- January 24, 2020
2019 left healthcare at the center of news headlines and policy discussions. Hospital and health systems nationwide enter 2020 with a focus on the age of the consumer, where technology reigns king and healthcare policy changes could drastically transform the industry.
Learn more about healthcare trends to watch in 2020.
The ACA and ‘Medicare for All’
Over the last decade, the Affordable Care Act was the driving force of many social and economic changes in healthcare. As a new election year approaches, the future of the ACA is unpredictable.
At the close of 2019, various litigation was pending in U.S. courts, including the constitutionality of the ACA and a federal rule which requires hospitals to disclose the rates negotiated with insurers. Presidential candidate debates that focused on U.S. healthcare presented a number of stances on the ACA ranging from building on current legislation, shifting to single-payer ‘Medicare for All’ or completely replacing it.
In an article published by Fierce Healthcare, Ben Isgur, leader of PricewaterhouseCoopers Health Research Institute, predicts there will be more state regulations rather than major federal regulations prior to elections in November and the direction of healthcare will most likely be set after the presidential election. [i]
On Dec. 9, 2019, Senator Lamar Alexander, Representative Frank Pallone and Representative Greg Walden unveiled legislation to address surprise medical billing. Despite aggressive efforts to squeeze the proposed legislation into end of the year spending negotiations, congressional negotiators did not include surprise billing in the final $1.37 trillion spending agreement on Dec. 16, 2019.[ii]
Many believe the proposed legislation falls short of protecting patients, physicians, hospitals and health systems, as well as other medical providers. Physicians across the country, including those of ApolloMD, and other patient advocates continue to work hard to educate members of Congress and ensure legislation for surprise billing focuses on three main points:
- Keeping patients out of the middle of payer-provider disputes and protecting them from surprise bills/insurance gaps
- Fair reimbursement for physician services, including an independent dispute resolution process which has been proven to be highly effective in several states that already employ this approach
- Improving transparency in healthcare
Entering 2020, surprise billing will remain at the center of legislative discussions. In the meantime, states will likely continue to address the matter with statewide legislation. On Jan. 1, 2020, four new surprise medical billing laws took effect in Colorado, Nevada, Texas and Washington. [iii]
The promise of Artificial Intelligence (AI) is not a new concept to healthcare, but the role it will play hasn’t always been clear. Discrete application of AI-enabled technologies is ushering micro changes throughout healthcare.
“We must keep in mind that AI’s most powerful use is to enhance human capabilities, not replace them,” said Carla Kriwet, PhD, CEO of Philips’ connected care and health informatics division, in an op-ed article published by the World Economic Forum. “The heart of connected care isn’t new technology, it’s people: the people who need to be cared for and the people who work so tirelessly to deliver it to us.”[iv]
Increasingly, health systems are focusing on specific tools that can support the organization’s needs, enhance capabilities, and augment human experience. In theory, a number of digital health technologies will improve care and access to care but adopting these tools should not happen all at once. Strategy is key when introducing new technologies in order to maximize the potential of the technology.
Examples of AI-technology integrations include:
- RCM Models/Coding: Process automation lowers costs and improves reliability.
- Patient Experience Chatbots: Chatbots enhance the patient experience using immediate response to guide patients to appropriate resources and escalate problems or concerns in real-time.
- Physician & Clinical Team Member Experience: Voice recognition technology improves work-flows and reduces EHR “click fatigue”.
- Detect & Diagnosis: Identifying trends utilizing existing data and providing further data to augment clinical decision support.
CMS and the Office of the National Coordinator for Health Information Technology (ONC) proposed new rules in Feb. 2019 to assist in the improvement of interoperability of EHRs.[v] The original expectation was to have a final ruling in place by the end of 2019. However, this ruling has since been delayed.
More organizations are recognizing data should be able to help tell us where we are going, not just where we are. It needs to help identify issues before they occur. Data needs to be widely available and shared across the entire care continuum to drive outcomes. The delivery of accessible, real-time data driven insights will be key to enhancing longitudinal continuity of care.
Not all organizations or health systems have the financial resources to adopt a 100% interoperable framework. However, we will likely see an upward trend in the number of organizations prioritizing digital strategies to support these technologies.
Expansion of Telehealth
In the age of consumerism and with the retailization of healthcare, patients increasingly make decisions based on cost, convenience and quality. Younger generations are not just willing to use but are looking for reliable, high quality telehealth and digital health technologies. We expect to see hospitals nationwide integrating these technologies to support hospital-based services and access to care across a variety of specialties to better serve their communities. [vi]
[i] 5 trends and issues to watch in the insurance industry in 2020, Fierce Healthcare
[ii] Congress unveils $1.3T spending deal: 5 healthcare takeaways, Becker’s Hospital Review
[iii] 4 new surprise medical billing laws to know, Becker’s Hospital Review
[iv] Here are 3 ways AI will change healthcare by 2030, World Economic Forum
[v] HHS Proposes New Rules to Improve the Interoperability of Electronic Health Information, HHS.gov
[vi] What healthcare will look like in 2020: 6 predictions, Becker’s Hospital Review