Healthcare Trends 2015: Transparency, New Players Narrow Payor-Provider Divide

Thursday, November 20th, 2014
This post was written by Patricia Donovan

Trends 2015
To paraphrase Bob Dylan: Healthcare roles, they are a’ changin:’

For example:

  • Providers are moving into payor spaces, assuming care coordination roles.
  • Payors are expanding into provider businesses.
  • Hospitals are being repurposed as post-acute care centers.
  • Empowered consumers are diving into data analytics for cost and quality information.
  • Innovators launching new care models abroad are poised to test them on U.S. soil, turning healthcare into a global market.

Given these role reversals and emerging players, the challenge of distinguishing oneself organizationally in the marketplace is a formidable one. Healthcare payors and providers received targeted advice for achieving this goal during Healthcare Trends and Forecasts 2015: A Strategic Planning Session.

And as Dorothy Moller, a managing director at Navigant, and Steven Valentine, president of The Camden Group, both attested to during the eleventh annual planning session from the Healthcare Intelligence Network, the biggest threat may come from outside the industry.

“Payors are experiencing new threats to their core business from new market entrants and competitors,” noted Ms. Moller, who offered the payor perspective. “Those could be anything from new health plans to new technology companies or companies chipping away at components of their core business, offering new services or decision-making tools to their existing customers.”

Walgreen’s retail clinics were on Ms. Moller’s list of nine such companies to watch in 2015. Similarly, Walmart’s venture into Direct Health is one example of a ‘disruptive strategy,’ contributed Valentine, representing the providers’ viewpoint. “We begin to see what direct health is doing. Walmart is getting people in their stores because they still sell goods. What happens when Walmart acquires a health plan or starts to offer its own healthcare products? If we think of some disruptive strategy, you might look at what a Walmart would do.”

Within the marketplace, Vivity, Anthem Blue Cross’s new, low-cost, patient-centered Southern California health plan that targets employers, is challenging Kaiser Health Plan for market share, added Valentine. Similarly, health plans are also threatened by ‘disintermediation,’ offered Ms. Moller— the movement of payors out of the value exchange, such as in the case of direct primary care.

Both thought leaders analyzed factors driving healthcare change, including the steady shift toward value-based reimbursement, changing healthcare delivery models and the increasing reliance on remote patient monitoring, then outlined areas ripe for potential innovation and growth.

While each proposed sector-specific coping strategies, payor-provider integration, collaboration and partnerships were also strongly encouraged.

Pressure for increased transparency also is taking its toll, with myriad sites and sources offering healthcare cost and quality data. “Healthcare systems can look at their competitors. They can get a sense of pricing in their market,” said Valentine, who advised providers to focus on pricing now in anticipation of increased awareness by 2016 and 2017, when he expects more states to include claims and pricing in exchanges.

“We used to say that healthcare was recession-proof; we now know healthcare is price-sensitive,” he said. “People’s copays and deductibles have grown enough that consumers will shop price.”

Ms. Moller advises payors to proceed carefully when considering new development. Her suggestions include collaborations with non-traditional industries, conducting long-term strategizing, and monitoring the global market.

In the closing Q&A, Ms. Moller and Mr. Valentine addressed more 2015 concerns, including the anticipated impact of Chronic Care Management reimbursement. Hospice and palliative care will likely be affected by the updated 2015 Physician Medicare Fee Schedule, predicted Valentine, who views chronic care management as a critical focus for healthcare providers in the year ahead.

“The area in which we see the most growth, and where we’ll see continued growth in 2015, is in the center for chronic care management. For example, we identify a diabetes care team, which is the diabetes center for chronic care. We find this is better in terms of using a multi-disciplinary team and it improves throughput for the primary care patient-centered medical home (PCMH).”

Commenting on impact from the numbers of newly insured on the system, Ms. Moller responded it is still too early to see the true effect, due to slow implementation and a claims lag.

For more provider predictions from Steven Valentine, including a surge in telehealth, e-visits and physician-hospital organizations, click here.

To listen to Ms. Moller’s expectations for payors in the year ahead, including co-located care management and progress by safety net payors, click here.

Have predictions of your own? Our 10 Questions on 2015 Healthcare Trends Survey runs through December 13. One winner who completes the survey will be eligible to win an on-demand recording of the 2015 strategic healthcare planning session described in this post.

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