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Most Impactful Changes You Should Know About Healthcare in 2015

Change has been a constant in healthcare over the last few years and that is no different this year. Between learning the new intricacies of the Affordable Care Act (ACA), hospitals being more involved and the use of integrated care, 2015 is shaping up to be a monumental year for change.

Many of the changes Americans are expecting to see are being phased in over time. Perhaps the most dramatic change was in 2014, when Americans were able to purchase healthcare insurance directly from the insurance exchanges. Many states set up their own insurance exchanges; in the states that opted out, the federal government stepped in and created insurance exchanges so that all citizens could purchase their own insurance.

Of course, companies have also been impacted by passage of the ACA - and those changes have an impact on employees of the companies. The changes are vast and wide reaching; some changes in 2015 include:

  • :: Employees working at companies with 50 or more employees must have access to health insurance.
  • :: Physicians will start to be paid based on their ability to provide high-quality care, rather than a high volume of care. (Historically, physicians have been paid based on what's referred to as a "fee-for-service" model, where they receive more money when they have more tests and treatments done on behalf of patients.)

Consolidation of healthcare organizations: impact on patients and cost

Because of the passage of the ACA, there has been increased consolidation among healthcare organizations. Two of the larger acquisitions include for-profit HCA (Nashville, Tenn.) with $38 billion in patient revenue and nonprofit Ascension Health (St. Louis, Mo.) with $15.3 billion in patient revenue. Large health systems are also acquiring smaller physician practices. Some experts say that all of this may have the impact of reducing competition and increasing prices.

Because of scrutiny with healthcare costs, patients will become more sensitive to the price of healthcare and more price transparency will be required. Also, physicians will need to have difficult discussions with their patients about the cost and value of various types of treatments and procedures, such as the hepatitis C drug Sovaldi. This drug has a 90 percent chance of curing hepatitis C, but it comes with a very high cost, too: $1,000 per pill, or $82,000 for a 12-week treatment.

Hospitals getting into the insurance business

Some healthcare organizations have decided to partner with insurance companies, as is the case with Florida Hospital, which acquired a 49 percent stake in Florida First Health Plans and continues to deepen that partnership over time. Geisinger Health System (Danville, Penn.) has run its own health insurance business since 1985 and has evolved into one of the largest rural HMOs in the country.

Whether by partnering with insurance companies or running insurance companies outright, healthcare organizations can gain access to a wealth of information about patients, which can help identify gaps in care. The idea is that, with access to that information, patients can be treated before their conditions become chronic in nature, and therefore more expensive to treat.

Experiments with community-based models and integrated care

One community-based care model was organized by General Electric, Procter & Gamble and grocery giant Kroger. In this model, the companies partnered with area healthcare organizations to find ways to deliver high-quality, lower cost care in Cleveland, Ohio. The focus has been on improving the health of area residents, improving the patient experience, and reducing the cost of care. This initiative has resulted in increased investments in health information exchanges, which enables better coordination of patient care, and quality improvements for chronic diseases such as adult diabetes and childhood asthma. Early studies of the project have determined a decrease in those who called in sick for work, though more hard work and research remains.

Change will continue to be a constant in the years to come. Whether you are looking for a career in health administration or you are involved with one of the healthcare organizations across the spectrum, expect vast changes in the field for 2015.