Top trends will include changing policies, pursuing value, and improving access to care.
With the Affordable Care Act (ACA) potentially seeing its final days in 2017, healthcare policy is likely going to undergo significant changes in the year ahead. Revamping the healthcare system by repealing the ACA is the major stated goal of Republican lawmakers this year, which, if last year’s health trends continue, will not be an easy task.
According to Avalere Health’s 2017 Healthcare Industry Outlook, 2017 will be a year of policy changes, pursuing value, and accessing care.
These are the 10 trends to look out for in 2017, according to Avalere:
1. How Will the Election Affect Insurance?
Besides the ACA repeal, experts at Avalere are predicting that Medicare and Medicaid programs will be altered to drive down spending, introduce more private plans, and give states more control.
2. Workers Will be Responsible for More Employer-Sponsored Insurance CostsSince many employer plans are modeling their options after ACA plans, patients may find themselves in a plan with narrow networks, high out-of-pocket costs, and restricted formularies, according to Avalere. This may result in patients forgoing necessary medical care.
3. Drug Pricing Will Change
In 2017, lawmakers may implement policies that encourage value-based contracts, FDA reform, and increase transparency in drug pricing to prevent pharmaceutical companies from inflating drug prices without cause.
4. Will be Biosimilars Hit Formularies?
As more biosimilars are receiving FDA approval, payers will have to decide whether they will include these drugs in their formularies instead of biologics. Payers may also choose to rely on the competition between biosimilars and reference products to reduce costs even further, according to Avalere.
5. Outcomes-Based Contracts Change Drug Purchasing
This type of contract could be the key to reducing drug prices, since payment is contingent on the quality of the product, which could deter manufacturers from selling a drug that is less effective than a competing drug.
6. Value-Based Payment
Private and public payers will continue to adopt value-based payment models. Currently, the Center for Medicare and Medicaid Innovation is testing these options in 46 programs to demonstrate their value, according to the report.
7. Quality Measures
Standardization of quality measures allows for a streamlined process of data aggregation, and can allow for easy comparison between drugs, health plans, and healthcare facilities. Using the Medicare Quality Payment Program to increase the creation of quality measures would benefit the industry.
8. Focus on Post-Acute Care In 2017, a focus on new care models will result in improving the care a patient receives after they are discharged from a hospital stay. This will lead to a reduction in unnecessary readmission, lower costs, and improve patient outcomes.
9. Improving Value Frameworks
Value frameworks are currently underused, and have demonstrated a limited beneficial impact thus far. Improvements in transparency measures, and the use of patient experience in models would likely generate a better uptake in 2017.
10. Digital Health
Web- and application-based programs have allowed patients to better manage their diseases, while increasing remote healthcare services. According to the report, even more of these programs will be actualized in 2017.