Healthcare Trends, Predictions, and Technical Innovations for 2018
It is that time of year again – time to look at healthcare trends, predictions and technology innovations for 2018.
Identifying trends is fairly simple, since it relies on looking back to see what the most popular topics have been and continue to be. Many trends tend to stay for more than a year as their momentum builds. Predictions are a little more difficult to identify and assure accuracy, since they are a look into the future. This year we will also be looking at the top 10 technology-related clinical innovations.
An article by Michael Dowling identified the Four Most Important Healthcare Trends for 2018.
Inconsistent healthcare policies
The uncertainty about the future of the Affordable Care Act (ACA) and legislative inconsistencies will continue to cause confusion and lack of focus. Questions about provisions of the new tax bill related to healthcare initiatives and revenue issues surrounding the funding for Medicare and Medicaid will also continue to create serious implications for the states. Healthcare providers will continue to push to preserve Medicare and Medicaid.
Hospitals and health systems need to innovate to keep pace with new organizations and partnerships
Creative, innovative mergers and partnerships will be more common. The CVS-Aetna, Google-Amazon-IBM Watson, and the Optum-DaVita Medical Group partnerships are going to change the healthcare landscape, but providers should not view these as a threat or resist change. The changes are going to spur innovation, facilitate partnerships and collaboration, maximize the use of artificial or augmented intelligence, improve prevention and telemedicine programs, and force us to be more efficient, productive and creative.
Healthcare strategies must encompass behavioral and mental health
Social stigmas surrounding mental health are breaking down, so we must focus on developing processes and programs to meet the needs of these individuals. This is especially important now because of the opioid abuse crisis has become one of this nation's most-challenging public health issues. We also need to look at addiction to mobile devices that is causing anxiety, depression, and loneliness in the younger generation. We need to tailor services to address these needs.
Improve the customer experience and online engagement
Consumer experience is becoming a focus of many healthcare companies and clinics. Consumers want to have a pleasant experience, more choice, easy access to quality care and services, and they want these things on their own terms. Providers need to meet these needs and expectations to develop consumer loyalty and improved communication. The following are five trends that are improving the customer experience:
- Leveraging Data For Healthcare: Automated systems can stratify huge amounts of varied types of data in real-time to provide a complete view of the patient’s healthcare status. This can potentially eliminate the need for pre-visit questionnaires (that patients dislike), allow predictions of patient illnesses and preventive treatment, and create personalized healthcare plans.
- Patient Personalization: By analyzing data, clinics are able to see a patient’s preferences, health history, the success or failure of medications and treatments, and any potential health issues. Having this information readily available means patient-specific treatment options, preventative care, and recommendations can be made.
- Using Wearable Devices In Healthcare: Wearable devices help to keep patients engaged in their personal health. Most patients who wear devices are more at-risk for healthcare complications and possible hospitalizations. These devices help consumers stay more active, monitor their diet and health metrics (blood pressure and heart rate), and decrease their need for office visits. They also allow patients to be connected to their provider, who will be notified immediately if there is a problem, so preventive treatment can be started as soon as possible.
- Hospitals Using Smart Technology: Smart technology is being used to decrease risks and increase comfort and efficiency. Examples include smart beds that adjust to each patient’s needs and preferences for ultimate comfort; and robots that can monitor a patient while providing privacy for the patient and efficiency for the healthcare team. 94% of healthcare executives said they plan to implement smart technology in their organizations.
- Online and Mobile Platforms: Consumers are using more and more online and mobile platforms to help them become more engaged in their healthcare decision-making.
- Augmented Reality Training For Healthcare: Augmented reality is a trend across all industries, but it is especially powerful in the healthcare field. It is being used to improve communication, cognition, and awareness in early dementia patients. It is also being used in medical training. Providers can see diagnoses and procedures, learn new skills, and expand their knowledge. This type of training allows more providers to be trained at the same time, so it could help fight the shortage of providers.
PricewaterhouseCooper’s (PwC) Health Research Institute (HRI) provides new information and analysis on trends affecting health-related industries. The research is independent and not sponsored by businesses, government or other institutions. Their report outlines 12 healthcare trends that will impact the healthcare industry in 2018. The trends list was developed by analyzing surveys of US consumers, providers, insurers and pharmaceutical executives; conducting in-depth interviews with industry leaders; and examining data and policy trends.
The Top 12 Defining Healthcare Trends to Watch in 2018 include:
The Healthcare Industry Tackles the Opioid Crisis
Opioid overdoses are now the leading cause of death for US adults younger than 50. It is essential that this trend be reversed. It is too large to be solved by a single group or strategy. The only way to resolve this issue is to involve all segments of healthcare (prescribers, payers and the pharmaceutical industry) to work in collaboration with federal, state, and local agencies.
Social Determinants Come to the Forefront
The US spends more on healthcare per capita each year than any other nation, yet has poorer outcomes and return on investment compared to the other countries. To improve health while saving money, the report says the industry needs to expand beyond the four walls of the hospital and “look holistically at the full profile of a patient, beyond their specific health issue.”
Price Transparency Moves to the Statehouse
Since there is no clear federal legislative path yet for health care reform, states are beginning to take matters into their own hands. More than 30 states are considering legislation that focuses on cost changes and direct control of drug prices. In the past state legislation has found its way to the national stage, so it is important to closely watch what happens at the state level.
Natural Disasters Create Devastation That Lasts Long After the Event Passes
Natural disasters (hurricanes, floods, and wildfires) can cause havoc on health systems, manufacturer supply chains, and financial operations. An example of a supply chain issue occurred after the hurricane in Puerto Rico when a pharmaceutical manufacturing plant was shut down, which created a shortage of small IV bags and drugs in mainland US hospitals. Health systems and pharmaceutical companies need to conduct proactive scenario planning so they are prepared, can recover quicker, and avoid making rash decisions that could have poor outcomes.
Medicare Advantage Swells in 2018
Medicare Advantage is projected to cover nearly 21 million people in 2018, which is a 5% increase over 2017. However only 28% of consumers between 50 and 64, surveyed by PwC HRI, said they knew about Medicare Advantage. This provides a new competitive opportunity for health insurers, who need to raise awareness of the available options.
Health Reform Is Not Over, It's Just More Complicated
While the Affordable Care Act (ACA) has not been repealed and replaced, healthcare reform efforts will probably continue to be made in 2018 to reduce and cap federal Medicaid spending, expand access to lower-premium health insurance, loosen ACA consumer protections, soften or eliminate the employer and individual mandates, and repeal ACA taxes and fees.
Securing the Internet of Things
Cybersecurity is an ever-increasing problem in healthcare. Breaches and a 525% increase in medical device cybersecurity vulnerabilities have become a major issue. Healthcare organizations need to take quick, decisive action to maintain data privacy and secure the thousands of connected medical devices on their networks to protect patient data. Cybersecurity is critical and companies need to have a strong focus on investing more in planning, defensive measures, and personnel.
Patient Experience Is a Priority
Consumers today are accustomed to unique shopping experiences tailored to their needs by retailers who analyze consumer information to determine how best to interact with their customers. As the healthcare industry moves more towards value-based payment, rather than volume-based payment, healthcare companies need to make strategic investments to improve the entire patient experience.
Artificial Intelligence – Your New Co-Worker
Ironically, utilizing artificial intelligence (AI) could help put the human touch back into healthcare by reducing bureaucracy and administrative duties that can take time away from personalized care. AI is being used to make routine, repetitive administrative tasks a lot quicker, such as screening drug candidates, routine paperwork, scheduling, streamlining finance processes, adverse event reporting, and more. 39% of provider executives said they were investing in artificial intelligence, machine learning and predictive analytics.
Healthcare's Endangered Middlemen
Pharmacy Benefit Managers (PBMs) and wholesalers are under increased scrutiny to prove value in creating efficiencies or risk losing their place in the supply chain. With the entry of Amazon and other new disrupters, intermediaries must become more than just a pass-through serving a contracting function. They must step up and focus on price transparency, hold manufacturers responsible for drug efficiency, and prioritize models based on outcomes.
Real-World Evidence a Growing Challenge for Pharma
Due to changes in the FDA, pharmaceutical and life science companies will need to change their approach to collecting and using real-world data gathered outside of randomized controlled trials, something that could potentially save the system millions of dollars. The 21st Century Cures Act will require the FDA to consider additional uses of real-world evidence for drugs and medical devices, including incorporating this data to support new indications.
Tax Reform Moves Forward
Corporate tax rate reductions and a shift to a territorial system will require new strategies from healthcare organizations and may also demand rethinking of business models and supply chains.
STRATEGIES FOR HEALTHCARE TRENDS
To help healthcare organizations cope with all the required changes, HRI’s report identified three strategies traditional healthcare organizations should consider to help them manage these changes:
- Cross-sector collaboration: The key challenges for 2018 include stemming the tide of opioid abuse and overdoses, placing greater attention to the social determinants of health, and addressing the rising cost of healthcare through pricing and transparency initiatives. These issues cannot be solved by working in siloes. In order to address these issues, industry stakeholders must break down barriers and begin to work collaboratively to determine what is best for the patients.
- Strategic investments: It is essential for stakeholders to be proactive and think strategically about the changes and what needs to be done, before potential disruptions occur. Key areas include increasing enrollment in Medicare Advantage, conducting scenario planning in preparation, continuing focus on protecting against cybersecurity attacks, and improving the patient experience in order to change behavior and improve health outcomes.
- Creating efficiency: In 2018, the healthcare industry must become efficient in improving performance and reducing risks. This can be achieved by harnessing artificial intelligence to streamline decision making and administrative tasks; pressing middlemen, such as PBMs and wholesalers, to prove their value; using real-world evidence to cut clinical development costs while bringing new drugs to market faster; and rethinking business models and supply chains in light of the new tax reform efforts.
(NOTE: For the full PwC report, visit https://www.pwc.com/us/en/health-industries/top-health-industry-issues.html)
Other important strategies that were identified in the Healthcare Leadership Intelligence Report include the mention of Outpatient Care and Population Health Management as prime value strategies.
- Outpatient care is a key strategy for hospitals, since over 40% of a hospital’s revenue is generated from outpatient care. This is much higher than it was 20 years ago before ambulatory and outpatient services were key areas.
- 57% of organizations have a population health management strategy in place or being implemented. Another study indicated 83% have a “total” or “significant” commitment to this strategy.
- Telemedicine is also on significant trend and strategy. Some type of telemedicine, telehealth, or telecare program is being offered by 75% of institutions surveyed.
HEALTHCARE INFORMATION TECHNOLOGY TRENDS AND PREDICTIONS
As new technology is adopted, new drivers emerge that affect how Healthcare Information Technology (HIT) is used to enable better care. The IDC FutureScape: Worldwide Health Industry 2018 Predictions looked at the following drivers to predict where healthcare IT will support care delivery over the next 3-4 years. The following are the IDC’s health industry Top 10 Predictions for HIT in 2018:
- Real-world Evidence: By 2019, more than 50% of life science and healthcare companies will have dedicated resources to support accessing, sharing and analyzing real-world evidence for use across their organizations.
- Digital Mobile Engagement: By 2019 digital mobile engagement among companies, patients, and providers will increase by 50%, improving clinical trial recruitment & medication adherence.
- Internet of Things (IoT): By 2020, adoption rates of IoT-enabled tracking and inventory management systems in hospitals will double, improving patient safety, staff satisfaction and operational efficiency.
- Patient Reported Data: By the end of 2020, 25% of medical data will be collected and shared with healthcare systems by the patients themselves (‘bring your own data’ or BYOD).
- Robotics: One hospital in four with 200 or more beds will have robotics handling time-consuming tasks, thereby reducing labor, preventing errors, sustaining business operations, and improving patient safety.
- Blockchain: 20% of organizations will no longer be using pilot projects, but will be using blockchain for supply-chain management and patient identity. (A simple description of blockchain is “a new type of internet that allows information to be distributed but not copied”).
- Cognitive / AI Technology: By 2020, 20% of healthcare and 40% of life-science organizations will achieve 15-20% productivity gains through the adoption of cognitive/ AI technology.
- Data Management: Due to overwhelming data management requirements, by 2021 20% of payer back-office operations will outsource their business processes.
- Medical Devices: By 2021, cyber-attacks will cause harm or death to patients connected to networked infusion pumps, resulting in large class-action lawsuits against medical device manufacturers for negligence.
- Digital Healthcare Services: By 2021 digital healthcare services will account for 6% of global healthcare expenditure.
HEALTHCARE TECHNOLOGY-RELATED INNOVATIONS
The Emergency Care Research (ECRI) Institute is an independent non-profit organization that provides hospital leaders with evidence-based perspectives on innovations and care delivery trends that have the potential to affect cost, quality, and patient outcomes. Their Top 10 List of 2018 Healthcare Innovations is a collection of technology-related innovations and patient care developments that hospital and health system leaders should pay close attention to over the next 12-18 months. Many healthcare leaders this information for informed decision making in planning programs and strategic initiatives,
This year’s top ten list includes:
- The reSET app which is the 1st US Food and Drug Administration (FDA) approved prescription mobile medical app. It helps treat substance use disorders involving alcohol, cocaine, marijuana, and stimulants. It is used in conjunction with outpatient therapy and a contingency management system that uses incentives to reward patients for adhering to their treatment plan. The app is not to be used for opioid dependence, but the company is developing the reSET-O version of the app for treating opioid use disorder. It is being tested now and has received the FDA's expedited review. It is expected to reach the market sometime in 2018.
- Direct-to-consumer genetic testing, while lessening the workload for labs, will increase the workload for providers as patients seek information about the test results.
- Acuity-adaptable care delivery models are being developed to keep patients in the same room from admission to discharge, regardless of acuity level. This is being done to improve workflows, continuity of care, patient safety and decrease length of stay and costs, although it does create challenges for infrastructure and maintaining staff competencies across all levels of care.
- Confirm Rx is an implantable loop recorder cardiac monitor that interfaces directly with a patient's smartphone to proactively transmit data to the patient's physician, eliminating the need for a bedside telephone transmitter. At intervals programmed by the treating physician, the smartphone app automatically uploads patient data to the network for clinician access.
- Distraction-based virtual reality (VR) for pediatrics provides a 3-D VR experience to distract children from the fear and pain caused by repeated injections and infusions.
- NeuroAD Therapy System for Alzheimer's disease delivers non-invasive transcranial magnetic stimulation (TMS) with computer-based cognitive training, along with existing pharmacologic therapy. The device is currently under review at the FDA and could receive clearance this year.
- A micro-needle blood-collection device is an FDA approved touch-activated phlebotomy device that extracts blood quickly and painlessly. It is about the size of a golf ball and adheres to the patient's upper arm. A push of a button activates the device to collect 100 microliters of capillary blood over 2 to 3 minutes and an indicator signals that the collection is complete.
- The Embrace Neonatal MRI System, approved by the FDA in 2017, is designed for point-of-care imaging of the neonatal brain and head. The system is used in the neonatal intensive care unit, thereby reducing risks associated with patient transport and enabling the staff to rapidly perform emergency care.
- The GammaTile Radiation Therapy System for Neuro-Oncology, currently under review by the FDA, incorporates cesium-131 Cs-131 brachytherapy seeds, which are embedded into a bio-absorbable collagen mesh that is sutured or stapled into place into the cavity of an excised brain tumor. This process delivers radiation to the target tissue more quickly and directly than other methods, thereby improving outcomes and reducing injury to adjacent healthy tissue.
- Micro-hospitals are being developed by many health systems to distribute care throughout a region and extend healthcare by positioning the hospitals in fast-growing suburban areas.
Healthcare predictions are a little harder to determine than trends. This year they tend to focus on mental health, personalized medicine, genomics, population health management, consumer-focused innovation, collaboration among diverse partners, stability, and support for not-for-profit healthcare providers. The following are some of the Top Healthcare Predictions for 2018:
- New Revenue Streams: Innovative digital health offerings will create new revenue streams and deliver value-added healthcare technology to consumers.
More hospitals and health systems will make innovative digital offerings a new source of revenue to offset declining reimbursements from traditional payers. Health systems will get directly involved in developing these new technologies. Value-added products and services will be offered directly to the consumer in order to keep them healthy and enhance their care.
- Technology: Empowering patients to become more involved in their care
Technology startups will leverage scaled cloud computing and AI/machine learning platforms. We can expect to see more apps and technologies that help patients track everyday health habits and share them with their care teams. Real-time, ongoing dialogue between physicians and patients will lead to better care and more effective, customized health regimens.
- Personalized Medicine: Leveraging DNA and personal data will improve wellness and prevent disease
Genomic data will be integrated with clinical labs and other personal health information to solve health care mysteries and create the ability to practice precision medicine. Direct-to-consumer tests will continue to become even more popular, enabling people to delve into their genetic makeup. This data will be integrated into clinical care in innovative ways to enable a more personalized approach to medicine. This will eventually lead to preventing, delaying or curing diseases.
- Population Health will soar in importance this year. Improvements in analytics and care management will make it easier to prevent illness and care for those with chronic conditions. The social determinants of health – including access to care and services, reliable transportation, housing, education, and nutrition – will become the key focus. More emphasis will also be placed on the measurable outcomes achieved through these important alliances.
- Innovation: New partners will address the growing mental health and substance abuse crisis
Mental illness and substance abuse are now the leading cause of death for Americans under 50, Community collaboration with health providers will increase to help people get access to care and resources. Collaboration will take place across many sectors, e.g. health care, schools, the criminal justice system, churches, businesses, social service agencies and veterans' groups.
- Ambulatory and Home Health: Care goes everywhere
Providers will expand their reach to retail pharmacies, neighborhood wellness centers, grocery stores, and brick and mortar retailers. Since telehealth services are now reimbursed, convenient at-home telehealth services, e.g. video, email, chat or text will finally go main stream.