Health care has never been more complex and unpredictable than now. Trying to predict key trends in health care for next year is therefore quite difficult. Nevertheless, some fundamental trends will be at play next year and impact the environment for PR and communications. Here are five major trends that will likely continue to transform health care and health care PR.
From volume to value
The transformation from volume to value will continue and accelerate in 2017 and beyond. As governments, public and private payers strive to improve patient outcomes at a lower cost, there will be an enhanced focus on new strategies to incentivize providers to improve outcomes for patients. The goal is to move away from a fee-for service model reimbursing individual procedures, physician visits and hospitalizations and shift towards value-based purchasing focused on patient outcomes. Centers for Medicare and Medicaid Services (CMS) are driving this effort in the USA with policies and pilot programs to reimburse providers and health systems through so-called bundled payment models for 90-day episodes of care in cardiac and orthopedic care. The intention is to reward providers for reducing complications and hospital readmissions and improving the patient experience during and after surgical procedures. The new CMS program is scheduled to be in effect as of July 1. 2017, but we should expect that the new HHS Secretary, Republican Congressman Tom Price, M.D. from Georgia, will seek to delay its implementation based on his previous questioning of CMS overstepping its authority by proposing mandatory health care payment and service delivery models. However, the shift from volume to value will likely continue as leading health systems have already started to embrace value-based payment models.
What ideally should happen: The debate about how to define and reward value in health care should continue. There is no scientific consensus on a good definition of value in health care and the indicators for patient outcomes. And there is a lack of unified data systems to support measurement of patient outcomes across health systems and institutions.
Repeal and replace?
We can expect that the Affordable Care Act, aka Obamacare, will be changed, but probably not completely repealed and replaced. A full repeal of the law will require Republications to have 60 votes in the Senate to overcome a Democratic filibuster. Furthermore, multiple statements from Donald Trump and GOP-law makers before and after the Presidential election indicate that key elements of Obamacare, such as protection of health insurance for people with preexisting conditions as well as health care coverage for children, will be preserved. Expect Donald Trump and the Republican majority in Congress to avoid being blamed for pulling insurance coverage away from the 20 million people who have received health insurance through Obamacare.
What ideally should happen: Irrespective of Obamacare and how it will be changed, there should be a stronger focus on the value of coverage and access to quality health care. Many of the people that have received insurance coverage through Obamacare have only had access to a limited number of providers because they are in restricted networks. There is also limited transparency for consumers regarding health plans enabling them to fully understand, compare and assess their options for health insurance coverage. If a Republican remake of Obamacare leads to the introduction of an open national market for consumers to shop for health plans, there is a even bigger need for better ways to help consumers make informed choice about their health care coverage.
From data to insights
The explosion of data and knowledge in health care is mind blowing. Obamacare produced 16,000 pages of new regulation for providers and health systems to follow. Doctors are drowning in health care regulations, as Cleveland Clinic’s CEO Toby Cosgrove has pointed out.
Add to this the skyrocketing number of medical journal articles that doctors are expected to read if they are to keep up with the pace of medical science. More than 800,000 medical papers are published every year, according to the Institute of Medicine. And the time for the entire medical knowledge to double is exploding. In 1950, it was estimated that the doubling time for medical knowledge was 50 years. In 1980, it was about 7 years. By 2020 it is estimated that it will only take 73 days to double the entire body of medical knowledge.
What ideally should happen: More emphasis should be put on insights and meaning rather than the volume of data. Many see artificial intelligence and big computers, such as IBM’s Watson, as a solution to the problem. Computer technology can be a tool to mine huge amounts of data and eliminate redundancies, but it can never replace human interpretation and ingenuity.
Health care technology
Health care technology will continue to be a powerful driver of transformation in health care. Technology is completely ubiquitous and has the potential to change virtually every aspect of health care – from science and innovation to how we detect, diagnose, intercept and treat disease to how health care is delivered along the entire patient care continuum. But technology also adds new levels of complexity. Often times, sophisticated diagnostic technology leads to more testing and generates knowledge where there is little, if any, clinical utility.
The excitement around digital health continues, and 2017 will bring as many new digital health apps, products, platforms and services as in 2016, if not more. There are signs that we may be at the cusp of major breakthroughs driven in particular by some of the larger technology companies, such as Apple. Stories indicate that Apple has been meeting secretly with the FDA for several years and may be developing new purpose-built products and platforms focused on heart disease and Parkinson’s disease.
The biggest opportunity with digital health is potentially the power to change personal health behavior, which according to some experts account for more than 40% of the total health care spending. But the challenge is that digital health tools don’t change human behavior on their own. The plethora of apps that are being pumped out every day will not change consumer health behavior despite all good intentions. But when effective behavioral health engagement efforts are combined with compelling digital health tools, there are opportunities for changing behavior.
What ideally should happen: Health care technology and health care companies should collaborate closely with medical experts and health systems to build larger scale models for clinical eco-systems to connect personal health technologies, such as sensors and smart phones, with all the clinical data patients need access to. This should go beyond the limited data on vital signs that wearables and sensors provide to real-time access to clinical data from diagnostic tests and information from the PCPs and specialists serving the individual patient.
Is the doctor no longer at the heart of medicine?
Driven by several of the above trends, such as increased regulation and the explosion of data and technology, there has been a flurry of consolidations and acquisitions among hospitals and medical practices in the US. There were more than 112 hospital mergers in 2015. Many small physician practices have been acquired by hospital networks. And a growing number of physicians have given up their independence to become employees. The number of hospital-employed physicians has increased with more than 50% since 2012. And it is now estimated that more than 60% of all surgeons in the US are employed by hospitals. We have also seen a trend to doctors losing their professional motivation under the burden of regulations. Studies from Mayo Clinic have shown burn out rates among physicians of more than 50%, primarily due to the increased clerical burden and electronic medical records.
A number of physicians are resisting the trend towards becoming employees. Many of the physicians I personally know are adamant about preserving their independence. They want to maintain their freedom to practice medicine and fear that being an “in-house” physician will compromise their ability to perform quality medicine. The jury is also out whether large consolidated provider networks and physician employment actually lead to an improvement in clinical quality and outcomes. Some even suggest that smaller, independent practices do a better job on clinical quality, as Bob Kocher pointed out in an article in The Wall Street Journal.
What ideally should happen: All the consolidations, the employment of physicians and the trend towards streamlining medicine raise the fundamental question whether we are forgetting about the vital role of the physician in medicine. As payers, regulators and business executives gain more power over how medicine is practiced, we run the risk of sacrificing one of the most important foundations for great quality medicine: the motivated and energized physician who is willing to go the extra mile to fight for his/her patient. Take a look at the Scandinavian and UK model for general practice where all primary care physicians are independent contractors within a single-payer, universal health care system.
How do these trends impact health care PR?
- Integrated: Health care is more complicated than ever and issues are equally complex and entangled. Great health care communication needs to be integrated and interconnected in order to help organizations and companies navigate this complicated environment. Gone are the days of silos and fragmentation where you can deal with issues and stakeholder audiences in isolation.
- Strategic: When working with clients – either as in-house communicator or agency partner – the health care practitioner needs to take a holistic approach and let strategy drive tactics, disciplines and tactics – not the other way around. Gone are the days where we can service clients successfully with sub-specialists who only know their own turf.
- Immersive: In a rapidly changing and unpredictable health care landscape, we need to immerse ourselves with the audiences that are important. We need to do a better job of spending time with patients, physicians and other relevant stakeholders to understand their perspectives, behaviors and issues. We need to utilize primary research, even social anthropology, to better understand patient needs and generate real, game-changing insights to drive strategy with impact. It is tempting to rely on the easy flurry of data stemming from social networks. They are important, but can never replace original, primary research.
- Digital: Digital tools and platforms are critically important as technology and digital health impact all aspects of health care, but we need to apply digital health communications within the context of strategic communications. Digital communications and virtual interaction will never replace strategic thinking and real human interaction and engagement.
Happy holidays and looking forward to an exciting and unpredictable 2017.