Recently, I had the opportunity to hear some of the most interesting and credible views on where our healthcare system may be heading.
For any of you that may be entrenched in our healthcare industry, you are noting a period of rapid change. That’s a positive, and I have compiled some thoughts and insights from a few industry leaders focused on the changes to come.
The move to a value-based healthcare system is underway and will replace the traditional fee-for-service model. While this isn’t new, the pace at which it is occurring is. An increasing number of hospital systems, health plans and physicians will become more closely aligned and collaborative, and payment incentives will also be focused on treatment results and the long-term health of the patients. Critical in this evolution is data and technology. The first steps include patient home models using electronic health records and data sharing. The use of clinical wearable devices is become more prevalent, with the focus being on delivery of higher quality healthcare services and better patient experience. Beyond that, serious efforts are underway to integrate artificial intelligence (AI) in diagnostic testing, and predictive medicine using data from personal wearable devices. Virtual care will become more mainstream and advanced, with greater use of genomics and precision medicine. Blockchain technology is expected to be used to encrypt all the sensitive data to ensure privacy and confidentiality.
Primary Care Modernization
Primary care modernization is a focus for the future. The outlook is for advanced primary care services with expanded and more diverse care teams. Those include social workers, nutritionists, health coaches and physicians who will provide a more holistic scope of services focused on greater health and wellbeing. Incentives for advanced primary care will be more aligned with patient outcomes and satisfaction, and possibly prevention of health risks. Bundled payments and episode of care payments will impact the delivery and cost of health care services. It will also allow for more transparency and understanding from the consumer’s perspective of what health care services cost. Capitated risk contracts are also becoming vogue once again.
Evolution of Traditional Benefits Plan
Traditional benefits plan design needs to change. Value-Based Insurance Design (VBID) will continue to evolve and encompass more high-value care services. Qualified High Deductible Health Plans that allow the use of Health Savings Accounts (HSA) are being challenged to enable coverage for high-value care services, pre-deductible. A bill has been drafted to allow coverage for high-value care services with no cost and not subject to a deductible. The reaction and decision from Washington, DC are pending. Mental health services will need to have better focus and more proactive. Organizations are looking to incorporate predictive mental health diagnosis and treatments using data and evidence-based care. With a reported 25% of employees experiencing some behavior issues (depression, anxiety, substance abuse, among others), the problems are real and severe. Traditional programs meant to address these are not working effectively.
Pharmaceutical Industry Transformation
Pharmacy benefits and the current mass-produced medication programs will also undergo change. Pharma science has not only advanced the creation of specialty medications and biosimilars, but drugs formulated based on an individual’s genetics. Precision medications using genetics for treating certain cancers is already underway. The pharmaceutical industry will most likely evolve into true life sciences companies. Data again will be critical as the use of one’s biometrics will be used for ongoing pharmacological treatments.
The future of health and healthcare is rapidly evolving. Technology, data, and the delivery of healthcare services are all expected to change. Innovation will be a driver. Consumers, providers, insurance carriers, pharmacy companies and intermediaries all will be impacted. The future focus and outlook are positive. The expectation is a better delivery of quality care, improvements in general wellbeing and health and hopefully cost containment. I, for one, am looking forward to embracing that future vision.
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