Key Issues And Trends For 2013
During the January Healthcare Web Summit, MCOL and Payers & Providers jointly sponsored a survey of healthcare professionals on the key healthcare business issues that will impact them and their organizations for 2013.
Participants were asked to respond to four items:
1. Please categorize your organization. (Payer/Provider/Other)
2. What healthcare business trends do you think will have the greatest overall impact in 2013?
3. Rate the ultimate anticipated impact in the marketplace of selected health reform provisions including those already implemented as either; unsure, none, little, moderate, or significant.
4. Please project who you think the economic winners and losers for 2013 will be: Who do you think will be economically better off, the same or worse off by this time next year?
Here are responses for the top trend in 2013 by organization type:
Trend Payer Provider Vendor/Other
Accountable Care Implementation 60.0% 44.7% 48.4%
Advances in Healthcare Technology 0.0% 2.6% 9.7%
Compliance Issues 8.0% 5.3% 3.2%
Consumerism Initiatives 4.0% 0.0% 0.0%
Effects of the Economy 12.0% 10.5% 9.7%
Government Spending Cuts 8.0% 28.9% 19.4%
Increased Consumer Cost Sharing 4.0% 5.3% 3.2%
Population Health/Wellness Initiatives 4.0% 0.0% 6.5%
Other 0.0% 2.6% 0.0%
For only the second time since this survey was first conducted in 2003, a majority of respondents were in agreement on what healthcare business trend will have the greatest overall impact in the coming year. Fifty percent of respondents said that accountable care implementation will have the greatest impact. This was the first time this trend was listed as an option.
Outside of one year (2006) from 2003 to 2008, increased consumer cost sharing was chosen as the trend which would have the greatest impact in the coming year. In 2009, predictably, the effects of the economy was chosen, and from 2010 till this year, all top responses have focused on government action; 2010 and 2011 were healthcare reform initiatives, 2012 was election year and Supreme Court decision.
Of selected health reform provisions that respondents rated the ultimate anticipated impact in the marketplace of, all but one had a majority of respondents saying it would have a moderate to significant impact.
Here is how they rated them, respectively:
% Rating Provision Moderate to Significant Impact
ACO Loss Ratio Exchanges Dependents
Little 19.1% 41.5% 18.1% 46.2%
Moderate 43.6% 38.3% 31.9% 34.4%
None 1.1% 0.0% 2.1% 2.2%
Significant 36.2% 14.9% 42.6% 12.9%
Unsure 0.0% 5.3% 5.3% 4.3%
EHR/MU Guaranteed Medicaid
Little 29.3% 14.0% 7.5%
Moderate 42.4% 39.8% 22.6%
None 0.0% 1.1% 5.4%
Significant 21.7% 44.1% 64.5%
Unsure 6.5% 1.1% 0.0%
Extension of dependent care coverage was the only provision in the survey that did not have a majority of respondents say it would have a moderate or significant impact (47.3%).
Some health reform provisions had more consistency among respondent categories than others on what their anticipated impact regarding the marketplace was when the results were broken out by category.
The greatest disagreements among respondent categories were on the impact of extension of dependent coverage and EHR development. A majority of providers (57.9%) thought that extension of dependent coverage would have a moderate or significant impact on the marketplace, while a majority of payers (52%) and those in the vendor/other category (56.7%) thought it would have little impact.
The biggest change, year over year, on the anticipated impact of health reform provisions was on ACO development. Respondents have become more optimistic of the impact, increasing almost 25 percentage points from 2012. Another noteworthy change from year to year occurred with the expansion of Medicaid.
While those thinking it would have a moderate impact dropped from 41.7% in 2011 to 22.6% this year, those saying it would have a significant impact went from 39.5% in 2011 to 64.5% this year.
Finally, respondents addressed the question of winners and losers for 2013: Who do you think will be economically better off, the same or worse off by this time next year?
Our stakeholder respondents were pessimistic on how different groups would fare this time next year economically. Only one group (pharmaceutical) had a plurality or majority of respondents that did not think it would be worse off this time next year.
By Next Year: Better Same Worse
Consumers 29.8% 25.5% 44.7%
Employers 19.1% 30.9% 50.0%
Health Plans 26.6% 34.0% 39.4%
Hospitals 13.8% 25.5% 60.6%
Physicians 12.8% 34.0% 53.2%
Pharma 24.5% 44.7% 30.9%
The pessimistic responses to how different groups would fare economically are not new when looking at responses to this question from past years. Since this question was first asked in 2003, there have been only four instances of a majority of respondents thinking a group would be better off: Health plans in 2006 and pharmaceuticals in 2003, 2004 and 2006. Here's the historical percentages feeling respective components would be worse off in the coming year; note the improving outlook for Consumers since the Affordable Care Act passed, and the pessimistic outlook for providers and plans since the outcome of the 2008 election:
% Worse Off: 2013 2012 2011 2010 2009 2008
Consumers 44.7% 48.2% 36.2% 65.9% 68.5% 75.3%
Employers 50.0% 50.0% 54.7% 58.1% 67.0% 47.4%
Physician 53.2% 60.7% 49.6% 55.0% 54.0% 50.0%
Hospital 60.6% 52.7% 40.8% 49.6% 61.4% 41.0%
Health Plans 39.4% 34.8% 36.9% 41.1% 44.8% 12.8%
Pharma 30.9% 32.1% 22.7% 20.9% 35.2% 16.9%
% Worse Off: 2007 2006 2005 2004 2003
Consumers 71.7% 69.7% 62.7% 78.0% 74.5%
Employers 34.9% 44.7% 42.7% 53.8% 61.8%
Physician 46.9% 45.5% 34.5% 33.1% 35.8%
Hospital 45.2% 41.7% 38.2% 25.4% 31.2%
Health Plans 11.0% 11.6% 15.5% 14.4% 21.0%
Pharma 29.2% 17.3% 25.5% 15.3% 13.9%
