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Health care trends most likely to pressure physicians

PwC’s annual “Top Health Industry Issue” report predicts that the pace of health care transformation will increase in 2013 because of technology, budget pressures and the Affordable Care Act. But an overarching theme in many of the trends is the role of the patient and how consumerism is expected to drive the way health care is delivered, especially in the primary care setting.

“The days of a very transactional approach to health care … is getting some pushback from consumers,” said Warren Skea, director in PwC Health Industries Advisory. Consumers are more informed and are demanding from health care the service they can expect in other areas, such as retail.

Keeping patients happy will not only help patient satisfaction and retention, it also will help physicians’ pay, Skea said.

More payment models are tying patient satisfaction to payment, he said. In addition, population health models will rely on good relationships between physicians and patients and prompt physicians to re-examine the patient experience.

“Primary care physicians, in the population health model, are very much the quarterbacks, the coordinators of care,” Skea said. “It’s a significantly different role than it has been in the past. Everything from medication reconciliation to managing information and activities and procedures amongst all the physicians and specialists in a much more coordinated way. It is changing that role and the dynamic between patient and physicians.”

The fact that physicians are playing this role is a trend that was not expected two years ago. It was thought that most physicians wouldn’t have the necessary technology and infrastructure. But partnerships and consolidations of organizations have helped them get there, Skea said. Only 21% of people change unhealthy behaviors because of employer wellness efforts.

A report issued by the Physician’s Foundation in December 2012 predicted more consolidations in 2013, but expressed concern about monopolies and subsequent rises in health care costs.

Skea expects that as physicians assume leadership roles in the population health models, the result will be better health outcomes and lower health care expenses. This is something many employers hope to see as well.

The PwC report said 2013 probably will be a turning point for how health care benefits are delivered. Employers are among the biggest supporters of population health models, despite little success with their efforts to improve the health of their workers. The report found that even though many employers have changed to a more consumer-driven health care model and instituted wellness programs, only 21% of consumers have changed their behavior as a result of those efforts.

Skea said there had been a limit to the penalties that could be inflicted on employees who engage in unhealthy behaviors, but many of the bans have lifted, he said. Now that both physicians and patients have higher incentives to change behaviors, Skea expects patients to become more compliant because of these converging trends.

Other trends to watch in 2013, according to the PwC report:

Implementation of the ACA at the state level. In 2013, all states will be deciding whether to expand Medicaid coverage and how to run their insurance exchanges. States will be working toward upgrading or improving their automated Medicaid eligibility systems.

Caring for “duals”: those eligible for both Medicare and Medicaid. Many states are turning to managed care companies to help control the rising costs associated with duals.

Bring-your-own-device polices at health care organizations. Many hospitals are allowing physicians to use their mobile devices for tasks such as accessing patient records, but haven’t taken steps to ensure patient data are protected.

Data-sharing partnerships between pharmaceutical companies and insurers. In addition to the long and expensive road to regulatory approval for new devices and drugs, pharmaceutical companies are facing challenges of reimbursement for use of their products. There is a growing demand for wider sharing of data between pharmaceutical companies and insurers to better monitor cost effectiveness and outcomes.

The full and original article can be found at: http://www.ama-assn.org/amednews/2013/02/11/bisb0211.htm

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