better understand how they are preparing their organizations for the anticipated healthcare trends. The top three workforce strategies cited as the top priority for 2020 included digital upskilling of the existing workforce (33%), using technology for tasks previously performed by employees (23%), and hiring employees with skills to support new capabilities, products or services (14%).
