16Care Management

Predictions 2016for

Insights and trends to watch in the New Year

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What’s in store for 2016?The healthcare landscape has seen seismic shifts in recent years. Gazing into the proverbial crystal ball, it appears that 2016 will see its fair share of disruptive forces as well. Yet these disruptions are primarily a response to past upheavals, with a focus on stabilization and creating a more sustainable future for healthcare. From technological

innovation to expanded access, the implications for care management are overwhelmingly positive and exciting.

In fact, the annual report from PwC’s Health Research Institute—the source of several predictions found within—heralds 2016 as a year of firsts for many players:

“In 2016, the health industry will begin to lay down rough new paths to a more connected, transparent, convenient ecosystem. Eventually these paths will develop into well-trodden trails, roads and highways. This hard work—this forging of new ways of receiving, paying for and delivering care—is a hallmark of the creation of a New Health Economy, an industry that is more digital, nimble, responsive and focused on consumers. As organizations master these tools and services, they will combine them in new ways, form new partnerships and ultimately transform the industry.”

To compile this eBook, we researched key thought leaders and publications across a wide array of issues that intersect with care management specifically—and healthcare in general. You’ll find topics spanning from

wearables and telemedicine, to cybersecurity and behavioral economics. After all, big splashes in one field often create ripples that are felt across the wider healthcare system in today’s inter-connected world.

So without further ado, here are 16 expert predictions to keep an eye on over the coming months…

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#1 Next-gen wearables—or “Ther-ables”—will offer less invasive but very effective substitutes for costlier medical therapies.

The new generation of “medical” or “clinical wearables” is going to be equipped with more sophisticated sensing, capture and analytical functionalities, thus making the clinical utility of those devices more actionable. Currently, sales of healthcare wearables primarily involve monitoring technologies like those developed by Vital Connect and Proteus Digital Health; moving forward, technologies like the Quell from Neurometrix that provides therapeutic support will continue to gain traction.

Expect healthcare and consumer technology companies alike to be highly active in exploring strategic acquisitions of early stage wearable companies.

Frost & Sullivan’s recent study on consumer behavior to digital health shows approximately 24% of consumers currently use mobile apps to track health and wellness, 16% use wearable sensors and 29% use electronic personal health records. This trend is expected to continue as 47% of consumers would consider using wearables in the near future.

Source: Das, Reenita. “Top 10 Healthcare Predictions for 2016.” Forbes. (See Here.)

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#2 In the continuing battle on drug prices, collaboration will be crucial to finding a pricing formula that’s “just right.”

Drug prices have reached a boiling point in the US. Insurers, patients and a bipartisan cast of politicians say they are too high. The pharmaceutical industry, meanwhile, is concerned about further downward pressure on prices and its ability to fund new innovation. Like the proverbial story of Goldilocks, the search is on for a pricing formula that is “just right.”

Under threat of strong government action in 2016, pharmaceutical companies are contemplating new ways to justify the cost of drugs. Collaboration—with insurers, patients and new value assessment groups—may be the key ingredient.

Many factors are fueling the debate. Spending on more complex specialty drugs increased nearly 27% in 2014. Price increases for branded drugs have outpaced inflation every year since 2006. Even generic drugs, ordinarily a price deflator, are increasing in price—nearly 9% on average in 2014. The trajectory is expected to continue into 2016 as new specialty drugs—many costing in excess of $100,000—expand their market share…

Scrutiny also is coming from third-party, non-profit value assessment groups such as the Institute for Clinical and Economic Review, the National Comprehensive Cancer Network and the American Society

of Clinical Oncology. All are developing formulas for drug prices based on clinical results, economic impacts, comparative effectiveness, drug toxicity and more.

Similar approaches have been used for many years by the UK’s National Institute for Health and Care Excellence, Germany’s Institute for Quality and Efficiency in Health Care and other countries to successfully bring down prices. US insurers—already challenged by escalating drug prices and seeking to limit or delay costs—may use this data to negotiate prices.

Implications: Use verified outcomes data to build trust. Neither insurers nor pharmaceutical companies trust each other’s data. Collaborative data collection and analysis efforts between insurers, drug companies and third parties will help lay the groundwork for new, mutually agreed-upon pricing and value models based on robust and credible information. Jointly developed value models will help avoid shifting criteria and defend against arbitrary drug access decisions by purchasers or legislators.

Source: “Top Health Industry Issues of 2016: Thriving in the New Health Economy.” PwC Health Research Insitutte. (See Here.)

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#3 A shift to bundled payments will quickly gain steam in 2016.

Close to 50 years ago, in March 1967, a landmark article described how to change the unit of analysis in medical care from an individual service to a medical episode. It’s a simple concept, after all: Instead of looking at and analyzing a set of seemingly disjointed services, group them into an episode that defines an illness, an injury, or a treatment. In doing so, suggested Jerry Solon, PhD, of the University of Pittsburgh, it is possible to start making real inferences about the inputs (health care services) that generate an output (treating a patient).

Since then, dozens of papers and articles have been written on episodes of care and their incarnation into a payment modality that, today, is referred to as a bundled payment. In fact, a 2012 report from the Congressional Budget Office identified bundled payments as the only Medicare payment demonstration project to date that had showed clear savings. And yet, despite the simple and intuitive nature of Solon’s observations, payments for episodes of medical care remain a rarity in U.S. health care…

We seem stuck in a quandary, knowing that bundled payments bring value for patients, providers, and payers, yet we are incapable of fully exploiting their potential. Fortunately, solutions are actively being developed in the private sector at the behest of forward-looking health plans … These shifts are finally creating the market demand—the business case—for solutions to emerge.

As a result, 21st-century innovation is about to hit the decades-old infrastructure for health care transactions. When that happens, and it will by early 2016, the shift will be swift and catch the incumbents unprepared, much as mobile telephony surprised the landline operators. Perhaps by the 50th anniversary of Dr. Solon’s paper, the simple vision he laid out will be the reality of the land.

Source: de Brantes, Francois. “U.S. Health Care Is on the Cusp of Bundled Payments.” Harvard Business Review. (See Here.)

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#4 As individuals manage more of their own health spending, consumer segmentation will become increasingly relevant to patient populations.

Patients approach healthcare with varied levels of sophistication. Taking lessons from retailers, healthcare companies should invest in a well-defined consumer segmentation to address specific needs and perspectives across a customer base.

Source: “Top Health Industry Issues of 2016: Thriving in the New Health Economy.” PwC Health Research Insitutte. (See Here.)

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#5 Financial wellbeing and personalized disease prevention plans will expand the boundaries of traditional wellness programs.

Bruce Elliott, manager of human resources at the Society of Human Resources Management, agrees that the trend to supporting employee financial wellness is on the rise. He points to PwC’s new employee benefit announced in September which will pay $1,200 a year for its associates and senior associates with one to six years of work experience to help reduce their student burden. The company expects that over time, this benefit could help reduce student loan principal and interest obligations by as much as $10,000 per employee, and shorten loan payoff periods by up to three years…

In the medical-wellness space, Elliott sees the use of DNA testing and genetics to develop personalized disease prevention

plans as definitely leading edge. In fact, Newtopia recently signed an agreement with [a payer] to begin offering its enterprise health engagement platform to the insurance company’s largest employer customers and their employees.

The agreement follows the successful completion of a robust pilot program with [the payer’s] employees who had, or were at risk for, metabolic syndrome, a combination of health factors that increase an individual’s chance of developing diabetes, stroke, and heart disease. By analyzing key health markers and health benefit claims in the pilot program, [the payer] verified that participants lost weight, reduced their waist size and had high levels of engagement in the program.

Source: Smolkin, Sheryl. “Wellness programs in 2016: What employers need to know.” Employee Benefit News. (See Here.)

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#6 As telemedicine continues to mature, enterprise-wide platforms will be coveted in 2016.

Not so long ago, telemedicine vendors had proprietary standards to connect point-to-point devices via the Internet to conduct a telehealth session. Now, there are open connectivity standards that eliminate additional steps to launch a session, making use of telemedicine simpler.

There remain significant differences among vendors in the architecture of telemedicine systems, says Steve McGraw, CEO at telemedicine vendor Reach Health, but proprietary standards for network connections are going away fast. “We worry about writing code now,” he adds. “Standards lets us write software that replicates the physician session rather than worrying about connectivity.”

Rise of the Software Platform: Healthcare organizations increasingly want an enterprise-wide telemedicine platform that supports sessions covering multiple types of medical conditions such as neurology, pediatrics, behavioral health and emergency care, among others. The advantages to providers, McGraw says, are one vendor to deal with, one security architecture, one consistent user interface, training curriculum and apps to measure and report metrics regardless of the medical condition being treated. Whereas vendors often in the past focused on one disease, those days are gone as the shift to enterprise platforms evolves in 2016. No vendor today can serve all the disciplines but that also will evolve.

Source: Goedert, Joseph. “Five Telemedicine Trends for 2016.” HealthDataManagement.com. (See Here.)

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#7 Healthcare IoT solutions will really start to heat up—spurring $10 billion in venture capital investments for startups.

The startup environment in healthcare is being reinvigorated by a wide spectrum of early stage companies looking to bring their IoT [Internet of Things] expertise honed in other industries to healthcare. With a focus on “disruptive” business models, these companies are looking to help tear down outmoded forms of care delivery and deploy approaches optimizing new tools and technologies.

Source: Das, Reenita. “Top 10 Healthcare Predictions for 2016.” Forbes. (See Here.)

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#8 Interoperability will be a top priority in healthcare IT to improve the patient experience and lower costs.

While over $28 billion has been spent so far on implementing health information technology, particularly Electronic Health Record Systems (EHR), these systems are not interoperable, meaning that information does not flow seamlessly between them. Earlier this year, the Office of the National Coordinator for Health Information technology (ONC) released a report on health information blocking that has been undermining healthcare reform and called for congressional intervention to address the issue.

Recent media coverage on this topic indicates that many health systems and networks are developing workarounds using available standards to exchange clinical information within and among themselves to improve the patient experience and reduce costs. However, the healthcare IT landscape is far from seamlessly integrated at this point with major EHR vendors and health systems driving independent agendas. The same report notes that 63 percent of hospitals and 69 percent of health systems expect interoperability to be one of the top three data-related challenges over the next three years in performing analytics.

Source: Padmanabhan, Paddy. “5 healthcare technology predictions for 2016.” CIO. (See Here.)

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#9 Behavioral economics will be leveraged more in healthcare to close the gap between predictive analytics and desired action.

Keeping health care utilization under control is a major goal of both predictive analytics and behavioral economics. In the United States alone, health expenditures topped $2.8 trillion in 2013, accounting for more than 18 percent of the country’s GDP. Furthermore, chronic diseases, exacerbated by unhealthy lifestyles, account for a startling proportion of this spending. All of this makes health spending an ideal domain for applying predictive analytics: The issue is one of utmost urgency; unhealthy behaviors can be predicted using behavioral and lifestyle data; and models are capable of singling out small fractions of individuals accounting for a disproportionate share of utilization. For example, in his New Yorker article “The Hot Spotters,” Atul Gawande described a health utilization study in which the highest health utilizers, 5 percent of the total, accounted for approximately 60 percent of the total spending of the population.

Of course, identifying current—and future—high utilizers is crucial, but it’s not the ultimate goal. Models can point us toward those who eat poorly, don’t exercise enough, or are unlikely to stick to their medical treatments, but they do not instruct us about which interventions prompt the needed behavior change. Once again, behavioral economics is the natural framework to scientifically attack the last-mile problem of going from predictive model indication to the desired action.

…[It] is unlikely that purely economic incentives are sufficient to change the behavior of the very worst risks. In this context, the worst risks are those with multiple chronic diseases. A promising behavioral strategy, described in Gawande’s article, is assigning health coaches to high-utilizing patients who need personalized help to manage their health.

Such coaches are selected based more on attitudes and cultural affinities with the patient than on medical training. Indeed, this suggests a further data science application: Use the sort of analytical approaches employed by online matchmaking services to hire and match would-be health coaches to patients based on personality and cultural characteristics. Gawande recounts the story of a diabetic, obese woman who had suffered three heart attacks. After working with a health coach, she managed to leave her wheelchair and began attending yoga classes. Asked why she would listen to her health coach and not her husband, the patient replied, “Because she talks like my mother.” In behavioral economics, “messenger effects” refer to the tendency to be influenced by a message’s source, not just its content.

Closely analogous ideas can be pursued in such arenas as financial health and back-to-work programs. For example, a recent pilot study of a “financial health check” program reported a 21 percent higher savings rate compared with a control group. The health check was a one-hour coaching session designed to address such behavioral bottlenecks as forgetfulness, burdensome paperwork, lack of self-control, and letting short-term pleasures trump long-term goals. Predictive models (similar to credit-scoring models) could be built to identify in advance those who most need such services. …But behavioral science is needed to identify the most effective ways to provide the coaching.

Source: Guszcza, James. “The last-mile problem: How data science and behavioral science can work together.” Deloitte Review: Issue 16. (See Here.)

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#10 The continued growth of CDHPs will require more (and more sophisticated) support and tools.

In 2015, enrollment in consumer-directed health plans (CDHPs) reached a new milestone—one-fourth of all covered employees. Mercer’s 2015 National Survey of Employer-Sponsored Health Plans found continued growth in both CDHP prevalence and enrollment rates. Growth has been fastest among large employers. More than half of employers with 500 or more employees now offer a CDHP (59%, up from 48%), and 28% of covered employees are enrolled.

A growing number of large employers contracted with a specialty vendor to provide employees with transparency tools that deliver price and quality information about specific health care providers or services to employees (15%, up from 12% in 2014). An advantage of these tools is that they can help consumers find an appropriate provider and obtain an estimate of the cost of a visit before the visit.

In addition, telehealth services, which can help employees manage out of pocket spending by providing a cheaper alternative to seeing a physician in person for certain non-acute services, are now offered by 30% of large employers, up from 18% in 2014 and 11% in 2013.

While health care consumerism has always made intuitive sense, in the early days it may have been an idea ahead of its time. But now, the tools and resources that make true consumerism possible are finally available, and all trends point to additional and more sophisticated resources on the horizon. Offering a complete “consumerism package” to employees takes more effort than simply implementing a high-deductible health plan. But providing appropriate support tools and education may be necessary to ensure that a consumerism strategy leads to a paradigm shift, and not just a cost shift.

Source: “2015 a Milestone Year for Consumer-Directed Health Plans.” Mercer. (See Here.)

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#11 Personal health data—and patient access to it—will fuel an explosion of new and innovative uses in 2016.

Expect greater patient access to clinical records in 2016. That’s the top predicted trend for interoperable health information exchange during the coming year, according to DirectTrust, an industry alliance for participants in the Direct exchange network.

1. Patients and consumers will increase participation in electronic health data exchange. Technology will enable patients to have greater access to their clinical records. As a result, they’ll be able to more freely and easily move their records whenever and to whomever they choose. At the same time, consumers will increasingly assume a right to control their own health information. Providers will be more open to this aspect of patient engagement, viewing it as positive and productive in the pursuit of better health outcomes.

2. Personal health data will be freed up to drive new uses. Personal health information will become increasingly accessible from health-related databases, including those in EHR systems or maintained by payers, health departments, health information exchanges, pharmacies, e-prescribing systems and others. Patient-facing applications will enable individuals to “mash up” content from multiple locations and services to enrich information for personal and professional uses. DirectTrust expects explosive growth here, but cautions that privacy and security issues will need to be worked out in the process.

Source: Irving, Frank. “Patients to Step Up Health Data Exchange Involvement in 2016. HealthITinteroperability.com. (See Here.)

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#12Big data will help drive evidence-based solutions, cost savings, and healthier members.

With better access to data, a conversation about treatment options between the patient and doctor might move from reliance on popular opinion to action founded in evidence-based solutions. For example, the age at which a woman should receive her first mammography is hotly contested. Given that evidence supports less frequent screening, the cost differences among advocated screening policies should be better understood.

Patient/doctor conversations might also include answers to the following questions:> What are the most common treatment pathways, and how much do they cost?> Are there regional differences in cost and treatment options?> What is the average age of detection across a demographically congruent

sample population?> What percentage of your patients experience complications from this treatment?

Having the answers to these questions could mitigate health risks, but without access to relevant cost and quality data in real time, they will remain hotly debated among healthcare experts.

If the healthcare system bilaterally committed to celebrating champions of health and defining best practices through closer examination of cost and treatment data, the system as a wholemight look very different in five years. Employers might be able to reinvest dollars saved through low-risk maintenance strategies in employee development and job creation. Health plans would likely experience greater re-enrollment and gains in customer loyalty by advocating the continued health of their healthiest members, as well as supporting those who are the

sickest. Physician/patient conversations would likely move from educated opinion to evidence-

based treatment pathways.

Access to data that allows us to celebrate the champions and engage in informed conversations about cost and treatment options: This is population health analytics.

Source: Stephenson, Lee “Using Data: The Power of Informed Decision Making,” Verisk Health, Inc. (See Here.)

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#13 Cybersecurity will take center stage as more smartphone-connected apps and devices are adopted by consumers.

Health apps and connected medical devices were underutilized in 2015, according to PwC. But this will change next year, in part, because of the move away from fee-for-service care as well as advances in wireless technology. One of HRI’s main findings this year is that between 2013 and 2015, use of health-focused apps doubled. While in 2013, 16 percent of consumers said they had at least one health app on their device, in 2015, that number rose to 32 percent.

The adoption of these smartphone-connected health devices will be led by those using them for primary care and chronic

disease management. These departments are already offering connected health devices, activity trackers, connected scales, health apps, and e-visits to their patients.

Cybersecurity concerns for smart health devices and apps will

also be a big trend in 2016. Companies will have to take

preemptive measures to maintain the trust

of consumers. After a hacking incident, 51 percent of consumers said they would be hesitant to use any of the manufacturer’s

devices, while a similar number of people, 50

percent, said they would be hesitant to use any

connected health device.

Source: Pai, Aditi. “PwC: Smartphone-connected health devices, behavioral health are top healthcare trends for 2016.” MobiHealthNews.com. (See Here.)

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#14 Free preventive care will be available to more than 90% of Americans.

To mitigate the cost and care burden of late-stage chronic diseases, everyone from payers, employers, and the government will be offering a wide range of technology and wellness enabled preventative services. With access now available, it remains to be seen how engaged consumers will be in leveraging those services.

Source: Das, Reenita. “Top 10 Healthcare Predictions for 2016.” Forbes. (See Here.)

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#15 Mining healthcare data to influence population health trends will be a major tactic against price pressure.

“The North Star now for healthcare, for all players in the system, is sustainable cost,” said Paul Keckley, managing director of Navigant, during Trends Shaping the Healthcare Industry in 2016: A Strategic Planning Session. Multiple forecasts indicate U.S. health costs will increase between 5.6 and 6 percent a year over the next decade, he noted, with the nation’s economy only recovering to about a 3 percent growth rate.

“Not to be missed is the pressure on price and therefore, the pressure on reducing operating costs and reducing the cost per episode of care,” agreed Laura Jacobs, executive vice president of GE Healthcare Camden Group. “Where you’re going to be in that cost value equation is a key strategic question and should be part of your board

discussions about where you want to be on that

spectrum.”

To become leaner and more efficient, healthcare organizations are closing ranks in increasing numbers. Ms. Jacobs predicted that this “dance of consolidation” would continue among all stakeholders in healthcare, with intense scrutiny by the FTC of those collaborations.

Some payors already are well ahead of hospitals, doctors and service providers in the degree of consolidation, added Mr. Keckley. “These super regional systems of care are evolving as a result of this transition of volume to value.”

At the moment, health plans are better positioned to profit from healthcare’s pay for value formulas and the proliferation of shared risk arrangements, he continued, largely because of the huge data repositories they have constructed. “A very strong meta-analysis of [health plan] data becomes the anchor for shared risk arrangements,” Keckley said, referring to the phenomenon known as infomediation. “The strongest asset health plans have is their data.” Manipulation of this data to influence population health trends is fast becoming central to health plan operations, he said.

Source: Donovan, Patricia. “Healthcare Drivers for 2016: Cost Management, Consolidation, Consumerism.” Healthcare Intelligence Network. (See Here.)

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#16 Behavioral health will become a priority for employers in 2016—and will increasingly be delivered via remote technology.

Next year, employers will also prioritize behavioral health. According to [PwC’s annual Health Research Institute report], mental health conditions cost U.S. businesses more than $440 billion every year. These employers are focusing on issues like stigma and mental health awareness. The reach of behavioral health offerings will also increase. More primary care physicians will start using remote technology to connect with behavioral health specialists, which will ultimately help primary care teams manage routine behavioral health problems. And behavioral health doctors will use remote technology to connect directly with patients.

Source: Pai, Aditi. “PwC: Smartphone-connected health devices, behavioral health are top healthcare trends for 2016.” MobiHealthNews.com. (See Here.)

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