Trends Affecting the Healthcare Industry for 2016

Pinnacle Claims Management health care trends

If you thought it would be smooth seas ahead after all the changes to the health care industry resulting from health care reform the past five years, think again. Changes are still coming and here are three of the top trends making a big impact to the healthcare industry in 2016 and beyond:  

Consolidation of Health Carriers

What is it: In 2015 alone, we saw three big consolidations among several others – Aetna buying Humana, Anthem purchasing Cigna, and United Healthcare to purchase Aetna. All signs show that this trend will continue as health carriers look for ways to maintain their leadership position in the market, leveraging resources acquired in a merger. 

The impact: The media has reported that many of these mergers are happening because the carriers believe that by consolidating, they will be able to provide more efficiency and have added leverage in negotiating rates with hospitals and physician practices that can lead to lower insurance premiums for employees. Also, according to a 2015 article in Benefits Pro, these larger insurers have a better opportunity to invest in technology platforms, patient engagement platforms and other innovations to ultimately benefit the consumer. 

Technological Advancements 

What is it: The breakneck speed of technological developments is impacting nearly every area of our lives and healthcare is no exception. Advances include big data to help providers offer better diagnosis and treatment  There are more tech-based options to help doctors communicate with their patients (see article on telemedicine) and health-tracking devices to help patients stay healthy (such as the popular Fitbit and Lark, a silent alarm clock and sleep monitor to encourage better rest). 

The impact: Employers who embrace these and other technological advances will do well in finding what best suits their needs in managing health care costs for their companies and managing the health data that is available for their employee populations.   

Move Toward Value-Based Care

What is it: The way providers are reimbursed for medical services is continuing to shift away from volume-driven care to value-based care, where the goal is to achieve the best outcomes at a reasonable price. This approach is more patient-centered and is organized around what a patient needs – not just striving for bringing more patients in the door. According to an article by FierceHealthcare, more hospitals are not just transitioning but actually implementing models of value-based care in anticipation of this trend continuing.   

The impact: A move toward value-based care will provide increased transparency so both employers and employees can see the true cost of services and how they compare to reached outcomes. In the end it will encourage the population to become better healthcare consumers. This is a paradigm shift indeed but one that will help in combatting rising medical costs each year.