Entering the new year, case managers and other health care professionals can expect to see a wide variety of changes to the health care landscape. A recently issued top 10 list from Pricewaterhousecoopers’ Health Research Institute pinpoints the new year’s coming attractions—and difficulties. The aftereffects of health reform, the remnants of the lingering recession, the newly adopted payment policies, and the increasing breadth of penalties for fraud and abuse comprise just part of what health care practitioners across the spectrum can expect to see.
“The government is taking a more active role in demanding quality and managing costs, the recession has pinched budgets, and both new and existing players are examining the value they bring to consumers,” reads an introductory passage to the report, titled Top 10 health industry issues in 2010: Squeezing the juice out of health care.
The need for case management departments to show their value is heightened in light of the report’s projections, as providers and payers will seek to control costs and create more efficient bodies. The report goes on to say, “The potential for savings multiplies as the industry converges, squeezing out inefficiencies and duplication. Health leaders must look beyond their own organizations and figure out how they can benefit by reducing costs elsewhere in the value chain.”
While there is a certain survival-of-the-fittest flavor from the report—which means opportunities, both created and lost—what follows are the top 10 projections for 2010.
1. Look for the aftermath of health reform. Already the Obama administration’s goals of increasing insurance coverage and modernizing health care—in the form of the State Children’s Health Insurance Program and stimulus money directed toward health IT, respectively—have been addressed, if in an abbreviated manner. The report projects wide-breadth insurance and payment reforms once a version of the health reform bill passes.
2. Look for cost-cutting measures. While the health care industry has weathered the Great Recession with relative aplomb, the report points out that the impact of the overall economy on health care tends to lag behind other sectors. It mentions cost-cutting measures taking place among pharma and device makers, nonlabor costs (i.e., food services, security, etc.) within hospitals, and payer costs.
3. Look for value-based purchasing. With an eye toward quality, the federal government is pushing for increased competition among health care providers and more programs and services backed by evidence-based measures. Within the past year, Congress has approved incentivized electronic health record and e-prescribing initiatives to help lower costs and increase efficiency.
4. Look for an increase in anti-fraud measures. According to the report, the “Obama administration has boosted its fraud and abuse budget for 2010 by 50%.” There is a keen eye directed toward fraudulent Medicare payments. Recovery audit contractors, which will widen their auditing prowess in 2010, will scour hospitals and other providers in an attempt to identify Medicare overpayments. (To learn how one case management department is dealing with RACs, click here.)
5. Look for new avenues of health IT services. Telecommunications companies, according to the report, are entering the health market in unprecedented ways. Verizon, AT&T and Sprint have all entered the market, which was boosted by the stimulus funds directed to expanded health IT.
6. Look for new pharma presence. With dropping revenue, big pharma is seeking out ways to enter the consumer wellness spectrum, says the report, which cites a drug manufacturer and an insurance company that have entered into an agreement surrounding patient wellness and fiscal returns.
7. Look for new physician employers. The number of physicians employed by hospitals has nearly doubled in the past 15 years, according to the report. With Acute Care Episode demonstration projects underway and interest in accountable care organizations, which streamline payment options, we could see a further increase in collaborative models.
8. Look for alternative methods of health care delivery. In another sign of the prevention-and-wellness paradigm, the increase in new methods of health care delivery is expected to continue in 2010. The report projects disease management and home health markets to increase to 25 percent this year and maintain stability over the next five years. The growth of retail clinics is an obvious example of this trend, while alternative methods like e-prescribing and telephone consulting have the attention of the industry.
9. Look for a resurgent flu year. While H1N1 did not live up some of the dire prognostications surrounding it, it remains an acute threat to public health and statutes remain in play. “Fifteen states have proposals for sick leave mandates,” reads the report, which advises a “connected safety net” of fluid communication, contingency plans and sound fiscal measures.
10. Look for an emergent population health status. The stimulus bill allocated money to community-based initiatives that address chronic disease and wellness. The Communities Putting Prevention to Work program will provide more than $640 million toward the effort and help put population health on the national radar.