Provider competition and comparison shopping will create better, lower priced care
With one year of the Affordable Care Act under the nation’s belt, there’s no doubt that major changes are still in store for the health care system and the people it serves.
Increased cost responsibility on all of us, smarter technology and more provider options are shaping health care for 2015 and beyond. Below are the five key changes we predict health care consumers will see in the coming year.
1. DIAGNOSES OUTSIDE THE DOCTOR’S OFFICE. There are several reasons your next diagnosis will happen outside of a doctor’s office. Retail clinics and urgent care centers are often more convenient to go to. Over-the-counter home kits are moving beyond just pregnancy tests and glucose monitoring: there are now home kits that can diagnose conditions like Hepatitis C, HIV and prostate cancer. And technology is forever moving closer to our bodies, allowing us to scan for everything from fevers to Parkinson’s disease.
This trend means that we’ll be seeing the doctor less often, and when we do, it will be for more serious problems. It will also translate into better office visits. Wearable technology provides hard data that you can discuss with your doctors, allowing for more accurate diagnosis and care.
Outlook for 2020: Diagnosis 2.0. Indeed, there is a huge appetite for self-diagnostics, which could reduce the cost and resources it takes to provide routine care. A wave of simple diagnostic tools and tests are coming to market and, within a few years, will become the norm.
2. PROVIDER PRICE WARS. More options for medical care and diagnostics, coupled with increased cost transparency, will rev the engine of the health care marketplace. Quality information on hospitals and doctors is now becoming available to the public through the internet. Now, companies and health plans are starting to pair provider quality data with cost, allowing us to shop for care. This trio of competition, cost and choice will fuel price wars among health care providers.
Besides just retail clinics like CVS and Walgreens, hospitals and medical centers will also compete on price. Places like the Surgery Center of Oklahoma guarantee the price for procedures, inclusive of doctor fees, initial consults and uncomplicated follow-up care. As a result, they’ve attracted patients from across the country. The cost is cheaper than that of local hospitals, and employers are willing to foot the bill for flights, travel to and lodging at these less expensive medical centers.
Expect to see more of it. Couponing, incentives and other retail-model discounts will become part of the shopping experience for us. Courtesy of the free market, we will have access to better quality care at lower cost.
Outlook for 2020: Centers of Excellence. On the heels of competition are consolidation and specialization. Hospitals will invest in specific diseases and disorders, while general surgeries and procedures will be outsourced to more efficient and price-competitive surgery centers.
3. EMPHASIS ON BEHAVIORAL DATA. Today, most consumer brands know more about you than your doctor does. Physicians routinely ask about alcohol and cigarette use but know little about your actual buying habits or how you select and use services.
The psychology of your behavior as a consumer is used to create desirable products, loveable brands and marketing campaigns. Those same principles are coming to health care. In fact, a recent Institute of Medicine report recommended that social and behavioral measures be captured in patients’ EMRs. Your credit score, magazine subscriptions and even your grocery list may start to reveal how doctors can better position wellness and motivate you to stick to healthy habits.
Closed loop systems owned by health plans will give insurers the opportunity to take the lead. Personal data, combined with incentives, will lead to proactive initiatives for managing both your financial and physical well-being.
Outlook for 2020: Bigger Data. New tools and services will be needed to connect and analyze a wider range of data sources and deliver deeper meaning as the health care industry moves from historical tracking to predictive modeling.
4. CARE DESIGNED FOR ONE. The convergence of behavioral data and trackable biometric technology will help drive the personalized care movement. Generic medicine has long ignored differences among patients in favor of generalized outcomes.
With more personal data and information becoming available, doctors can go beyond your medical history form and treat according to the unique genetics and behaviors of each of us.
Outlook for 2020: DNA-designed Pharmaceuticals. As personalized health evolves next to genetic mapping, we will soon see bespoke medications and treatments designed specifically for your physiology.
5. COST INCREASES SPUR CONSUMER SHOPPING. Unfortunately, there’s no end toward the move to high deductible plans (HDHPs) as employers look to provide lower cost health benefits to their employees. While these plans keep monthly premiums down, large deductibles mean our out-of-pocket spending on medical bills for most of the year will increase.
The upside of these higher costs will be a more deliberate consumption of health care in 2015. In other words, comparison shopping and thoughtful consumer purchasing becomes the norm. The result will lead us towards a less wasteful, more efficient health care system.
Outlook for 2020: More Benefit Trimming. Pharmaceutical benefits will be redesigned. Expensive specialty drugs will force employers to start controlling drug spending by pushing back on brand names and increasing cost sharing for medications.