KELLY BARNES 

2014 was the year of the Affordable Care Act.  There were other profound and important developments in health, but for consumer interest, media attention, and impact on the health business, the ACA dominated the picture.

2015 is expected to be different.  This increasingly wired, consumer-oriented, and innovative health industry is poised for profound transformation: 2015 will be the year that a true, industry-wide healthcare market begins to take shape.  To help navigate this emerging market, we’ve identified ten Top health industry issues of 2015 driving transformation.

Three issues coalesce around consumer–centric digital health technology:

Do-it-yourself healthcare        
U.S. physicians and consumers are ready to embrace a dramatic expansion of the high-tech, personal medical kit. Our Health Research Institute (HRI) surveys show that clinicians may be more open to using these tools than consumers. One-third of consumers said they would use a home urinalysis device. But more than half of physicians said they would use data from such a device to prescribe medication or decide whether a patient should be seen.

Making the leap from mobile app to medical device        

The proliferation of approved and portable medical devices in patients’ homes, and on their phones, will make diagnosis and treatment more convenient, redoubling the need for strong information security systems. Regulatory approval may provide a competitive edge — 20 percent of consumers and 26 percent of clinicians said FDA approval was important when deciding to use apps.

 Balancing privacy and convenience  

As consumers increasingly make their demands known to the market, the balance between privacy and care convenience will shift to fit those demands.  More than 65 percent of consumer respondents told HRI data security was more important to them than convenient access for imaging, test results, and other medical information. But, more than half of survey respondents also said they would be willing to share data to improve care coordination.

Health costs for those patients who consume a disproportionate share of U.S. health spending, and for costly specialty drugs and medical products, underlie two other Top Issues:

1. High-cost patients spark cost-saving innovations          

There are approximately 9.6 million “dual eligible” individuals who qualify for both Medicare and Medicaid.  In 2010, Medicare spent an average of $19,418 on each of these patients, compared to $8,789 spent on other beneficiaries.

Consequently, health systems experimenting with creative care delivery systems will be key to bringing these patients’ costs down while improving their outcomes.   For example, one Midwest hospital system identified 30 frequent visitors to its Emergency Rooms.  Offering those patients medical and case management interventions, such as finding primary care physicians close to their homes, cut emergency room visits by 90%.  The cost of treating those patients fell from $1.1 million a year to under $130,000.

2. Putting a price on positive outcomes  

High-priced new products and specialty drugs will hit the market in 2015, increasing demand for new evidence of results and perhaps even redefining the term “positive outcome” along the way.   From a long term standpoint, a high drug price may pale in comparison to eliminating decades of ongoing medical treatment, but first the industry will demand more and better evidence of positive outcomes.

In 2015, we’ll see wider application of new tools to make those determinations.  Data on subsets of patients with specific diseases – drug histories, hospital admissions, etc. – can help pharmaceutical companies predict which patients will have the best experiences with specific drugs.  And our research shows that consumers are willing to pay for value delivered.

Separately, the terabytes of data being churned out around healthcare – information about the millions of newly insureds, about drug testing and development, and data from devices and monitors – shape three other crucial Top Issues:

Open everything to everyone  

New transparency initiatives targeting clinical trial data, real-world patient outcomes, and financial relationships between physicians and pharmaceutical companies will improve patient care and open up new opportunities.

One initiative, the FDA’s Open Payments law, went live in September, making public the financial relationships between drug and device companies and physicians.  Consumer attitudes about physician payments are mixed. But HRI’s research shows that some consumers will continue to trust their doctors regardless of drug industry payments.  That said, the research also shows that organizations that can demonstrate value to patients and physicians by improving care and outcomes will continue to form mutually-beneficial and positive relationships with customers.

  Getting to know the newly insured  

As healthcare companies learn more about the millions of newly insured healthcare customers, they’re developing more nuanced approaches to the expanding market.   For starters, as knowledge of the new exchange and Medicaid populations grows, the number of healthcare insurers offering coverage on the ACA’s public exchanges increased by 25% over 2014.

 Physician extenders see an expanded role in patient care  

Consumers tell us they are ready to embrace this shift. Three-quarters of survey responders would be comfortable seeing a nurse practitioner or physician assistant for physicals, prescriptions, treatment of minor injuries and ordering lab tests. Meanwhile, more than one-third of doctors surveyed say extenders could handle up to half of their patient encounters.

As the consumer base shifts to more economically-empowered millennials, and innovation becomes more competitively important, go-to-market strategies and health industry business structures will both see change in 2015:

Redefining health and well-being for the millennial generation    

The U.S. Bureau of Labor Statistics predicts that in 2015 millennials will be the majority in the U.S. workforce and by 2030 they will make up 75% of it.   Millennials expect to be marketed to differently – seeking out more engaging and supportive end-to-end experiences, and in health, with a greater focus on overall well-being.  In 2015, insurers and providers will develop new approaches to motivate millennials with meaningful incentives to buy health insurance, and offering services and products designed to help millennials achieve their goals. That requires convenient access to resources, personalized and timely feedback and support with aligned programs and seamless processes.

Partner to win  

For healthcare companies, it is no longer enough to partner just to stay in the game. HRI found that 40% of Fortune 50 companies –20 out of 50 – pursued new healthcare partnerships in 2014. Consumers also see value in these new alliances; 58 percent told HRI they would choose a healthcare company that partnered to improve services.

With consumers leading the way, bearing more costs and making more decisions, change is erupting through the health industry.  Established healthcare companies, new entrants, and other sector players are rapidly developing cost-efficient products and services tailored to consumers.  We’ve seen such transformative change before – in banking, in retail.  Our Top Health Industry Issues for 2015 highlights the revolution taking place, as Healthcare aligns around a consumer market model.

 Kelly Barnes is a partnerwith PwC’s health care practice.