Risk Shift
Due largely in part the ACA the healthcare world has been undergoing a major shift in risk. According to PwC risk has now shifted “financial, enterprise, operational and market share not only to include traditional insurers, but also hospitals, physicians, pharmaceutical companies and consumers.” Hospitals and providers have been forced to innovate in order to survive, while the competition in the insurance marketplace has skyrocket, resulting in a need for insurers to uniquely differentiate themselves from the competition. This shift and transference of risk has been evolving over the past few years and PwC marked value-based payments as an important trend to rise out of this risk-shift.
Primary Care
Thanks to the ACA, primary care is getting a boost and becoming more and more crucial to the healthcare ecosystem. Accountable care organizations are no longer a myth thanks to healthcare reform and primary care providers and acute-providers are beginning to band together to focus on preventive care. What to expect for the future of primary care? A shift in focus to quality care and according to PwC “The challenge for primary care now is to strike the right balance between old and new, easing the learning curve associated with the inevitable switch to a value-based system without leaving money on the table in a still predominantly fee-for-service world.”
New Entrants & Innovation
From EHRs, to telehealth to big data, innovation is one of the most important trends we’ve seen for the healthcare industry for 2015. By pushing more consumers into the healthcare marketplace, as well as pushing transparency, the ACA has opened the door for innovation and new ideas within the healthcare system. This could mean a shift in focus from companies who offer a wide variety of services to healthcare companies who provide very specialized services. Whether you are a startup hoping to meet the needs of some of the gaps brought on by the ACA or a company hoping to bring innovation to data analytics, it’s certain 2015 will be a year for growth.
Health Insurance Growth
Perhaps the biggest change as a result of the ACA is the healthcare exchange. The concept which encourages consumers to “shop-around” for policies to fit their specific needs, pushes more consumers into the pipeline and gives health insurers a big opportunity for growth and innovation. Hopefully, this means that insurers will shift their focus to the consumer and how they can generate higher satisfaction rates within the insurance marketplace. PwC reports that this change in the health insurance market could result in insurers focusing more on the “business-to-consumer (B2C) model” and zeroing “in on this notion of consumer directed health, as plans focus on the consumer experience across all lines of business and not just the individual market.”
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Works Cited
PricewaterhouseCoopers, Healthcare reform: Five trends to watch as the Affordable Care Act turns five, March 2015. (http://pwchealth.com/cgi-local/hregister.cgi/reg/pwc-hri-aca-five-year-anniversary.pdf)