Healthcare shifts again: Part 2

It seems the healthcare system is shifting again to address reductions in costs and maintaining quality. We asked our Zintro experts to comment on these shifts, changes, and new trends, such as hospital mergers, insurer moves to purchase provider practices, and employers’ greater interest in employee care. Craig Howell, an expert in the sales and marketing area of the clinical molecular diagnostics industry, says that increasing consolidation in health insurers puts negative pressure on overall healthcare costs and will tend to stifle innovations in care. “We should anticipate more restrictive coverage policy from fewer insurers as they attempt to control cost and extract value from their new businesses. This will inevitably lead to fewer opportunities for innovative care and the payments for delivering improved care,” says Howell. “Increases in control over coverage policy will dovetail with implications of Affordable Care Act assuming it into existence. We may see a continuation on lowering payments, more difficulty to get appropriate reimbursement for innovative and valuable care, and more difficulty to enter new care into practice.” Howell says these shifts will tend to negatively affect consumers and smaller businesses that will not have buying power to minimize care costs. “They will continue to pay more and get increasingly average care unless they pay out of pocket. The diagnostics area, which is long seen as a cost center, will also lose, especially the large manufacturers as they provide the lions share of routine diagnostics, They do not influence the overall healthcare system effectively to preserve a valuable position in the environment going forward,” he says. “The winners? Innovators who are smart enough to build medical evidence into the development areas and so can influence coverage policy and reimbursement access in comparative effectiveness and influencing medical practice effectively.” Cardiac Rhythm Doc, a cardiac electrophysiologistand healthcare IT consultant, says that consolidation and contraction among hospitals and mass purchasing of medical practices (72% of physicians are now hospital owned) are occurring due to several factors:

“The increases were put in place by CMS to orchestrate the purchasing, putting all the players in the same sandbox before total cuts come through,” he says. “All these shifts will be accompanied by drastic changes in purchasing of drugs and devices. The government (and possibly ACOs) will purchase directly, drastically lowering prices, as has been done in Europe. These shifts are occurring at a time of physician shortages, which will, I think, spur the wireless health technology industry.” Nicole Bradberry, a VP of Healthcare Operations, says that it is definitely not business as usual. “The healthcare system is fundamentally changing. Healthcare costs have increased at unprecedented levels for the past 10 – 15 years as HMOplans lost favor. These costs are unsustainable even without adding the 33 million new members to the rosters due to health reform legislation,” she says. Bradberry says that this fundamental change can be seen in these shifts:

  • Accountable Care and Patient Centered Medical Homes are the current buzz words.
  • Primary care is getting a much needed focus as the true managers of cost.
  • CMS and HHS are fostering innovation with grants and the never before release of government owned healthcare data.
  • Payors are re-thinking traditional payor-based case, disease, and wellness management. This is spurring hospitals and payors to partner or buy primary care.
  • Primary care groups are either signing up or trying to consolidate on their own.
  • Employers seem to be the last group at the table but the most important one outside of primary care itself.
  • The patients and the health care system will win if the employers and primary care join forces to be the leaders behind the next truly accountable care model.

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