10 moving health market objects

How important is health care?

In 2013, the national health care debate shutdown the U.S. government.

As 2014 strategic action plans are formulated, what’s on the radar screen of leading health care and health insurance companies?

Here are 10 trends that ought to be on your tracking screen in 2014.

1. PPACA 2.0: Much of the next 12 to 18 months will be spent stress-testing the Patient Protection and Affordable Care Act (PPACA). There are improvements to be made and glitches to be fixed: public/private integration, technological and administrative repairs, product mix refinements, and user experience streamlining. Health plans will need a robust post-enrollment learning agenda to understand the 80 new competitors that entered “marketplaces,” or exchanges, and which customers came into the market, who stayed out, how they shopped, and what their mix of risk looks like.

2. Risky business: We will see millions of underserved, high-risk health care consumers with unmanaged illness enter the insurance and medical delivery systems. For insurers, elimination of pre-existing condition exclusions and tight pricing parameters threatens profitability and has pricing actuaries in panic mode. For providers, who last year doled out $41 billion in uncompensated care, post reform means serving millions of ailing patients with shiny new health insurance ID cards and pent-up demand.

3. Quality: Providers of health care are putting skin in the game. Pay-for-performance reimbursement, from basic risk sharing to episode of care and bundled payments are rapidly moving health care toward outcomes-based financing system – incentives and disincentives based on quality of care delivered and patient clinical results. Expect growth of accountable care organizations (ACOs) and medical home patient care models as well as hospital systems becoming licensed as insurers to sell directly to consumers.

4. Chronic America: In the next 5-years 17 million baby boomers will turn 65. Today, chronic medical conditions account for $3 out of every $4 of the country’s $2.8 trillion health care bill. Next generation care management  will be built around recognition that healthcare is local and relies on integrated data that gives the patient’s front-line providers information to effectively collaborate and manage an individual’s care based on evidence-based clinical practices and new patient engagement techniques.

5. Behaving healthy: It’s time for consumers to change their health attitudes and behavior. More than half of employers with 50 or more workers offer a health improvement program because they know that healthier employees not only reduce health care costs, but lower absenteeism, result in more energetic employees and create better workforce retention. And, with health care costs rising faster than wages, employees are searching for ways to reduce personal health expenditures.