Health care in the year ahead

In 2013, research revealed overuse and overspending on drugs and devices that had been found to be less effective than advertised. Journalists opened the floodgates with milestone pieces on the industry’s opaque and often exorbitant costs and CMS responded by making Medicare data public. The Affordable Care Act (ACA) survived a government shutdown only to barrel into a disastrous rollout. Somewhere between all that, surgeons grew a working nose on a man’s forehead.

In 2014, we will begin to see if the ACA is doing what it was designed to do: Is the quality of health care becoming better and more affordable for all Americans and more accessible to the poor and uninsured?

In this post, we round up what bloggers and scholars are naming as the key health care topics in 2014.

Will ACA help or hurt the nation? While the media continues to feature narratives showcasing the law’s success and/or failure, 2014 will still only offer limited evidence one way or the other. It may be true, as The Hill’s Sam Baker put it, the law cannot fail, because every time the White House misses a deadline, it “replaces initial standards with ones that are lower, squishier, or nonexistent.”

That being said, the health care landscape shifted enormously at midnight on January 1 and there are ways to observe its influence. Millions of Americans will soon have health insurance for the first time, including 3.9 million on Medicaid, according to the White House. Wonkblog’s Sarah Kliff offers a two-minute video breaking down key dates to watch in the new year.

First-month premiums were due for most new policyholders on January 10. As of last week, only about half of people registered for insurance via exchanges had paid; technical errors continue to delay processing for insurers. It may take days or weeks but attention will turn to the number of enrollees, who they are and how they compare to the latest Congressional Budget Office estimates and administration benchmarks. A healthy mix of enrollees will help keep costs down when enrollment opens for 2015 coverage in November when premiums will be based on data and experience, not estimation. In this Jonathan Cohn piece, eight health policy wonks share their predictions.

Then, on March 31, the individual mandate kicks in. Though the most critical element of Obama’s signature law has survived political battles so far, some pundits, including Washington fixture Robert Laszewski, doubt it will roll out on time or stick around under the political pressure.

While Republican repeal fervor may fade, the law – and the individual mandate especially – could be a pawn in debt ceiling talks in February and March. It may also be a key topic in this fall’s midterm elections, foreshadowing the 2016 presidential race.

In 2013, consumer leverage grew along with the demand for publicly-available price and quality information. In 2014, many more providers, insurers, hospitals and suppliers will compete based on value and service instead of volume and reputation. Maryland lawmakers just announced a bold new hospital payment system along these lines.

On a federal policy level, legislators will continue to pursue a bipartisan alternative to the sustainable growth rate (SGR) formula, commonly called the Medicare “doc fix.” Congress will act by the end of March, coinciding with the next debt ceiling decisions, writes Health Care Lighthouse’s Billy Wynne.

ACHP’s member plans were leaders on this issue in 2013 and their congressional testimonies will maintain relevance as players consider payment reform this year.

In response to the demand for price transparency, compounded with a nationwide doctor shortage, insurers and providers will reshape traditional models of care with new emphasis on the patient-centered medical home. Industry leaders will scrutinize whether accountable care organizations (ACOs) deliver or stumble on the ACA’s objective to cut costs. Ceci Connolly of PwC’s Health Research Institute calls this shift “wholesale to retail.”

Mobile apps prevailed in 2013 and will continue to grow this year. Telehealth will increase as a trend, as will online health appointments. HealthPartners earned a Tekne award for its 24-hour virtual clinic virtuwell, which features resources to diagnose patients and prescribe treatment.

As electronic health records (EHRs) continue to become more prevalent, insurers and providers will harness data to increase efficiency and improve care. Dean Health Plan, for example, measures how health care providers perform to improve quality. PwC research predicts “social, mobile, analytics and cloud” are an essential part of the future of health care.

In the end, who knows (nose?) what will happen. As always, follow our Twitter feed and check in with the blog regularly for ACHP commentary on health care innovation and policy.


Sophie Schwadron