Health Care Trends to Watch in 2019
Welcome to 2019. This time of year always elicits lists, so here are a few of the large trends I’m keeping my eye on.
The rise of the lawsuit. I see a continued trend of using lawsuits to fight new laws or regulatory policies. Lawsuits may be the only viable way for states, providers, payers and consumers to fight legislative and executive branch policies. For example, the ACA lawsuits continue, including the ACA recently being struck down in Texas v United States. Another ruling came out in favor of hospitals related to the 340B payment cuts (AHA, et al. v Azar, et al), and a ruling is expected in 2019 on agency rulemaking authority (Azar v Allina Health Services). These are just a few examples. There are any number of other federal and state-based lawsuits underway as well.
The rise of the states. With split control in Congress, major health care policy change will stem from the states. Those will be from 1332 or 1115 waivers (which we discussed earlier this year in our article, Medicaid Waivers Bring Opportunities to State Programs), other Medicaid policies, new payment or delivery (like direct primary care) models and more.
The normalization of risk (value-based payments). Bundled payments for hips and knees are already mandatory in certain locations nationally, and HHS indicates continued interest in mandating other bundles, like radiation oncology and cardiac care. Along with other models, HHS finalized a new Accountable Care Organization model (Pathways) that pushes risk faster. And Medicare Advantage plans – what I’ve called the “Godfather” of the value-based movement – are rapidly growing. Risk-based models or contracts will become even more commonplace.
The shrinking health care margin. From hospital cuts to post-acute care payment changes, HHS wants to equalize what it pays across settings and/or pay for value. Add on to this that the next chairman of the U.S. Senate Finance Committee is none other than health care oversight guru Chuck Grassley, watch for more attention in DC on health care providers and cost. There is also increasing competition from new entrants and current competitors alike while overall costs (of drugs, labor etc.) have not decreased.
The growing concern with drug costs. What exactly will happen is yet to be seen, but there is strong (and often bipartisan) interest in addressing the costs of pharmaceuticals. HHS has pushed international reference pricing and allowed Medicare Advantage plans to have more negotiating power for drugs. Typically an ally to PhRMA, last year a Republican-led Congress dealt them an almost $12 billion hit. Provider-led Civica Rx is on track this year to produce its first batch of drugs in short supply. Drug costs will continue to be on the table, and innovations or policies to ensure access at better prices will be an ongoing focus.
The shifting marketplace. Whether it’s Apple or Amazon’s health care moves, the Cigna-Express Scripts or ProMedica-ManorCare deal, tons of mergers, acquisitions and partnerships (big and small) will continue in 2019, resulting in ongoing disruption in the health care sector.
The rise of virtual health, tech. Consumer wearables, virtual visits, telehealth, remote monitoring and much more will allow for more virtual care delivery. Blockchain, Artificial Intelligence, APIs, direct to consumer applications/services and biotechnology advances will continue making progress.
What trends are on your list for 2019? And Happy New Year!
Jennifer Boese is the Director of Health Care Policy at CLA. She is a highly successful public policy, legislative, advocacy and political affairs leader, including working in both the state and federal government as well as the private sector. She brings over 20 years of government relations and public policy knowledge with her to CLA. Well over half of her career has been spent dedicated to health care policy and the health care industry, affording her a deep understanding of the health care market and environment, health care organizations and health care stakeholders. Her role at CLA is to provide thought leadership, policy analysis and strategic insights to health care providers across the continuum related to the industry's ongoing transformation towards value. A key focus of that work is on market innovations and emerging payment models. Her goal is to help CLA clients navigate and thrive in an increasingly dynamic health care environment.
Dear Jenny,
This is a great article. Thanks for the overview and sharing what is on your radar for 2019.
I appreciate your informative posts!
Happy New Year!