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What specific trend has really caught your attention regarding its potential impact on the business of healthcare in 2014?"

   Cyndy Nayer
Cyndy Nayer

Cyndy Nayer
President, CyndyNayer.com
Founder/CEO of Center of Health Engagement
The trend of resistance and confusion across the health care system and payers has been stunning this year. There have been positive steps forward, such as the incentives to physicians for PQRS reporting and the removal of copays/deductibles for prevention screenings, and there will be a longer time period for producing meaningful use (MU2) and receiving incentives for MU2. There have been some incredible mistakes, the largest of which is the ACA website launch in October.

But I've spent a lot of time speaking with and for doctors and associated clinicians, consultants/brokers, small to medium employers, and Medicare beneficiaries. It was a revelation to learn how many did not know there were incentives to install EHRs, to report outcomes and criteria for measures, and more. There has been an enormous amount of misinformation in the broker community about penalties, delays, and private exchange opportunities for their clients. The single clients--CEOs of small businesses, senior citizens on Medicare--are quite uninformed about changes and, more importantly, perceived changes that they are hearing from news outlets and from friends.

I'd like to detail the rapid IT expansion and the bubbling of consumer price advocacy, but these have not been so loud as the confusion/resistance that has enveloped the communities outside of the large metro areas and especially the Northeast and California. The rest of the country is clamoring for accurate, objective, data-driven information.

Mark Lutes
Mark Lutes
Member of the Firm,
Epstein Becker & Green, P.C.

I have been struck by the trend among group plans to impose beneficiary responsibility in the form of high deductibles and limiting payment to so-called "reference prices". There has been some moderation in health care spending recently. It is common for that moderation to be attributed to the Affordable Care Act. I would however speculate that the cumulative impact of these coverage and payment limitations is more likely to be responsible for the slow down than the ACA itself.

Not only are these trends remarkable for their impact on costs but for they are notable for their potential to cause consumers to engage directly with providers over price. Health policy wonks have long sought to engage the consumer in health care purchasing decisions. The refashioning of coverage and new payment limitations, as the trend accelerates, may spur competitive provider responses. Those responses might actually drive more system reengineering than the now limited federal governmental efforts around value based purchasing.

 Lindsay Resnick

Lindsay Resnick
Principal, KBM Group


Customer Experience. Picking one trend from what's ahead in 2014 is a challenge: Obamacare 2.0, Paying for Quality, Digital Disruption or Socialnomics. But, I have to go with customer experience. This is the year when payers and providers need to stop talking about being customer focused and actually start delivering personalized, relevant and multi-channel consumer interactions. Superior customer experience (aka UX) is no longer an option. With benefit standardization, provider network parity, price transparency and regulatory constraints commoditizing markets and neutralizing brands...what's left?

In a 2014 healthcare marketplace defined by personal responsibility, it's the consumer's obligation to deal with intimidating financial and clinical decisions. If we ask customers to step-up and take control of their healthcare destiny they need to be engaged. The only way to accomplish this is through a customer experience that respects the complete customer journey - from prospect to participant to promoter - each built on a foundation of trust, empowerment and outcomes.

Like it of not the retailization of healthcare means consumers are in control: budgeting benefits, choosing providers, and navigating care options. As a result they're talking about you, reviewing you, price checking you, and recommending you...or not! Today's customer has an abundance of choice and it's up to them to determine your value and what your brand stands for; or they will take their money and spend it elsewhere. However, as much as they're in control, remember, customer experience encompasses every aspect of a consumer's interaction with your company's services, products and people.... the sum total of everything they see, hear, feel and experience as part of their dealings with your company. And that's something you can control! How well do your brand touchpoints resonate with your customers' needs, drive engagement and promote loyalty?

How do healthcare companies deliver superior customer experience? It won't be easy. Annual consumer surveys by J.D. Power and Forrester consistency rank health insurers far below other sectors when it comes to a few basic customer questions: Do they meet my needs? Are they easy to deal with? Would I recommend them to a friend? The current state of healthcare customer communications needs an overhaul. There's redundant and siloed messaging, no personalization, and very little measurement. Turning around healthcare's UX will be driven by customer insights that allow you to know your customer, create relevant content delivered through relevant channels, deploy cross-organization satisfaction metrics, and most importantly, have champions for your customers' experience that reside in the C-Suite.

Every touchpoint throughout the customer lifecycle must create a value exchange through an integrated communication stream that deepens engagement and improves loyalty. And in healthcare, unlike transactional retail markets, loyalty needs to focus on interactions (vs. transactions) with an ability to leverage individual motivators as well as emotional and rational drivers of customer behavior. The payoff is not only better customer retention and LifeTime Value, but a healthcare customer experience differentiated by personalization and most importantly, one that produces happy customers.

  Vince Kutaitis
 Vince Kutaitis

Vince Kuraitis
Better Health Technologies, LLC

"Narrow networks" is the specific trend catching my attention - one that has been grossly mis-characterized in the press. The topic has generated headlines in the Washington Post, the Wall Street Journal, CNN, AP, USA Today, and numerous regional news outlets.

The issue has gained visibility as a result of the "narrow" provider directories being offered in the Federal and state health insurance exchanges. The plans typically do not include all the providers in a geographic region, particularly ones that are highest cost, e.g., academic medical centers. These narrow networks often are priced 10-25% below networks offering a broad selection of care providers.

Here's how the issue of "narrow networks" has been mis-characterized in the popular press:

  •  Health plans are the bad guys in creating narrow networks.
  •  The narrow networks have been created by health plans offering low ball prices to doctors and hospitals. Price is the predominant factor being considered by health plans.
  •  Narrow networks are inherently bad. They limit patient choice of providers and sometimes force patients to change long standing relationships with doctors and hospitals.
  •  Excluded doctors and hospitals are outraged; some are suing to be included and/or promoting legislation to prevent their future exclusion.

The issue of narrow networks actually isn't new - it's been around for over two decades... but the issue will look much different in the future. Here's how I'm hoping a more educated press will begin to reposition the issue that I'm relabeling as "Patient-Provider Value Networks":

  •  Provider networks increasingly will be created and operated by providers themselves. Think about it. Medicare ACOs, commercial AC-Like initiatives between plans and providers, clinical integration networks, bundled payment initiatives, capitation arrangements - all of these are forms of "narrow networks".
  •  Price will be only one factor in broader Patient-Provider Value Networks. Yes, in the past price has been a primary differentiator in putting together provider directories. Surveys have shown that for many consumers price is the primary factor in selection of a health plan. But...the so-called narrow networks haven't been true networks; the word "network" implies a prior relationship, coordination, common systems and policies - not just lists of providers that have haphazardly put on a sheet of paper or a website.
  •  Patient-Provider Value Networks offer many advantages. In the future, quality, care coordination, patient experience will increasingly take front-center stage in creating true networks. Consumers will recognize that there are many tradeoffs that must be considered in their choices.
 •  Competition among providers will shift and will be based on quality, cost, patient satisfaction. The press and public will realize that specific providers being excluded from health plans is a healthy result of a more competitive, transparent health care system. Some people will still want the broadest choice possible - and that's OK, but it will have a price tag attached.

  Henry Loubet
 Henry Loubet

Henry Loubet
Chief Strategy Officer

While the public focus has been on the opening of the Exchanges this year, attention will quickly shift to the employer-provided benefits segment, where the vast majority of the population obtains their health coverage. According to a report published by Families USA in November, nearly 19 out of 20 of Americans under age 65 will not be seeking coverage in the individual market. Most of those will be obtaining their coverage through an employer.

With the impending approach of January 1, 2014, the one-year reprieve from employer reporting and penalty enforcement under the Affordable Care Act (ACA) is quickly evaporating. So the time has come for employers to get serious about how they plan to handle the data collection and recordkeeping tasks that are not far ahead.

Employers have to be able to translate their more conventional employee classifications and benefit eligibility definitions to determine which employees fit the two definitions that matter in the ACA: Full Time Employees (FTEs) working 30+ hours a week, and Not Full Time Employees (NFTEs) , working less than 30 hours a week. It will not always be easy to make the distinction especially in industries with a lot of variable scheduling or seasonal peak periods.

The dollars at stake are significant, and we have been encouraging our clients to use 2014 to analyze their workforce, assess their systems and evaluate their policies and procedures to ensure they are ready for the ACA requirements to go live.

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