Imagine Blog

The Forces Shaping Healthcare: 2017 Trends You Should Know

It has been quite the year for healthcare providers and their patients. Major shifts in policy like the MACRA Final Rule and the end of the ICD-10 grace period have ushered in a new era of value over volume. Not to mention a new president-elect, declaring the repeal and replacement of the ACA one of his top priorities. The future of the industry is hazy, but what’s certain is the undeniable growth of value-based care. It can no longer be ignored. To survive this new world, health organizations must adapt, innovate, and create value. Let’s discuss some emerging trends you should know for 2017, and how to tackle them head on. 

MACRA
  • The Medicare Access and CHIP Reauthorization Act (MACRA), weighing in at a whopping 24 pounds when printed, marks the shift to quality-based physician reporting. Replacing the Sustainable Growth Rate formula with the Quality Payment Program, physicians now have two reporting tracks to choose from: The Merit-Based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (APM). Under MIPS, providers earn a payment adjustment based on providing quality care supported by technology (think EHR). Under APM, providers earn more for taking on risk for patient outcomes. 
  • Key Takeaways - The Final Rule is meant to enable providers to embrace MACRA with confidence, so don’t waste time! It’s important to start reporting as early as possible. The more you measure and report on outcomes using proactive and intelligent practice management models, the more you’ll see payment premiums in your future. If your head is rolling from information overload, have no fear. Our MACRA Final Rule whitepaper simplifies everything you need to know – including deadlines, tips and best practices. 

Artificial Intelligence and Machine Learning
  • We may not live in an age of robots and flying cars, but a computer helping a doctor form an accurate diagnosis on a patient’s MRI in real-time is on the horizon. In fact, 85% of customer interactions will be managed without a human in 2020. This innovation is possible through machine learning – an automated approach to analytics that enables computers to draw conclusions from data and perform a specific task, all while continually learning and refining its outcomes. It basically gives computers the ability to learn without being explicitly programmed. 
  • Key Takeaways - There is so much possibility in the realm of AI. In the not so distant future, machine learning will not only play a large role in routine workflow and diagnostic support, but also early detection and diagnosis of disease. However, it’s important to note that AI should never be viewed as a replacement for clinical care, rather compliment it. It’s really up to the provider to determine interaction with this field. Do your research and determine whether or not AI is right for your practice. You can learn more about machine learning here

Rising Healthcare costs and the power of Consumerism
  • Insurance premium increases, heightened patient out-of-pocket spending, growth in high-deductible plans, hiked pharma prices… it’s enough to scare anyone away from routine visits to the doctor’s office. As I mentioned in this blog post, patients are beginning to comparison shop before they choose a provider, before they go in for surgery, or before they decide to purchase medication that their doctor prescribed. With value-based care in full swing, patients have essentially become healthcare’s window shoppers. These changes aren’t only affecting patients, though. Pressure to reduce costs travels from employers to payers and onto providers. Now, providers must make the changes necessary to curb costs but also satisfy their patients’ needs for top notch, quality care, all the while facing the prospect of declining reimbursement and narrowing provider networks. 
  • Key Takeaways - Communication between patient and provider is really crucial here. Make sure patients know upfront how much services will cost. Educate them on practice payment policies. Basically, act as the patient’s coach. Teach them to speak up about the price things like medication, X-rays, etc. if it’s an issue. Often times, patients won’t communicate their concern simply because they’re embarrassed, so meet them halfway. Encouraging patients to discuss their financial barriers will not only save both parties time, but strengthen the provider to patient relationship. It also prevents a lot of wasted physician time. So, check on costs and educate the patient, before care is provided if possible. 

Prior Authorization 
  • Requirements for prior authorization have increased steadily in recent years, and there are no signs of slowing down in 2017. A recent Kaiser Family Foundation analysis of Medicare data found that 23% of drugs in private drug plans are covered by Medicare Part D required prior authorizations, up 8% from 2007. During that same period, the percentage of drugs carrying some type of utilization management restriction more than doubled from 18% to 39%. As prescription drugs become more expensive, especially ones that are complicated and require a whole slew of questions about appropriateness, there’s a heightened use of prior authorizations. Also, the nation’s changing demographic is playing a large role. As more of the population becomes eligible for Medicare Part D, drug costs rise and plan administrators turn to prior auths to control costs. 
  • Key Takeaways - The good news? There are products and services available to practices that speed up and streamline the process, as well as minimize that amount of practice time they consume. Imagine uses an engine that includes over 27,000 payer and provider-specific rules to determine whether a prior-auth is needed, while checking CPT-specific eligibility and benefits. There is also a possibility that value-based payment models will decrease the number of drugs and procedures that need approval before payers will cover them. The healthcare industry is moving toward rewarding outcomes, so there’s a possibility that value-based care could end the need for pre-auths entirely!

Cyber Security 
  • Words typed on a keyboard can’t possibly express the level of risk associated with the exposure of patient medical records. Personal medical information is one of the most valuable types of data for hackers. Patient data really provides a double whammy when it comes to theft – both identity and its variant, medical identity theft. When a person uses another’s identity to obtain medical treatment, not only is the victim’s medical records meddled with, their insurance company is defrauded as well. Medical identity theft victims actually spend an average of $13,000 or more to get their life back. Beyond financial risk, any loss of patient protected health information (PHI) could cost practices their reputation and the trust of its patients. Health networks are really a prime target for attackers, since data is spread over different networks, making it harder to defend.
  • Key Takeaways - There are steps that can be taken to improve your defenses. Sam Khashman, CEO of ImagineSoftware made several suggestions: "Education and training of health organizations are vital, ongoing mititgation steps allowing for discipline, documentation, compliance, and buy-in from staff and stakeholders. Healthcare providers should properly vet and re-vet their human resources, using technology to detect any departure from the lines of compliance. Providers could either lean on readily available data loss prevention systems (DLP) that stop PHI from being exploited, or choose to implement a tokenizaton system that will render the data useless without its environment." 

2017 will be the year of the patient. They're becoming much more involved in their own health, taking control and making their own decisions. To succeed, healthcare providers must embrace value-based care and meet their patients halfway, becoming the helping hand they need. 
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