Jan. 10 — The top 10 issues that will hold the healthcare industry’s focus in
2013 range from state implementation of the Affordable Care Act (ACA) to
increased emphasis on convenience, price, and transparency, mobile
security, and population management, according to a recent report.
PwC’s Top Health Industry Issues report, released today,
identifies the following issues as key challenges for providers and
payers as they work toward meeting ACA requirements and prepare for a
shift in market dynamics.
State decisions regarding insurance exchanges, expansion of Medicaid coverage, and insurance market regulation.
The biggest challenge states could face in responding to these key
issues in 2013 could be IT: Designing the infrastructure to create a
single, seamless entry point to the exchange will require some states to
overhaul existing Medicaid eligibility systems.
Increased emphasis on convenience, transparency, and price.
As consumers have greater say in how they will spend their healthcare
dollars, key players throughout the healthcare industry will find
themselves competing on these three attributes.
Impact of excise tax on medical device companies. A
2.3 percent excise tax on medical device companies took affect Jan. 1,
representing potentially $29.1 billion to the federal government over
the next 10 years. The $380 billion global medical device industry will
likely be unable to pass the tax on to its customers, but could look to
its suppliers to share in the burden.
Caring for dual eligibles. Dual eligibles—people who
qualify for both Medicare and Medicaid—make up many of the 16 million
people the ACA will add to Medicaid rolls by 2019. The cost of care for
duals is skyrocketing—much of it wasted due to a lack of care
coordination between the two programs—and 70 percent of state Medicaid
spending on duals goes toward long-term care support services, such as
nursing homes, according to the report.
Mobile device security. Physicians and nurses are
bringing their own mobile devices to work, but many hospitals do not yet
have a secure enough environment to protect sensitive patient
information. According to PwC, only 46 percent of hospitals have a
security strategy to regulate the use of mobile devices.
Redesign of healthcare delivery. Having already
plucked low-hanging fruit with labor productivity and supply cost
reductions, more hospitals in 2013 will embark on full-scale
transformation efforts to redesign how they deliver care, according to
Effects of customer ratings on hospitals and insurers.
Pay for performance will take on new meaning in 2013 as consumer
reviews generate penalties and bonuses for hospitals and insurers. Such
reviews could generate a bonus payout of more than $3 billion for
insurers and a hold back of $850 million for providers in 2013,
according to PwC.
Increased expectations related to pharmaceutical value.
As costs shift to individuals, drug and device makers will be under
greater pressure to prove value to consumers, PwC says. Providers and
payers also will demand evidence that evidence that new drugs fill an
unmet need or outperform similar products at a more reasonable cost.
Employers rethinking their role in health care.
Employers have an opportunity to reexamine their long term role in
providing healthcare coverage and explore alternative approaches
provided by state and/or private exchanges. In 2013, CEOs will ask tough
questions about how and why so many resources are going toward health
Population health management. Medicare's accountable
care organization and patient-centered medical home initiatives laid a
foundation for improving population health, but other collaborations are
fueling growth in population health management. In 2013, more companies
are likely to form partnerships to build their population health IT
infrastructures and to share responsibility for patient outcomes and
satisfaction, data collection and analysis, member education, and
engagement, with a focus on at-risk populations, according to PwC.
Publication Date: Thursday, January 10, 2013