A blood pressure monitor stands in the diagnostic imaging area at the Hong Kong Integrated Oncology Centre in Hong Kong, China, on Tuesday, Nov. 3, 2015. Equipped with biopsy facilities, body scanners, and quiet 'VIP' chemotherapy rooms, the Hong Kong Integrated Oncology Centre is the first of a string of such facilities that TE Asia Healthcare Partners, a portfolio company funded by TPG Capital, is planning in Asia. Photographer: Xaume Olleros/Bloomberg
Last year was a particularly eventful one for the healthcare industry.
Megamergers such as the CVS-Aetna and Cigna-Express Scripts deals both passed, and the Amazon, Berkshire Hathaway and JPMorgan Chase venture shook up the market. At the same time, heated debates in Washington and increased scrutiny of healthcare organizations have brought to light the need for greater healthcare transparency. This issue has become a tremendous challenge to employees seeking and receiving the medical care and prescription drugs they need — a challenge that, when coupled with low healthcare literacy, has led to excess expenses and both unnecessary and avoided care.
In 2019, the healthcare system is facing — if not a turning point — a call-to-action for progress. As the industry works to meet this demand, there are a few key trends on the healthcare horizon.
Employers elevate their role.
Given the slow movement seen by insurers and providers in 2018, 2019 will likely see more employers — whether alone or banding with others — exerting their influence on the healthcare industry. From partnerships like the Amazon/Berkshire Hathaway/JPMorgan Chase venture to more localized, industry-based arrangements, employers may be looking to negotiate deals directly with providers and carriers to get better deals for employees.
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Data-driven healthcare decisions.
More healthcare data is being collected now than ever before, with 76% of healthcare organizations investing in big data and analytics within the next two years. In 2019, savvy employers will use this information to identify high-cost providers and services to more accurately weigh their options. These data-driven insights will enable employers to better target communications to their plan participants and negotiate better deals with providers — ideally lowering costs for the companies and their employees.
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Chief medical officers enter the scene.
In an effort to control healthcare costs in-house, employers are opening a new seat within their C-suite. Chief medical officers will serve as expert resources dedicated to controlling costs and improving overall employee health.
Increasing focus on behavioral health.
According to the World Health Organization, depression is now the leading cause of poor health and disability worldwide. And, as HealthyPeople.gov reports, depression and anxiety can affect people’s ability to participate in health-promoting behaviors. In turn, problems with physical health, such as chronic diseases, can have a serious impact on mental health and decrease a person’s ability to participate in treatment and recovery. Employers are beginning to realize the hard and “soft” costs of behavioral health conditions and are beginning to focus real attention on developing education and outreach programs.
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New approaches to cost-sharing.
Employers seem to be realizing they have hit the limit of what the market will bear in terms of “upfront” cost-shifting to employees (e.g., higher premiums, deductibles and copays) or high-deductible plans as the only option. We’ll likely see more creative approaches to cost containment and reduction, such as no longer covering out-of-network expenses (other than in true medical emergencies) and offering more narrow-network options.
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As more millennial and Gen Z employees join the workforce, the healthcare industry is seeing an increased demand for “customizable” benefits. With so many different generations in today’s workforce, one size certainly does not fit all — a trend that shows no signs of slowing. To address this demand, the industry will likely see the role of brokers increase as they identify plan-design alternatives and bring more voluntary benefits options to the table.
Personalized benefits communications.
As benefits become more personalized, so will the way employers communicate them to employees. Every generation — and every individual — has preferences as to how, when and why they receive information, as well as differing healthcare priorities. Employers (and, more specifically, HR) must learn to leverage these preferences and priorities to get their messages across, while still achieving corporate goals. Content may become more gender-, age-, condition- and utilization-focused. And, as more tech-savvy generations become a larger percentage of the workforce — and older generations become more comfortable with technological advances — the industry will see a rise in interactive communications materials.
Smarter healthcare consumers/shoppers.
The demand for more information about health costs and how to “shop” for healthcare will only continue to intensify. As U.S. consumers continue to realize that healthcare is a commodity with pricing that varies by “store” and location, they will seek the ability to access prices and quality reviews — just as they do for everything else they purchase (cars, books, TVs, even food). While providers and insurers will need to supply more transparency for cost comparison, it will be up to employers to help employees shop smarter in the near-term.
This year will be an impactful one for the healthcare industry. As healthcare issues continue to enter the forefront of national conversations, it will be increasingly in the hands of organizations and consumers to determine how those issues are met. In an increasingly complex healthcare market, employers and employees must educate themselves on all options available to them to ensure they are adequately covered, while not paying out the nose for that coverage.