By Yusra Murad
December 16, 2019 at 12:01 am ET
With a contentious presidential election ahead, Congress’ difficulty in moving forward on even bipartisan health priorities, and the future of the Affordable Care Act in the hands of the courts, much remains uncertain for the health industry heading into 2020. Off Capitol Hill, experts predict 2020 will be the year investments in digital health and the value-based paradigm begin to mature, as health system leaders attempt to curb spending with experimental models across the country.
Here are five health industry trends to watch next year:
The Trump administration will continue to push transparency…
If you thought you heard an unusual amount about “transparency” this year, your instinct is right — and there’s more where that came from.
In November, the Centers for Medicare and Medicaid Services published its proposed rule requiring hospitals to publish the pricing information of their services online, which is expected to go into effect Jan. 1, 2021. The 60-day comment period for the administration’s companion rule for insurers, which would similarly require health plans to publicize their price and cost-sharing information, is underway.
Cynthia Fisher, founder of Patient Rights Advocate and the inspiration behind the administration’s decision to make transparency the cornerstone of its health care agenda, said federal health agencies already have plenty of tools at their disposal to enforce transparency, with or without sign-off from Congress. In the meantime, a growing chorus of physicians, surgeons and payers are already leaving the traditional system to launch their own price-transparent centers. Walmart Inc., Texas Free Market Surgery and the Surgery Center of Oklahoma are among those leading the charge, and Fisher said dozens more are taking notes.
Expect the administration to invoke the Health Insurance Portability and Accountability Act, which gives consumers the right to access their health information, and the Employee Retirement Income Security Act of 1974 next. According to Jeff Harris, a Supreme Court litigator and former associate administrator of the Office of Information and Regulatory Affairs, even without executive orders, insurers could be vulnerable to lawsuits filed on behalf of patients if fiduciaries of plans aren’t willing to disclose prices.
…But the industry won’t go down without a fight.
After CMS published its hospital price-transparency rule, providers wasted no time in making good on their pledge to fight back: Led by the American Hospital Association, a coalition of hospitals has already filed a lawsuit, arguing that the mandate to disclose negotiated contracts with health plans violates the First Amendment. Payers share the hospitals’ sentiment: America’s Health Insurance Plans is arguing this approach to transparency undermines competitive negotiations.
Harris said he is skeptical the hospitals’ First Amendment argument will hold water.
“The case is brought by all the industry cartel groups that like the status quo,” Harris said. “All the rule is doing is saying, hospitals have to disclose their prices before people use the service. Which is how every other business except health care works.”
The Trump administration is no stranger to industry pushback on transparency efforts — in July, the Department of Health and Human Services’ proposed rule to force drugmakers to include the wholesale prices of drugs in television advertisements was struck down in federal court.
The AHA, the Association of American Medical Colleges and the Federation of American Hospitals are pushing to expedite the litigation — and just as 2019 pushed conflict between the pharmaceutical industry and the administration to center stage, 2020 may pull back the curtain on hospitals, which have historically avoided the limelight for their pricing practices.
No such thing as low-hanging fruit in health policy
Powerful industry stakeholders had no shortage of opportunities to flex just how quickly they can shut the door on bills they perceive as an existential threat to their business, as a yearlong conflict between payers and providers on how to protect patients from surprise bills prevented Congress from moving on the issue despite overwhelming bipartisan energy to do so.
With another government spending package looming, key lawmakers on the Senate Health, Education, Labor and Pensions Committee and the House Energy and Commerce Committee patched together a plan tackling surprise billing — splitting the difference between doctors and plans by proposing rate-setting with an independent dispute resolution for claims at $750 or higher — but congressional aides and lobbyists aren’t optimistic it will be included in the government funding package that needs to pass on or before Dec. 21.
The House Committee on Ways and Means introduced a new plan last week, and though the details are still unclear, support from the FAH indicates it will be friendlier to providers. In any case, advocates and lobbyists are expecting a delay on the issue. Ways and Means Chair Richard Neal (D-Mass.) and ranking member Kevin Brady (R-Texas) said lawmakers would be better off taking a fresh look at all the surprise billing options on the table in 2020, and it looks like they’ll get their wish.
In 2019, players in every corner of the health industry proved they’re serious about getting up close and personal with data. In 2020, they’ll have to prove they know what to do with it, and invest in integrating it into their workflow
Ben Isgur, the leader of PwC’s Health Research Institute, said the main issue for everyone is digitally upscaling their workforce, but bringing new voices to the table that can transform digital investments into clear value for patients is one of many steps.
“If you want to try to integrate the data and insights so people can benefit, we have to have a rethinking of the process,” Isgur said. “You can’t hire your way out of this challenge.”
Every part of the economy is using new technology to inform their business practices, but the intimacy of health care is unique. Companies are increasingly raising concerns about whether advances in artificial intelligence and analytics could erroneously create even more health disparities, Isgur said, so diversity and inclusion will be paramount.
If the response to Google’s recently announced partnership with Ascension Health was any indication, fears about privacy and data security will put new collaborations between health systems and technology companies to the front page in 2020. Even if those partnerships adhere to regulatory statutes, it’s a perception issue: There is a strong trust between doctors and patients, and the industry will have to do its diligence in assuring patients Alexa won’t come between them.
Nuanced plan designs will attempt to curb health spending
Even as premiums for plans on the ACA exchange have begun stabilizing, costs remain untenable for Americans across the board, including the 181 million people with job-based coverage. On the private side, one of the main drivers of health spending in the United States is the high cost of premiums, shared by employers and employees.
Katherine Baicker, a health economist and dean of the University of Chicago’s Harris School of Public Policy, said the rise in high-deductible plans offered by employers was an attempt to slow utilization — by creating financial incentives for patients to evaluate whether health services were always worth it. But there’s evidence that high-deductible plans not only stemmed low-value spending as intended, but also deterred some high-value care.
Going forward, Baicker said more nuanced models might begin to crop up, with more sophisticated cost-sharing, narrower networks and value-based designs. Such reforms on the payment side have the potential to meaningfully impact health spending, if well-executed, Baicker said.
Even still, costs will continue to climb. As Americans grow older and approach the Medicare age of eligibility, CMS estimates national expenditures will grow by 5.5 percent per year on average until 2027. As Baicker put it, “I do not think that health economists will be put out of business anytime soon.”