PwC: Top 10 healthcare issues for 2013

As that nation’s healthcare industry moves forward with the implementation of the Affordable Care Act (ACA), 2013 is shaping up to be a busy year, and PricewaterhouseCoopers (PwC) has outlined the top 10 health industry issues to watch over the next 12 months.

PwC’s Health Research Institute (HRI) compiled the top 10 list based on feedback from industry leaders and stakeholders, and the institute warns of a faster pace overall in changes to the industry throughout 2013.

“Health organizations can hear the thundering footsteps of 30 million newly insured Americans on the horizon. Yet they are feeling the full force and impact of federal spending cuts and pressure from states, employers and consumers to operate more like a consumer-focused, retail industry,” says Kelly Barnes, PwC’s U.S. health industries leader. “By this time next year, the major provisions of the health reform law will be in effect, and the health industry has a lot of work to do before then. It’s now a foot race to 2014. The evolution of healthcare that has been in effect over the past several years will become a full-scale transformation in 2013.”

The top 10 issues, according to PwC:

• ACA implementation: Over the next year, state leaders must figure out how to run their state health insurance exchanges, decide whether to expand Medicaid coverage, and determine new regulations for insurance markets. Information technology developments will add more challenges as the industry works to create a single, seamless entry point to the new exchange system, according to PwC.

• Patient revolution in health coverage: Consumers are becoming more vocal about how they want to spend their healthcare dollars, leading to increased competition within the healthcare market to offer convenience, best prices, and greater transparency. HRI’s report notes that consumers are already getting on board with new ways to buy health insurance, revealing that nearly one-fourth (up from 18% in 2011) of consumers surveyed say they are likely to buy health insurance from non-traditional sources such as retail stores.

• Medtech industry braces for excise tax impact: A 2.3% excise tax on medical device companies took effect January 1, representing a possible boost of $29.1 billion to federal coffers over the next 10 years. The $380 billion global medical device industry is unlikely to be able to pass the tax on to its customers but could look to its suppliers to share in the burden, PwC says. The report indicates that the tax effect could kick start new innovation, industry consolidation, and operational recalibration in the medical technology sector.

• Caring for the nation’s most vulnerable, the dual-eligible: Patients who qualify for both Medicare and Medicaid make up a large portion of the people who will be added to Medicaid rolls by 2019 under the ACA. With increasing cost of care and a lack of coordination between the two programs, state increasingly may turn to managed care companies to help coordinate care and find new efficiencies.

• Bring your own mobile device: With more providers bringing their own mobile devices into practice, concern exists about whether hospital networks offer enough security to protect patient information. Nearly 70% of consumers surveyed in the HRI report said they are concerned about the privacy of their medical information when accessed though personal mobile devices.

• Goodbye cost reduction, hello transformation: Skyrocketing medical costs are a huge concern-for providers, payers, and consumers. HRI found that 40% of consumers put off some kind of medical care in 2012 due to costs, and hospitals in 2013 will look to make full-scale transformations to care delivery in an effort to increase the affordability of healthcare.

• Customer ratings hit the pocketbooks of healthcare companies: Consumer reviews will generate penalties and bonuses for hospitals and insurers in 2013, meaning healthcare companies will need to invest in consumer research and education to take advantage of new payments. Pay-for-performance measures could mean more than $3 billion in bonuses for insurers and penalties of $850 million for providers, HRI notes.

• Meeting the new expectations of pharma value: Physicians have less say in pharma payment decisions than insurers and large providers. Though pharmaceutical and medical device companies play a pivotal role in health outcomes, they will have to prove it to earn it by demonstrating their value and comparative effectiveness, HRI reports.

• Employers rethink their role in healthcare: The ACA will provide employers a chance to re-think their long-term role in providing healthcare coverage due to state and/or private insurance exchanges. HRI reports that chief executive officers may redesign their benefit strategies in 2013 to cut costs that are not central to their own business.

• Building blocks of population health management: Medicare’s accountable care organization and Patient-Centered Medical Home initiatives laid a foundation for improving population health, but other collaborations are fueling growth in population health management, reports HRI. More companies are likely to form partnerships to build their population health information technology infrastructures and to share responsibility for patient outcomes and satisfaction, data collection and analysis, member education, and engagement, with a focus on at-risk populations, the report states.

See the full report here.

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