Tag: PA Consulting

Health IT Trends for 2019

Healthcare technology continues to proliferate the sector, the developments almost too many to track. The sector abounds with innovation and push forward in the name of better – even the minutest – advancements of care and better care outcomes. The coming year will be no different. As we enter the final year of the 21st century’s second decade, we’ve witnessed a tremendous amount of evolution in just 19 years. What role will our healthcare technology play in the healthcare industry in the next year?

A lot. And not just for a few, but members of many, many areas, even those peripherally involved with the boundaries of care. We must understand where current innovation is, but also the challenges these migrations attempt to solve. Being aware of the trends ahead can give us all a better grasp of how care delivery is changing and we can better understand how new areas can resolve real industry problems.

To help us navigate the year ahead for healthcare and its technology, the following are some of the trends that it leaders, observers, insiders, consultants and investors think are important or need to be taken notice of in 2019.

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Reflecting on Lessons from the Past to Predict and Improve the Future of the Healthcare Industry

Guest post by Bret Schroeder, healthcare expert, PA Consulting Group.

Bret Schroeder
Bret Schroeder

Everybody knows that the US healthcare system is in trouble. Issues ranging from cost, to quality and access of care are rampant and only getting worse. On a macro level The Affordable Care Act (ACA) has solved some of the previous access issues, but has added tremendous cost within the system, and at the same time it has not solved the quality issues that exists.

Research suggests that the cost situation is becoming increasingly worse, which is causing firms to scramble for viability. Waves of cost cutting efforts have led payers and providers to capture some, but not nearly enough of the costs necessary for long-term survival.

There are two main cost challenges that both healthcare payers and providers share:

  1. Wildly inefficient operating models and processes. The Harvard School of Public Health projects that of the $2.8 trillion the US spends on healthcare each year, 30 percent or $840 billion may be wasted. For organizations that function on small operating margins, this alone represents the boundary between success and failure.
  2. Large stranded infrastructure and costs combined with declining revenues – The ratio of hospital expense vs. revenue has increased from just under 15 percent in 2011 to nearly 30 percent in 2014 with 25 percent of hospitals reporting an operating loss. For nearly 49 million enrollees in Medicare, hospitals receive only 88 cents for every dollar with lower reimbursement rates predicted in the future.

These pressures have led organizations to make hasty decisions about how to fundamentally solve the problem.  Merger and acquisition activity among both payers and providers is at an all-time high, and the ACA appears to have been the catalyst for this M&A activity. Since its enactment, hospitals started merging with competitors at unprecedented rates. In 2009, pre-ACA, there were 52 announced transactions involving 80 hospitals. That number more than doubled by 2012, with 107 announced transactions involving 244 hospitals.  The M&A frenzy among healthcare payers has also increased with Anthem’s announcement to acquire Cigna, and Aetna’s acquisition of Humana. Both of these were announced last year and are two of the largest payer M&A deals in history.

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Interoperability Demands a Single National Patient Identifier

Mark Summers
Mark summers

Guest post by Mark Summers, healthcare expert, PA Consulting Group.

At HIMSS this year, multiple speakers laid out visions for a future where parents could consult with a pediatrician via a telemedicine encounter during the middle of the night, take their children to receive immunization shots at a retail clinic, and have all of this information aggregated in their primary care provider’s record so that providing an up to date immunization record at the start of the next school year is as simple as logging into the PCP’s patient portal and printing out the immunization record. In short, multiple speakers presented visions of a truly interoperable future where patient information is exchanged seamlessly between providers, healthcare applications on smartphones, and insurers.

While initiatives such as the CommonWell Health Alliance, Epic’s Care Everywhere, and regional health information exchanges attempt to address the interoperability challenge, these fall short of fully supporting the future vision described above. Today’s solutions do not address smartphone applications and still require manual intervention to ensure that suggested record matches truly belong to the same patient before the records are linked. This process is costly but manageable in an environment where a low volume of patient records are matched between large provider organizations. In a future world where patient data is available from a multitude of websites, smartphone applications and traditional healthcare organizations, it would be cost prohibitive to manually review and verify all potential record matches.

Of course, one solution to this dilemma would be to improve patient matching algorithms and no longer require manual review of records before they are linked. However, for this to be possible, a standard set of data attributes would need to be captured by any application that would use or generate patient data. In a 2014 industry report to the Office of the National Coordinator for Health Information Technology, first name, last name, middle name, suffix, date of birth, current address, historical address, current phone number, historical phone number, and gender were identified as data attributes that should be standardized. Many of the suggestions in this report were incorporated into the Shared Nationwide Interoperability Roadmap that the ONC released in January 2015.

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