Legal Affairs

The Future of Healthcare

The future of healthcare will rest in the hands of providers and employers. Despite recent lawsuits challenging the legality of the Affordable Care Act (“ACA”), it is unlikely that there will be any serious legislative challenge to the ACA. Therefore, what you will see in 2019 will likely involve:

1. Presidential hopefuls will outline a number of reform proposals as healthcare is likely to be the most important issue for 2019.
2. Expect ACA-noncompliant plans to penetrate the market in 2019 and potentially reduce the number of enrollees from ACA compliance plans. Rates submitted to state insurance commissioners by insurers are likely to increase (effective in 2020). Medicaid work requirement programs are making their way through the court system and could have a significant impact on coverage provided by Medicaid for large numbers of individuals.
3. 2019 will bring an increase in payor/provider partnerships, not only involving improved communication and data sharing, but increasingly utilizing co-branded or joint venture insurance products. Value-based care programs that align priorities of payors and providers to manage health in a cost-effective way will also be increasingly utilized.
4. Both commercial payors and governmental payors will tie reimbursement to performance metrics. Relevance on metrics will increase administrative paperwork causing physicians to spend more time than ever documenting through their Electronic Health Records (EHR) and leaving less time to care for patients.
5. Look for more physicians to leave the healthcare field. Decreasing reimbursement and increased administrative costs are accelerating physician burnout. Consumers should anticipate more early retirements for their physicians and an increased use of telemedicine to provide medical services.
6. Employers will also be changing healthcare plan designs in an attempt to control the ever-growing cost burden. Smaller employers are likely to drop healthcare coverage altogether which has become easier by the elimination of the individual consumer mandate under the ACA. Employers will increase deductibles and co-payments and co-insurance obligations for employees. Health plans will reduce patient choice for physicians, hospitals and other providers and implement narrow networks and focus on-site clinics dedicated to specific employers.
7. Expect employers to send their employees to centers of excellence for specific healthcare needs instead of allowing employees to randomly select their own providers. Employers will entice their employees to travel to specialized, high volume centers where they fly in, stay in a hotel and receive their medical procedures at a lower cost than if the same procedures were received by a random provider.
8. Pharmaceutical spending and price growth have become a hot issue in Washington. Legislation will be introduced to address tighter control of industry misconduct, limiting out-of-pocket costs for patients and direct pharmacy to consumer tactics to lower pharmaceutical costs.
9. Expect the emergence of more cutting-edge pharmaceutical treatments with high costs. Some of these treatments may save money in the long run because high-cost drugs could ultimately reduce the cost of managing a disease over many years. The potential problem is the high upfront cost which conflicts with a system that normally pays for costs over time.
10. Finally, plan participants should anticipate forced participation in educational initiatives designed to reduce the cost of care. These programs include nutritional and patient education programs, biometric screening, and education on the utilization of urgent care facilities as opposed to emergency rooms and dedicated locations for acquiring pharmaceuticals and Durable Medical Equipment (DME).

There may be no bigger issue in 2019 (and thereafter) than dealing with the increasing costs in healthcare. Innovation which enhances quality outcomes and an aging population requiring more extensive care carries a high price tag. The number of factors driving the cost of healthcare delivery and the complexities of the healthcare financing system are so great, that it is unlikely any single strategy or system will be achieved in the near future.

Please feel free to contact this author regarding this article.

Randal L. Schultz, Esq.
Lathrop Gage LLP
10851 Mastin Boulevard, Building 82, Suite 1000
Overland Park, KS 66210-1669
913-451-5192
rschultz@lathropgage.com