The healthcare industry has seen a lot of change over the past decade, from increased regulatory focus to mass deployment of a now digital US healthcare “chassis”. In the wake of the recent national election and looking ahead to continued healthcare reform, 2017 looks to be a year of both great opportunities – and subsequently great challenges - for those across the care and payment continuum.
The emphasis on consumers and the delivery of exceptional patient care remains clear, illustrated by three key trends to watch for in 2017 – the shift to true value-based care, a continued emphasis on interoperability, and the increased realization of precision medicine.
1. Value-based care: Finding strength in patient-centered, collaborative care networks
The shift to true value-based care is moving full-steam ahead. Leadership within the healthcare industry is focused on the Institute for Healthcare Improvement’s Triple Aim – higher quality, lower costs and better outcomes – and increasingly models aimed at reaching those goals are gaining traction. In fact, CMS recently announced that more than 350,000 eligible clinicians are enrolled in four of the available alternative payment models for 2017, reflecting a strong increase over prior years.
With legislation and federal regulations, such as the MACRA, shifting the reimbursement model from volume-based payments to a more comprehensive value-based framework, care providers have begun in large numbers to employ new strategies to help them meet requirements and provide the best quality of care. We anticipate a further increase in the development of patient-centered care models, as well as additional engagement with patients who seek to own and understand their own health data. Forward-looking organizations will use analytics to drive outcomes by applying claims, cost and clinical data. And members of patients’ care teams will be encouraged to seamlessly work together to create community based, individually optimized care for their patients.
2. Interoperability: Growing demand for true community connectivity
Care coordination, the organization of patient care activities between the healthcare professionals involved in a patient’s care, is only possible if the multiple stakeholders across the industry work together to share critical information. We are making progress toward interoperability, but the demand for true connectivity continues to grow. In fact, the new care models expanding at the sponsorship of both public and commercial payers, require health IT infrastructure that can facilitate interaction between multiple technical solutions, devices and applications in a more streamlined, scalable and efficient way.
A key component of this infrastructure is the open Application Programming Interface (API). APIs are sets of tools and specifications that describe how software should interface with each other. Fully supported APIs come with sample code, documentation, sandbox environments, training, and live resources to help navigate the process. They improve collaboration with EHR vendors and allow healthcare organizations to configure their workflows, patient engagement strategies and business management with less customization of their EHR. APIs also tend to be very accessible, easier to use and a lower cost option when compared with other integration efforts.
The U.S. government will continue to be involved in interoperability efforts. Congress recently passed the 21st Century Cures Act, which gives us the first codified definition of interoperability in the U.S., and we can anticipate Congressional offices and the Department of Health and Human Services to closely watch progress and measure whether MACRA does, in fact, drive more collaboration and connectivity, and therefore, innovation.
3. Precision medicine: Proactively providing genomically-aware care
One of the most exciting trends to watch in 2017 is precision medicine. Genomic information presents potential for precise diagnosis, optimized treatment and predictive aspects to keep patients healthy, as well as curing people faster when they are ill. Until now, medical knowledge and therapies were tested on broad populations and prescribed using statistical averages. That meant treatments would ultimately work for some patients, but not for many others.
The approach of employing precision medicine signals a shift from generalized medicine – the traditional one-size-fits-all and trial-by-error approach - to a personalized care methodology with testing and treatments specifically tailored for individuals. It factors genes, environment, lifestyle factors and family history into clinical decision-making for earlier, more accurate diagnoses, as well as more effective treatment and prevention.
Patients aren’t the only ones whose lives will be improved by precision medicine. Precision medicine is already positively affecting providers (for example, by reducing ED visits by 30% through application of molecular profiling treatment strategy); payers ($25 billion expected annual spending on genetic tests by 2021, and 45% of FDA approvals were geared toward targeted therapies in 2013); and pharma (the pharmacogenomics market is expected to be $7.5 billion by 2017).
This is an exciting year for health care. There will be challenges, but if we continue to move towards a more open, connected community of health, we can work together to deliver higher quality care, lower health care costs and achieve better outcomes for our patients.
HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.
This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.