It has apparently been five years since the Administration and its allies in Congress used every underhanded trick they could find to get the so-called health reform law passed. While it hasn’t lived up to any grandiose promises proponents made to get it passed, it hasn’t (yet) created the disaster opponents feared. One thing for sure is that it has added hundreds of billions in public spending, including tens of billions for administration, with no relief in sight. The Health Research Institute at PriceWaterhouseCooper has issued a report giving its perspective on five key trends stemming from the law. (PWC Report) The HRI’s five trends include a shift in reimbursement methods that put more risk onto providers, including bundled and episode payments, pay for performance, shared savings approaches and full capitation. Providers need tools and management expertise to be able to manage this additional risk effectively. Another trend is a supposed re-emphasis on primary care and implementing new primary care approaches, like the medical home and accountable care organizations. The third is the arrival of new entrants, according to the researchers there are at least 90 new companies offering innovative approaches to consumers. Fourth is a shift in health insurance marketing from employers to retail models of direct-to-consumer, largely due to the exchange business. Finally, states have a newly enlarged role through decisions regarding whether and how to expansion Medicaid and how to implement insurance exchanges. Each of these trends is causing the major industry participants–providers, health systems, health insurers, drug and device companies–to evaluate how they do business in response to changes. PWC has a recommended set of strategic steps for these participants. It is always worth trying to understand the major forces affecting any business and to anticipate the effect of changes in those forces. But it is also easy into being fooled by surface changes. Health care is always going to primarily be about the delivery of health care services and products to patients. The people who are actually involved in that delivery are always going to demand as much revenue and profit as they can for the delivery of those services. That is the pressure on cost that is so hard to control. And the diagnosis and treatment of people’s health needs is not yet, and may never be, an exact science, which drives variation in quality. So whether the reform law or other factors and forces are creating “trends” or changes, what really matters is what is happening with quality and cost outcomes. There it is not clear to me that there is any real improvement, certainly not from the reform law.
✅ Subscribe via Email
About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
Healthy Skeptic Podcast
This is an outstanding report on total global drug spending and trends, with projections out to 2025. It helps you understand this important area of health care, which does much...
June 1, 2021
MedPAC 2019 Report to Congress
June 18, 2019
Mental health company Headway makes, well, headway, by raising an impressive $125 million round of new capital. The company connects patients with mental health providers and facilitates providers working with...
October 11, 2023
Two health care firms owned by private equity firms are merging in a transaction supposedly valued at $3 billion. HealthComp administers self-funded plans for employers and other groups and Virgin...
September 27, 2023
NextGen, an electronic medical records firm, is being put out of its public company misery, as a PE firm will pay $1.6 billion for the one-time high-flier.
September 7, 2023
Access ACO Care Management Chronic Disease Comparative Effectiveness Consumer Directed Health Consumers Devices Disease Management Drugs EHRs Elder Care End-of-Life Care FDA Financings Genomics Government Health Care Costs Health Care Quality Health Care Reform Health Insurance Health Insurance Exchange HIT HomeCare Hospital Hospital Readmissions Legislation M&A Malpractice Meaningful Use Medicaid Medical Care Medicare Medicare Advantage Mobile Pay For Performance Pharmaceutical Physicians Providers Regulation Repealing Reform Telehealth Telemedicine Wellness and Prevention Workplace