The Affordable Care Act (ACA) is now five years old and the PwC Health Research Institute marked the occasion with a report on trends spurred by the law and how those trends will continue to impact healthcare over the next five years.
In Healthcare reform: Five trends to watch as the Affordable Care Act turns five, the authors note the following five trends:
Risk shift: The ACA puts some weight behind payment models that focus on outcomes and penalize high readmission rates and hospital-acquired conditions. “By championing models such as shared savings, bundles and pay for performance, the ACA has accelerated a shift in risk away from traditional insurers and onto providers, pharmaceutical companies and even consumers.”
Primary care: “Experimentation in new payment models and expansion of insurance coverage are making primary care once again the critical touch point.”
New entrants: More than 90 new companies have been created since 2010, including 29 related to telehealth. “New businesses are inspiring innovation and redefining value based on consumer preferences.”
Health insurance: The report says that rapid enrollment in public exchanges has renewed interest in private exchanges. And, more business directly with consumers is leading insurers to change their business model.
States: “States have emerged as key players in the reconfigured healthcare landscape” due to exchange design and the scope of Medicaid. These variations have led to “highly diverse, geographically dependent health reform experiences.”
Looking ahead to the next five years, the report offers suggestions on how these trends will play out and what healthcare organizations should do about them:
Risk shift: “Weigh the risks of taking on new functions as business models change.” Organizations need to emphasize saving and quality.
Primary care: Organizations must consider ways to deliver quality care to meet the increased demand due to newly insured individuals.
New entrants: Organizations can’t do it all so they should consider partnerships and other alternatives to fill the gaps, according to the report.
Health insurance: “Target the consumer. Pursue opportunities to enhance consumer choice and engagement in selecting health benefits.”
States: Organizations should plan to work with states “as they continue to shape the future landscape and to assume an even bigger role in the management of healthcare costs.”
Read the complete report.