Healthcare Trends to Monitor in the Year Ahead

Drug pricing pressures, narrow networks, and information technology among top healthcare trends in 2016.

A recent study identified the top 10 health care trends to watch for in the United States for 2016 and 2017.

Four major emerging themes that represent the top trends include pricing pressures, narrow networks, information technology, and macro issues in the United States, according to the analysis by Access Market Intelligence published in American Health & Drug Benefits.

As medical care inflation continues and pricing pressures around the world continue to go unaddressed, global macro trends are emerging, the study found. The Affordable Care Act’s (ACA) continued market changes and the implementation of physician payment reform will continue to add pressure to the healthcare system.

Pharmaceutical manufacturers have continued to argue the necessity of high costs in order to fund research and development of new drugs. However, the increase in money spent on drugs may give less money to other healthcare or non-healthcare services.

Currently, market shareholders are creating new plans to help control the rising cost of drugs, while still ensuring that patients are able to get the medication they need.

The Centers for Medicare & Medicaid Services (CMS) reimbursement reductions continues to put further pricing pressures on providers, hospitals, and health systems, which will cause some pushback.

Additionally, the 5000-fold increases in generic drug prices and the 10-fold increase in drugs prices that results from the increase number of biologic drugs will require manufacturers to come up with a new business model.

As new rules are being developed for narrow networks, there will be an increase in the importance of provider network decisions during 2016. The new rules will maintain accurate provider lists to help consumers better choose a network.

The National Association of Insurance Commissioners proposed new regulations to ensure the trend does not harm consumer access to affordable and quality care.

The researchers noted that stakeholders have realized that education gaps exist and are developing programs and products in 2016 to help educate consumers. Furthermore, insurers, employers, and providers will allocate more resources to give online and cellphone tools that help consumers understand the cost and benefits of healthcare plans.

During the 2016 election season, Republican house speaker Paul Ryan has announced that the first issue to be addressed this year will be putting a bill on the House floor to repeal the ACA. Meanwhile, Hillary Clinton will continue to paint the ACA as a success that only needs some small changes, according to the study.

The implementation of the ACA has created an increase in the consolidation of healthcare and pharmaceutical industries, and will most likely continue through the year because of small companies needing to increase their negotiating power when competing with new and larger rivals, according to the study.

As far as employers, they are considering 2 strategies to continue to offer health benefits that maintain a healthy and productive workforce, the researchers found. These strategies include health plans with increasing employee cost-sharing, like consumer-directed health plans and providing employees a more defined contribution for purchasing their own coverage.

Over the past 5 years, the study found an increase in the amount of employers focused on an effective way to manage the rising cost of specialty drugs. A report by Towers Watson found that 53% of employers have added new coverage and used restrictions for specialty prescription drugs, while 32% of employers are expected to add restrictions by 2018.

There is an increase in interest for growth in quality in relation to value. However, few patients use the proprietary or nonproprietary quality and price transparency apps. Still, patients are consistently unable to interpret the collected data and see how this data may impact their decisions.

Data breaches will continue to be an issue, with last year’s breach numbers shockingly high. The Office of Civil Rights says that there were 253 healthcare data breaches that affected ≥500 individuals and have a combined loss of more than 112 million healthcare records, the study noted.

For the top 10 data breaches, this accounted for more than 111 million records stolen, lost, or inappropriately disclosed. The top 6 breaches affected 1 million individuals, and 4 of the 6 companies affected were Blue Cross Blue Shield entities.

The authors conclude that 2016 will show accelerated change, increased governmental oversight, and patient engagement in care decisions.