In the United States, it’s the Day After. The future of American policy – from immigration to foreign trade to national defense – is full of kinetic uncertainty. One thing is certain: that Donald J. Trump – who has brought something very different from palpable policy proposals to the American electorate – is President Elect of the United States.
There is no shortage of morning-after polemic: some are crying, some are celebrating, and others still are sleeping off the night. Whatever one’s political belief, our industry is perhaps at the center of the new sea of trumpian uncertainty. Indeed, the future of healthcare in the United States, and particularly the role of technology in healthcare, is neither bright nor grim. Unlike last night, it’s too early to call.
What we know about Trump and healthcare is both frustratingly limited but also widely telling. Trump has summarized his post-Obamacare vision as a system that boasts “lots of plans” that will function amorphously across state lines, toppling a partly imagined barrier against competition among plans in different states. We know he views the Affordable Care Act as a “disaster” and, like other drivers of federal spending, sees dealing with corruption, overspending, and “bad deals” at the core of the still-unknown solution to healthcare’s many woes.
Despite the uncertainty, the ethos (and pathos) of the President Elect make it not unreasonable to make early predictions on what the future of healthcare IT will become. Here are five changes, I think, we are likely to see in the years ahead. Vendors and delivery systems should prepare for tomorrow, or risk getting left behind today.
Population Health Management will include Population Health Negotiation
Big Data just got bigger. Advanced cost and utilization reporting will be assumed in any market leading Population Health Management platform. Many platforms already support metrics like these, but too many others are developing from infancy. Metrics like per member per month, top diagnoses by cost, cost per member, revenue per provider, and so forth must be reportable, expected out of the box and camera-ready.
It’s not so much the existence of these reports that will change. Instead, their use case will evolve. How, in the age of Trump, could a payer in the New York exchange cajole prospective patients across the border in Greenwich, Connecticut, without proving their competitive advantage? Better yet, what data would the Connecticut legislature need to allow such an arrangement? And what data would Congress need to justify a repeal or refashioning of the Affordable Care Act to constituents to permit such an arrangement?
Expect report consumers to change significantly. Big Data will become the new ammunition of payers, providers, and possibly even patients in tomorrow’s business-like approach to healthcare efficiency. The average patient in the United States does not know his or her monthly cost or profit to their health insurer. Depending on his health, he may very well need to produce that figure on demand.
Technology will be expected to capture, and rectify, fraud
If a vendor can’t produce a report called “Most Wasteful Practices by Month,” get to coding. It’s true that most research indicates Trump’s claims of corruption in federal spending are either overblown or of limited impact to the bottom line. Nevertheless, there remains a critical eye on Medicare spending and strong pressure to reduce waste – and out those responsible.
Technology will be expected to not only recognize fraud, but call it out and prevent it at the point of care. That means EMRs will double as waste-prevention tools, and entirely new end users groups – think nurses, mid-levels, even scheduling staff – will be charged as the gatekeepers to prodigal spending. Public reports will be their motivators. New user groups and physician alliances will emerge in the defense of fraud accusations. Vendor-produced reports will serve as plaintiff, defendant, and ultimately jury.
State and local agencies will be subject to intense analytical reporting requirements
Look for state public health agencies – and even physician alliances and urban delivery systems – to perhaps be required, by federal law, to publish readily available analytic reports on providers and delivery systems who are and are not good stewards of healthcare monies, both public and private. The President is watching.
A still undefined federal authority will have new influence over the disparity in healthcare delivery across states, and will need the technology to drive the ensuing change. Expect state governments to bear some responsibility for this charge, and to report results “up” to a strong but blurrily removed federal authority. That way, conservatives can claim state control while still keeping taut the purse strings.
A new IT spotlight will shine on Big Pharma
Pharma Bro Martin Shkreli seems now like a hazy nightmare, but expect to hear more of these stories. Each one will be louder and more public than the last. I don’t expect a Trump administration, though, to necessarily prohibit dizzying profit. Rather, Big Pharma will be expected to play by Trump’s rules – which would include reporting on, at least, investments and monies held overseas, efficacy for each drug, outcomes summaries, and the longitudinal records of patients whose lives have been improved by a drug. Of course, the cost-saving data of a drug versus another more expensive, medically taxing course of treatment would be best.
Expect a new, still unforged relationship between the pushers of expensive drugs and documented outcomes in a patient’s legal medical record. We may haven’t yet figured out how to give a small, unaffiliated specialist practice access to the longitudinal chart. We may now need to figure out how Pfizer and Glaxo can do the same.
Outcomes management and cost control will be inextricably linked
Quality reporting, no matter the measure or program, will see a significant facelift and new cost-driven criteria. Quality programs, even the newly conceived MIPS and APM paths, will be subject to faster and clearer cost control targets. Expect reporting requirement-only years and the gradual introduction of changes to subside to quick performance-driven requirements.
Two organizations that both satisfy a given measure, by the now-ancient numerator and denominator standard, will seem mediocre. We’ll now quickly learn who’s gotten to the same outcome but for a cheaper cost. Medicare reimbursements, and even commercial payments, will become much more granular and measure-oriented.
Some level of capitation will still be around, but I expect the devil to quickly focus on the details. Specific practices, people, and processes will be in the crosshairs. A Trump administration will demand that this data be published and, to an extent to be determined, publicly available. Expect real consequences – backed by an angry and now vindicated populist movement – for those mishandling the coughers.
Peter Wiley is a manager of program services at Wellcentive.