Q&A: Predicting 2013 Healthcare Trends

Tuesday, January 29th, 2013
This post was written by Jessica Fornarotto

“There will be a significant investment in EHRs in 2013,” predicts Dennis Eder, managing director of Strategic Health Group. Eder also expects there will be more physician-run ACOs in 2013 compared to 2012.

Prior to their presentations during an October webinar on Healthcare Trends & Forecasts in 2013: A Strategic Planning Session, Eder, along with Hank Osowski, managing director of Strategic Health Group, and Steven Valentine, president of The Camden Group, shared the changes they see coming in 2013 for the healthcare industry, including future payment models, ACO administration, and demands for services.

HIN: Physician payment models are getting a lot of retooling — from the addition of pay for performance incentives for hitting quality metrics to care coordination payments for patients and members in medical homes. Is this going to change much in 2013? Are we going to see a shift toward shared savings or another payment model in the coming year?

(Hank Osowksi): Watching the trends over the last year or two and many of the innovations that are being tried, the industry is moving toward value-based purchasing and population risk-based purchasing. We think this is going to accelerate as we look at 2013, 2014 and beyond.

(Dennis Eder): I would agree with Hank. We believe with the events of 2012 and the significant interest in ACO participation, it will mature and continue into the future.

HIN: In comparing some results from our 2011 and 2012 surveys on accountable care organizations, we noticed a sizeable shift in ACO administration from hospital-run to physician-administered. Why do you think so many hospitals backed away from this role when the ACO model seemed so promising?

(Dennis Eder): One of the reasons we think this may be occurring is that hospitals administering ACOs is not part of their core competency. Many of the characteristics of an ACO are a health plan or a management service organization (MSO). And this is not what hospitals do, for the most part. In addition, hospital margins are thin, and have even become thinner, so any overhead that they can offload is a good thing. Physician organizations do this and they’re the ones who are responsible for the medical management and other care management in an ACO. I think it makes logical sense to have the physician organization take on more of an administrative role for an ACO.

(Hank Osowski): I think the point Dennis made is critically important. It is the physician organization that is controlling the array of services that the beneficiary is receiving. It makes sense for them to take a lead in running an ACO. They are the ones who best understand how all the pieces fit together and where the opportunities are to get efficiencies to improve quality and reduce the costs of care.

HIN: The IOM has recommended better and shared use of health data, particularly at the point of care, where key health decisions are made. What will be the technology to invest in or embrace in 2013 to improve data analytics for population health management?

(Dennis Eder): We’re going to continue to see a significant investment in EHRs. We know that it’s an important tool in some health plans. Kaiser, for example, is gaining significant market share. We see further investments in that particular area.

(Hank Osowski): It’s also important to take a self-examination of us as an industry. We have mountains of data. We have very little intelligence about where the value is in our system. Where can we leverage the most efficient of the care providers and change some of the things that are inefficient, that don’t contribute to high quality care and that drive up the costs? It’s digging into that mountain of data and pulling out the real healthcare intelligence that we as a system, and as an industry, can use to provide better care to patients.

HIN: What’s ahead for population health management?

(Steven Valentine): We will begin to see more fierce competition, if you will, around population health management. People are going to try to concur and grab more populations to work with in their delivery systems. We’re expecting that we should have slightly soft demands for services. We would find that even with the population getting older, and with these new delivery systems and lower utilization rates, we don’t expect to see an uptick in volume — stable to a slight decline — which means you have to reduce your expenses and go after an additional market share population.

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