A new report released by PwC outlines the top health sector issues for organizations to prepare for in 2018. Based on the happenings of 2017, the report identifies 11 risks the industry faces this year, along with opportunities for mitigating those risks. Everything from security breaches and the opioid crisis to natural disasters and healthcare reform is predicted to make an impact on the ever-changing industry.

With an intensified focus on value-based care, industry leaders are currently working to adapt by modifying their plans to withstand an uncertain environment. Above all, the PwC report advises providers and insurers that the only certainty is uncertainty as the industry continues to evolve. The upside, the report states, is that “in the face of an unsettled environment, the health industry could come out the other side of 2018 stronger and more creative, helping solve some of the nation’s most pressing health issues and becoming more engaged with their patients and consumers than before.”

To prepare, BioIQ will be keeping an eye on the following four issues in 2018.

Social determinants come to the forefront

The report notes that the U.S. “spends more on healthcare per capita than other developed nations yet lags in outcomes” and that “health disparities account for $102 billion in direct medical costs annually.” Research has shown that knowledge of the social determinants of health impacting patients, such as socioeconomics and other patient demographics, can help healthcare organizations anticipate and work to circumvent poor health outcomes. The report mentions that federal and state governments are starting to tackle these issues through a variety of care delivery and reimbursement model demonstrations.

In light of this information, health organizations would be wise to evaluate these factors when developing strategies to succeed in the industry’s value-based environment. Organizations could benefit from gathering quality data on the communities where they operate. In addition, investing in those communities and developing a social responsibility initiative can also have a significant impact when it comes to improving population health.

Medicare Advantage swells in 2018

As more baby boomers begin to age into Medicare, Medicare Advantage plans are on track to have nearly five percent more members in 2018, and competition amongst providers is ramping up. In addition to this increase, research shows that more and more members are making the choice to enroll in higher-rated Medicare Advantage plans. In fact, the report shows that the number of Medicare enrollees in the highest rated plans jumped 16 percent in just three years. To top it off, this population is tech-savvy and “increasingly willing to use digital health services.”

To satisfy this growing member base and attract and retain customers, it will be key for health plans to invest in quality customer engagement initiatives. The report suggests educating and recruiting members before they turn 65, and creating plans to suit the needs of each service area as opposed to a one-size-fits all plan. Given the increasing need for coverage, insurers can also count on greater oversight from governing bodies. To succeed, health plans would do well to tighten processes and shore up provider coding and communication.

Health reform isn't over, it's just more complicated

While lawmakers were not successful in dismantling the ACA in 2017, they will continue to push health reform through a piece by piece approach in 2018. As a result, experts anticipate the uninsured rate will rise and place added cost pressures on the industry. These pressures stand to set back progress that has been made through earlier transformation efforts.

For organizations to thrive in spite of such uncertainty, engagement with policymakers at the state level, as well as other entities in the healthcare sector, and preparing for a variety of policy outcomes is paramount to establishing a forward-thinking, value-oriented public policy stance. Developing cost-cutting strategies and re-evaluating strategies tied closely to the ACA will also be essential to weather the changes that are sure to come.

Patient experience as a priority and not just a portal

With competition in the healthcare space increasing and value-based reimbursement becoming the norm, personalized, quality care will be the best way for organizations to succeed. Taking a cue from retailers, organizations continue to make strategic investments in not only technology, but also personnel to improve and customize the patient experience. These organizations are bringing on “chief patient experience officers” to spearhead efforts in understanding consumer behavior and building tailored patient engagement models with measurable returns on investment.

While technology plays a key role in tackling this issue, the report is quick to point out that the technology must make sense for the end user — not become an additional barrier for them to receive care. Finally, organizations must also take care of those who are taking care of the patients. Fostering a positive work environment is shown to boost morale and result in an improved patient experience.

To learn how BioIQ helps health plans and employers make the shift to value-based care through gap closure and health testing programs, please call (888) 818-1594 or email sales@bioiq.com.

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