It’s that time of the year when writers and pundits put together recaps of the past twelve months and offer opinions about the significance of what happened over the past year, along with predictions on what big events are on the horizon.
As an avid reader and consumer of healthcare industry news, it’s fair to say – a lot happened in 2018 in the world of healthcare and information technology. I encapsulated what I consider five significant happenings that had profound influences on healthcare coverage, how technology extends healthcare and some moves and pronouncements by a few notables who helped us look a little differently about what really matters in healthcare.
Okay, drum roll please!
- Medicare Advantage Rocks! 2018 was a significant year for Medicare Advantage (MA) as CMS backed more flexibility for plans to innovate to support patient needs. This resulted in an 8% growth rate in MA membership in 2018 which is projected to grow even higher in 2019. While MA plays an increasingly larger role in Medicare, CMS proposed new changes to the way it calculates risk adjustment payment to MA plans. MA rates continue to climb and risk models continue to get smarter. CMS also recognized the importance on socioeconomic factors in informing and improving care delivery and is now including mental health and substance abuse disorder into the HCC risk model.
- The ACA is a Survivor! The Affordable Care Act (ACA) survived another year despite death by a thousand cuts and a Texas judge’s decision to declare the law unconstitutional in the eleventh hour. The opinion rendered late in the afternoon on December 14, 2018 – the day before open enrollment closed – by a Federal US District Judge, is likely to be appealed and the decision may ultimately lay with the U.S. Supreme Court. However, the exchanges remained open for 2018 – are alive and well for now – and 2019 coverage will not be impacted. In fact, there was a late rally which saw an estimated 8.5 million new enrollees. But, the consumer rate increases for 2019 are not pleasant as individual buyers directly assume more and more healthcare costs.
- Amazon – the next new healthcare tech Giant! Amazon throws its hat into the NLP ring with Comprehend Medical – making Amazon the latest to join a growing list of other technology giants including Apple, Facebook, Google, IBM and Microsoft, who are all retooling their businesses around the belief that AI and machine learning are the future of healthcare. Amazon’s recent announcement about extending its natural language processing (NLP) service for finding insights in large text data sets to the rich world of medical information, has attracted a lot of attention. As it should. And that is good news for Talix. Stay tuned for an upcoming blog on the Comprehend Medical announcement.
- Non-tech solutions can work! Oprah had a health scare – yes, Oprah, the queen of all media, came down with a bad case of salivary gland blockage. Before she got a diagnosis, she feared the worst. The remedy? Sucking on a lemon and drinking lots of water. Oprah’s fears were allayed, and she gained a new respect for the power of simple remedies to help the body heal (and get those salivary glands working again!) Returning to perfect health, will Oprah run in 2020?
- Former health tech entrepreneur re-enters the scene! The former CMS chief, Andy Slavitt, who helped implement the ACA under President Obama – and is rumored to have turned down the leadership of a big healthcare play based on the West Coast – decided that the world needs fewer Fitbits and more healthcare support for older and underserved Americans, so he started a venture capital fund, Town Hall Ventures. This fund invests in companies like CityBlock, which will help at-risk and low income Americans with a range of services including ending the opioid epidemic, targeting mental health and tackling the social determinants of health.
So there you have it.
But wait. Bonus 2018 recap: There’s been an abundance of unhappy and controversial news from 2018 but one thing stands out as an amazing positive story about healthcare, teamwork, and international cooperation. The story is the world-captivating search and rescue of the boys’ soccer team and its coach deep in the cave at Thom Luang in Thailand. A Talix strategic advisor, Dr. Paul Auerbach and an authority on wilderness medicine, was interviewed several times by international news services about the healthcare issues associated with this event.
Here’s one video snippet.
Now, here are my five predictions for 2019. Let’s have another drum roll!
- Artificial intelligence (AI) in healthcare finally reaches a moment of truth and is discovered to be a big, overblown promise, and once again, tech visionaries dream up scenarios that are impossible to realize in the complicated healthcare industry.
- Doctors stage a revolution and take to the streets, creating bonfires of software code in front of their medical office buildings. Some of them toss their laptops off tall buildings, while thousands dress in t-shirts that proclaim, “No More Clicks!”
- With a new lease on life since her salivary glands were healed, Oprah changes her plans and declines to run for President in 2020. Instead, using her star power and vast financial empire, she tries to privatize CMS in concert with several PE firms, and make healthcare available to all Americans.
- Ambulatory care doctors (otherwise known as those who walk the talk) finally get the message that taking on true financial risk (both upside and downside) is the best thing to happen in medicine since the invention of golf. Like their dental cousins, primary care docs find ways to leverage clinical and other resources, make more money, and deliver better healthcare outcomes to their patients.
- Learning that higher co-payments and premiums don’t deliver better care, patients revolt and exchange talk about “patient engagement tools” with a demand for lower costs, more convenience and better quality outcomes. “Don’t stick me with higher costs and then tell me to ‘comply’ with more healthcare requirements and waiting times” say patients all over the country.
And now, for a bonus prediction. (Actually it’s a pitch). I predict Talix will help dozens of health plans finally achieve better than 95% accuracy in submitting HCC codes to CMS, which others have promised but have struggled to achieve. Along that line, Talix’s new Claims InSight product, which will help health plans avoid billions of dollars in potential audit fines and claw backs, brings significant relief to health plan CEOs and boards. Last but not least, physician leaders will rejoice that Coding InSight and its partners will reduce the number of clicks medical professionals need to understand the medical acuity of the healthcare population they manage.
Happy New Year!