The controversial law has now been in effect for five years and a new report seeks to evaluate the five trends it has helped create or accelerate.
Arundhati Parmar
Love it or hate, there's no denying that the Affordable Care Act or Obamacare, has wrought a significant amount of change in the world of healthcare.
PricewaterhouseCoopers's Health Research Institute took a deeper dive into those very changes and in its latest report, enumerate the five trends to watch.
"Not since the Telecommunications Act of 1996, has a piece of legislation sparked such significant changes in a leading sector of the economy," the report posits and few would argue about that conclusion.
So, here are the trends as PwC sees them:
Risk Shift Occurs
It's not a surprise that report authors have chosen to put the shift of risk at the no. 1 position. This is perhaps the most profound trend to emerge as the ACA essentially moves risks away from traditional risk bearers - the insurance companies - on to payors, life sciences companies and even consumers, the report states.
- Medicare has instituted financial penalties and incentives with the overarching goal of improving care coordination, reducing fragmentation and variation in treatment, as well as delivering superior clinical outcomes. This can be seen in the Medicare penalties for hospitals who see a high rate of readmissions of patients.
- By 2018, half of Medicare expenses will be moved to alternative payment models. That would hasten the move to a fee-for-service to the fee-for-value based healthcare system.
- No longer is it enough for pharma and device makers to show value that is enough for an FDA approval. They have to do more outcomes-based research to provide the evidence that their therapies work.
- Partnerships abound - physicians and hospitals are partnering, payers and providers are teaming up and overall there is more business-to-business partnership today - in a bid to uncover what truly provides value.
- Hospitals and health systems will ask for more risk-sharing value-based contracts with their life sciences vendor companies.
Focus on Primary Care
It's back to the basics as the report states that the Affordable Care Act has brought primary care and its need for sharply back into relief.
- The ACA has dedicated $31 billion to support and boost primary care.
- It also created the Center for Medicare and Medicaid Innovation, which among other things researches ways to improve delivery of primary care.
- ACOs have become more formalized allowing physicians to participate in new risk-based payment models that can allow them to share in any savings
- Telehealth gets a big bump through the ACA as the law encourages primary care physicians to care for patients remotely
New Innovators Enter Marketplace
PwC has found that more than 90 companies have been formed since 2010 and this includes some that were conceived directly in response to ACA requirements. Omada Health is one such example. It has created mobile and virtual programs to keep people at risk of developing chronic conditions such as diabetes and cardiovascular disease. The Centers for Disease Control just provided pending recognition to Omada Health and two other virtual disease management companies for demonstrating outcomes that proves that they can help people lose weight and gain healthy habits and not become a chronic patient.
- New entities aside, the opportunity in healthcare is drawing well known names from the tech industry - Apple, Google, Samsung are the biggest names who are looking to capitalize on the needs of a new consumer and new healthcare ecosystem.
- Companies are also eager to wear different hats as providers become insurers and insurance companies buy up physicians' practices.
- New entrants are being formed through partnerships forged by known players - for instance, not-for-profit health provider MedStar is teaming up with CVS's Minute Clinic such that patients' availing of the retail clinic know that their data wil be shared with their MedStar physician
Health Insurance Goes Retail
The ACA has facilitated the rise of health exchanges taking what has historically been a wholesale business to have a retail angle too. The second year of enrollment brought in 11.7 million people who sought to be covered through these markets, the report said.
- With that, insurance companies will have to invest in educating individual consumers about program benefits.
- Insurers will also begin to look at consumer experience more closely across their businesses as a result of having to do that for consumers in the healthcare exchange business.
- As a result deeper consumer engagement and more choice will become available
States Play Big Role in Reform
When it comes to implementing the ACA, states are key players, the report states.
- Legal challenges to the law's subsidies will be decided in the Supreme Court this summer and if found unconstitutional, the subsidies given to millions of people through state healthcare exchanges may be eliminated.
- Half of the states have chosen to participate in Medicaid expansion.
- In the future, insurance companies seeking to enter a state's healthcare exchange may be faced with barriers depending on the rules that the states have set up
Arundhati Parmar is senior editor at MD+DI. Reach her at [email protected] and on Twitter @aparmarbb
[Photo Courtesy of iStockphoto.com user StephanieFrey]
