Top 5 Health Care Trends
to Watch in 2015
SJC GRADUATE SCHOOL
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Interoperability
Rising Cost of Specialty Drugs
Innovations (Policy…etc)
Transparency
Accountability
Top 5 Healthcare Trends in 2015
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From electronic health records (EHRs) to
clinical measures and decision support tools
New technologies that automate processes and
capture new types of data
However, these systems are limited in their
potential because they don’t all “talk” to one
another. (not interoperable)
They’re locked away within proprietary
technologies that render them the equivalent of
an email account that only sends messages to
people in your company, or a phone that only
makes calls in your house.
The Year of Living Interoperable
The Year of Living Interoperable
The Year of Living Interoperable
As long as data remains captive behind proprietary
walls, we can’t unlock its true potential, which helps
explains why widespread dissatisfaction exists among
providers.
 According to a recent survey conducted by Premier
and the eHealth Initiative, 95 percent of providers
say interoperability challenges limit their ability
to exchange data across care settings
 The ability to seamlessly integrate this data into a
single repository is essential for providers to be able
to mine information, spot community health needs,
improve population health management, reduce costs
and improve quality.
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The Year of Living Interoperable
Health care’s interoperability revolution of
2015 will likely bring renewed pressure on
proprietary systems.
 At the same time, providers will push for
application programming interfaces
(APIs) and open source tools that
developers can use to design new
applications that make sense of all the
data, and that turn it into something
clinicians can truly leverage.
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The Year of Living Interoperable
The Year of Living Interoperable
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It’s rare to see the insurance industry, patient
groups, employers, providers and pharmacies all
aligned on a single issue…high cost of new
specialty drugs has raised fears across the
industry.
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Specialty drugs are expensive to develop and
target a very small subset of the population. To
recoup research and development costs on
therapies for a small pool of users, specialty
drugs tend to carry very high price tags that
can range from $30,000 up to $1 million
over the course of treatment.
What Goes Up Must Come Down
What Goes Up Must Come Down
What Goes Up Must Come Down
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Just 1-3 percent of the population uses
specialty drugs, yet spending for these
therapies will account for 50 percent of
total U.S. drug expenditures by 2018.
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While specialty drugs have the potential to
reduce the total health care bill as patients
are cured of chronic illnesses and avoid costly
complications, the near-term cost problem is
hard to overcome.
What Goes Up Must Come Down
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Although almost all attention has focused on
programs designed to incent greater care
coordination, disease management and
preventive care, innovations are starting to
take root
This trend is being driven by two factors:
◦ 1) The strain on budgets (Phil-Health, Election
2016)
◦ 2) The need to align with government
programs that push providers toward more
coordinated, accountable care.
Innovation Nation
More and more health care data will be
made available to public scrutiny in 2015.
 The newest area of transparency is
financial, with Medicare’s (US) release of
physician procedure charges across the
nation, as well as new data comparing
insurance plan premiums and benefits
through the health insurance
marketplace.
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Let The Sun Shine
Let The Sun Shine
Also new this year is the Open
Payments website, allowing anyone to
see payments of value made by drug and
device manufactures to care providers.
 In 2015, look for this debate to continue
to expand as individuals become more
receptive to pricing information now that
many are facing higher co-pays,
premiums, deductibles and high-value
networks.
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Let The Sun Shine
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More important than the financial aspect is
the increasing prevalence of quality and
performance measures data.
Medicare got into the transparency game
with its provider star rating website, which
has expanded in the last few years to include
data on hospitals, physicians, nursing homes,
home health providers, and dialysis centers.
A spate of private sector firms also provide
quality data, including groups such as
Consumer Reports, Leapfrog Group,
Consumer’s CHECKBOOK, and more.
Let The Sun Shine
Let The Sun Shine
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But transparent quality data is still
very much in its infancy, and can be
based on disparate, complicated measure
sets that aren’t usable by consumers
interested in making meaningful
comparisons. Watch for continued
developments in this evolving sector.
Let The Sun Shine
Let The Sun Shine
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Along with all the attention on accountable
care organizations (ACOs) as the leading
model for care transformation, this year will see
a rapid expansion in bundled payment.
Bundled payments group all the services patients
receive during an episode of care — including for
conditions that require pre- and post-hospital
care, such as heart surgery or hip and knee
replacements — under a single target fee
If providers are able to provide necessary
services more efficiently and with a higher
quality outcome, they keep a portion of the
savings generated.
Bundled Payment Takeover
Bundled Payment Takeover
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Paying for care across the whole episode,
rather than paying for each service
separately, has advantages that directly
benefit patients.
◦ For one, a bundled payment incents physicians,
nurses, specialists and post-acute providers to
collaborate to ensure the best outcomes – they
are all equally responsible for controlling the quality
and cost of services, as well as costs associated
with preventable complications.
◦ It mirrors how patients envision their care. A
knee replacement patient thinks of the totality of
their care and the outcome of the procedure, not all
the individual aspects that went into providing it.
Bundled Payment Takeover
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Although the voluntary federal bundled payment testing
program was slow to get off the ground, it could have
thousands of participants in 2015, making it the most
popular value-based payment program in the country.
Employers are also jumping on the bundled payment
bandwagon, with Wal-Mart and Lowes offering no-cost
knee- and hip-replacement surgeries for more than 1.5
million employees who seek treatment from facilities
participating in a bundled payment program.
With all the experimentation going on, 2015 could be the
year that we prove the merits of the concept and diffuse
best practices for success in the new model.
Going forward, it is highly possible that bundled payment
will become a mandatory program in additional states, and
at the federal level soon thereafter.
Bundled Payment Takeover