The Top Three 2020 Healthcare Trends and How to Prepare

The Top Three 2020
Healthcare Trends and
How to Prepare

© 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Stephen R. Grossbart, PhD
Senior Vice President and
Chief Quality Officer
This report is based on a 2019 webinar given by Stephen Grossbart, PhD,
Senior Vice President and Chief Quality Officer, Health Catalyst, titled, “The
Biggest Healthcare Trends of 2019 and What’s to Come in 2020.”
Top Three 2020 Healthcare Trends

After a year full of change and many
topics competing for the headlines in
2019, politics and reform, the Affordable
Care Act (ACA), prescription drug access
and pricing, and price transparency were
major areas of focus politically.
As healthcare and politics are deeply
intertwined, we know that any changes
in our political landscape have a direct
impact on healthcare.

As healthcare organizations scramble to
respond to changes from 2019, they need to
look forward and prepare for changes in
2020 that could imminently impact procedure
pricing protocol, reimbursement rates, and
patient satisfaction.
Health systems have more opportunity than
ever before to leverage data and technology
to deliver the best care to all patients, no
matter where they live.

Top Healthcare Trends from 2019
Trend #1. The Affordable Care Act
The ACA was enacted in March 2010 and was
still one of the top 2019 healthcare trends.
Although some courts have fought the
legislation, it has yet to be repealed entirely.
For example, in December 2018, the Texas
District Court ruled that the ACA was
unconstitutional.

In May 2019, the Trump administration
and justice department, which is
historically responsible for defending a
federal act or statute in the courts, chose
to support the repeal of the ACA.
The case reached the Fifth Circuit Court
of Appeals, which heard oral arguments
in July 2019.

Of course, no change will be enacted
until 2020 when the Supreme Court
hears the case.
However, if the Supreme Court votes to
repeal the ACA, the effects will be far-
reaching for patients and health systems,
as 21 million Americans will lose
insurance coverage.

With an unsuccessful attempt to repeal the ACA, a gridlock in Congress,
and the absence of constructive legislative action, the Trump administration
still made big waves that deeply impacted health organizations, payers, and
patients through executive orders:
Lowering the
cost of short-
term insurance
plans.
Reducing
federal
financial
support for
insurance
exchanges.
Reductions in
Medicaid
spending.
Expanded
use of health
savings
accounts.
Banned
access to the
insurance
exchange for
those with
illegal
immigration
status

Trend #2. Medicaid Expansion
Medicaid expansion was a hot topic for
debate in 2019 and will continue to be
well into 2020.
Although Medicaid expansion legislation
was passed in 2018 and took effect in
2019, referendums and legislation are
still pending in many places throughout
the United States.
37 states and the District
of Columbia provide
Medicaid expanded
coverage under the ACA.
Legislation is still
pending in Kansas, North
Carolina, and Wyoming.
Referendums for
expansion are expected
on the 2020 ballot in at
least four states.

The Medicaid expansion legislation
intensely affects healthcare organizations
and patients because Medicaid expansion
means more people have access to
healthcare than before.
Health systems need to be prepared to
care for this new influx of patients without
compromising quality and ensuring they
meet CMS standards of care in order to
receive reimbursements.

Medicaid expansion allowed people in
remote communities, such as throughout
the Mountain West, to access care that
was previously unavailable.
As a result, critical care hospitals and
smaller healthcare organizations started
merging and contracting specialty
services with other organizations.

For example, small hospitals throughout
southern Utah, southeast Idaho, and
southern Wyoming with University of Utah
Health and Intermountain Healthcare to
provide specialty care to patients within
their communities.

Trend #3. Prescription Drug Prices
As prescription drug prices skyrocket, and
pharmaceutical companies and politicians
continue to debate who should pay, a new
bipartisan bill appears to offer at least
some of the answers.

The White House endorsed the Senate’s
bipartisan Prescription Drug Pricing
Reduction Act, sponsored by Chuck
Grassley (R-Iowa) and Ron Wyden
(D-Ore), in November 2019.
Unlike the House’s titled the Elijah E.
Cummings Lower Drug Costs Now Act, the
Senate Bill does not give the Department
of Health and Human Services (HHS), the
government body with jurisdiction over
public health, the ability to negotiate drug
prices or target private insurance.

Although the Prescription Drug Pricing
Reduction Act bill establishes a $3,100
cap on annual out-of-pocket spending in
Medicare Part D, starting in 2022, its main
objective is to create incentives for payers
to manage costs throughout all phases of
the Medicare Part D benefit journey.

If Congress passes this bill, Medicare
Part D beneficiaries’ out-of-pocket costs
will be dramatically reduced and, ideally,
the payers will negotiate lower drug
prices with pharmaceutical companies
that would lead to lower, more affordable
drug prices and effective drug pricing
negotiations and management.

Trend #4. Price Transparency
Price transparency is a trending concept
in today’s healthcare landscape.
President Trump’s executive order in
June 2019 called for increased pricing
transparency in healthcare so that
consumers could understand the full
cost of a procedure or service and have
the ability to shop around and make the
most informed decision.

Trend #4. Price Transparency
The executive order calls for HHS to
publish prices that “reflect what people
actually pay” and requires healthcare
providers and payers to disclose out-of-
pocket costs.
With increased information available to
consumers, payers and providers are
incentivized to improve quality and cost,
driving down healthcare prices without
compromising the level of care.

What to Expect: Three 2020 Healthcare Trends
As we reflect on the many revolutions
that changed the healthcare climate, it’s
time to look forward. With pending
legislation, health systems must prepare
for the changes to come in 2020.

Trend #1. Consumerism—One of The Biggest Disruptors in Healthcare
As price transparency increases and
consumers—and CMS—demand quality
care for less, healthcare organizations need
new ways to succeed within the VBC
landscape.
Alternative payment methods—including
ACOs, shared savings, shared risk and
bundled payments, and population-based
at-risk contracts—are just some examples
of new payment models that link cost and
reimbursements to quality as the fee-for-
service model continues to diminish.

Another aspect of the new consumerism
approach to healthcare is mergers and
acquisitions.
As companies from both the private and
public sector join forces to solve health
care’s biggest problems, health systems
should ask themselves if they are ready to
compete in this new landscape.
Data shows that healthcare providers are
not currently meeting their consumers’
highest priorities (Figure 1).

81%
61%
42%
28% 28% 27% 27%
11% 10%
4% 4% 3% 3% 3%
Improving customer
experience
Offering variety of
facility-based access
points
Utilizing digital tools
to engage
customers
Providing price
transparency
Developing an
outpatient pricing
strategy
Offering variety of
virtual access points
Using consumer
learning to guide
strategy
High Priority High Capabilities
Figure 1. Consumer-centric priorities versus capabilities.

Another part of a consumer-driven
healthcare landscape is access through
virtual healthcare, or telehealth.
Healthcare organizations should offer, or
consider offering, easily-accessible
healthcare consultations—like virtual
healthcare and telehealth—that also
emphasize quality care with convenience
and easy scheduling.

As the push for virtual healthcare continues, so does the pressure for health
systems to develop these programs, which requires a major overhaul for
some organizations. Health systems need have the following capabilities:
Enough
providers with
the scheduling
capacity to
care for
patients via
telehealth.
Collaboration between
hospitals and clinics and
other health systems to
create contracts that
address payment, liability,
and transportation if a
provider is traveling to
provide care.
The
infrastructure
to avoid
technological
errors.

Although implementing virtual healthcare and telemedicine programs is
challenging, many health systems are proving they’re up to the task:
Jefferson Health, a 14-hospital system
across the Northeast, reached 100,000
telehealth visits in 2019.
Stanford Children’s Health, located in
the San Francisco Bay area, reached
3,500 telehealth visits in primary and
specialty care in 2019 and currently
offers home monitors for Type 1
Diabetic and Single Ventricle patients.
St John’s, a hospital in Rochester, New
York, offers rehabilitation consults for
post-discharge surgical patients via
mobile health care and has 700
providers currently trained to provide
quality healthcare through technology.

Trend #2. Financial Performance Indicates the Ability of Healthcare
Organizations to Survive
While there have been many notable mergers
in the past few years—for example, the
merger of HCA Healthcare and Mission
Health, and Mercy Medical Center joining
Cleveland Clinic, to name a few—it is unclear
how these newly created companies will
impact the future of health systems and
insurance companies.

Private sector companies are also playing a
part in healthcare on an unprecedented level.
Companies like Amazon and Sam’s Club are
taking aggressive tactics to solve these
complex healthcare challenges rather than
relying on traditional methods.

For example, both companies now offer
virtual clinical and home visits for their
employees.
Google is hiring physicians from and to
develop new healthcare solutions that
could possibly threaten current healthcare
organizations by taking patients away
from traditional hospitals and clinics.

In addition to mergers and private sector
activity, dramatic changes in healthcare
costs occurred in 2019—an increase in
family coverage plans, increases in
overall insurance costs, worker/employer
share, etc.—and those changes are likely
to continue well into 2020 (Figure 2).

Figure 2. Average annual worker and employer contributions to premiums
and total premiums for single coverage, 1999–2019.

Employers also had to deal with the 1.9
million new beneficiaries added to Medicare
Advantage in 2019, representing 34 percent
of the total Medicare population.
These add more cost burdens for employers
and healthcare organizations as they strive
to provide care for this increasing population
with limited financial resources.

Trend #3. Social Issues
As the business of providing healthcare
becomes more complex, so does the process
of treating individual patients.
Instead of looking through a myopic lens that
only allows a provider to see a patient with an
illness, clinicians and their multidisciplinary
teams are now collecting socioeconomic
information as part of the care process.
Where a patient resides, employment, family
situation, etc. all affect an individual’s health
and clinicians should include this information
throughout the care process.

Social determinants of health
Social determinants of health (SDoH) impact
mortality, morbidity, life expectancy,
healthcare expenditures, and health status
and functional wellbeing, to name a few.
They also cause major disparities in health
and healthcare.
The data clinics, health plans, and hospitals
are collecting today is far richer than it used
to be and can highlight inequality.

Data shows, for example, a stark disparity
when it comes to healthcare cost being a
deterrent to getting care.
Anywhere from 10 percent to 22 percent,
depending on race and ethnicity, did not see
a doctor because of the cost, and anywhere
between 19 percent and 35 percent delayed
needed medical care because of the cost
(Figure 3).

Figure 3. Delayed Care in the Past Year by Race/Ethnicity Graph, 2016

These disparities lead to situations where
patients is prevented from following
medical advice due to cost.
For example, a diabetic patient will stop
taking insulin or use less insulin than they
need to survive because of the high cost
of this prescription drug.

The percentage of patients with a usual
source of care ranges from 75 to 87,
depending on ethnicity.
Those who have seen a doctor in the past
12 months or had a healthcare visit in past
12 months ranges from 75 percent to 85
percent, again, depending on ethnicity.
Lastly, this disparity also appears among
those who have seen a dentist in the last
12 months; between 54 percent and 68
percent (Figure 4).

Figure 4. Nonelderly adults with usual source of care,
health Care, and dental Care Graph.

The Opioid Crisis
As the fight to combat , so does the
legislation to overcome it—the Substance
Use Disorder (SUD) Prevention that
Promotes Opioid Recovery and Treatment
for Patients and Communities Act was
passed in 2018.

The benefits of this legislation will continue throughout 2020:
Expands treatment of SUDs.
Provides funding for residential treatment
programs for pregnant and postpartum women.
Authorizes CDC grants, states, and localities to
improve their prescription drug monitoring programs.
Expands the use of opioid-focused telehealth services.
Helps stop illicit opioids from entering the country.
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Another promising development to help
combat the opioid epidemic is the additional
number of codes for on opioid use disorder
and the telemedicine parity law, passed in 36
states and District of Columbia.
Telehealth allows people who live in hard-to-
reach places to access the same opioid
addiction recovery services that are offered
in an urban area.

The new telemedicine parity law requires
private insurance companies to cover
telehealth the same way they cover in-
person visits, making opioid disorder
support services more affordable.

How Can Health Systems Prepare for 2020
Healthcare Trends?
2019 was a tumultuous year for healthcare.
Health systems should adjust to the changes and
also prepare for 2020 by considering key questions:
What will health organizations do if the ACA is repealed?
Are health systems ready for, and practicing, price
transparency?
How do prescription drug prices impact a health system
and its patients?
Can a health organization access and analyze its data to
support risk?
Do health organizations collaborate and work with
community organizations to collect race, ethnicity, and
language data to identify care disparities?
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Healthcare Trends?
The time to prepare for change in
healthcare legislation, healthcare access
and delivery, and payment methods is
now—health systems need a clear goal and
a strategic plan, based on their current
knowledge, that will help them get there.

Healthcare Trends?
As health organizations continue to evolve
in an everchanging landscape, digital
health, alternative payment models, and
better data, including social determinants of
health, are key pieces to the puzzle.
Health systems have opportunities to
improve like never before; new types of
organizations are entering the healthcare
industry with new ideas, technology is
changing the method of delivery, and
patients are demanding price transparency.

Healthcare Trends?
The only way for health systems to
remain successful, and flexible, is to be
willing to try new ways of healthcare
delivery and to never lose sight of the
reason the organization exists—to
provide the care to each patient,
when, where, and how they need it.

For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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Link to original article for a more in-depth discussion.
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Click to read additional information at www.healthcatalyst.com
Stephen R. Grossbart, PhD, is an experienced health care executive with experience as a senior
vice president and chief quality officer and chief analytics officer at Mercy Health, Cincinnati Ohio,
where he oversaw Mercy’s Center for Patient Safety and Clinical Transformation. His published
work has appeared in Medical Care Research and Review, American Journal of Health-System
Pharmacy, Journal of Healthcare Management and Archives of Surgery. In 2012, his book chapter,
“Conceptualization and Definitions of Quality,” appeared in Health Care Quality: The Clinician's
Primer edited by David Nash, MD, MBA. He has served and co-chaired on multiple National
Quality Forum committees, dating back to 2003. In 2013, he was named as one of the 50 Experts
Leading the Field of Patient Safety by Becker’s Hospital Review.
Stephen R. Grossbart, PhD

Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company
that helps healthcare organizations of all sizes improve clinical, financial, and operational outcomes
needed to improve population health and accountable care. Our proven enterprise data warehouse
(EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more
than 65 million patients for organizations ranging from the largest US health system to forward-thinking
physician practices.
Health Catalyst was recently named as the leader in the enterprise healthcare BI market in
improvement by KLAS, and has received numerous best-place-to work awards including Modern
Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for
Millenials, and a “Best Perks for Women.”

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