Last year, we put together a list of five healthcare trends in 2017. The list included blockchain moving from theory to reality, the rise of healthcare e-commerce, and the increasing use of telehealth. Our mid-year update showed that those trends were coming to fruition and profoundly changing the industry.
As we move into a new year, here are our predictions for the trends we think will impact healthcare in 2018.
1. Disruption Comes to the Pharmaceutical Space
Pharmacy services could be subject to a major disruption in 2018 due to two factors: shake-ups in the pharmaceutical distribution system and the introduction of price transparency in prescription drugs.
Businesses Challenge the Existing Pharmaceutical Distribution System
Amazon looms large over the world of distribution, and this goes for all consumer purchases: from personal electronics to prescribed medicine. The entry of a company like Amazon in healthcare, with its vast distribution network, could bring the same consumer-friendly services that they've brought to a whole host of other categories.
How might this work? Given the high barriers of entry into the space, Steve Brozak at Forbes posits that pharmacy benefits managers could be Amazon’s starting point. Entering healthcare through PBM seems to be the most beneficial move, as Amazon’s primary demographic of customers between 30 and 45 years old will increasingly need to fill more prescriptions.
Just the mere possibility of Amazon entering the pharmacy space has the big players in the industry scrambling for stronger market positions. CVS and Walgreens are both changing their strategies in ways that will affect the consumer experience.
On December 3, CVS Health announced its acquisition of Aetna in a bid to “redefine access to high-quality care in lower cost, local settings whether in the community, at home, or through digital tools.” The $77 billion acquisition will allow CVS to act as an onramp into the healthcare system for many of its customers, who will then be able to purchase CVS insurance, go to a CVS clinic, and fill prescriptions at a CVS pharmacy. Further, Robert Klara at AdWeek predicts this vertical integration will translate to better in-store experiences for many of America’s healthcare customers, which could then set a high bar for competitors.
Walgreens, the No. 2 player in this market, is also making moves. It announced a rebranding strategy just one day after news broke of the CVS-Aetna merger. What does that mean for consumers? Walgreens Senior VP and CMO Adam Holyk tells Klara that this translates to providing “personalized, care-oriented service.”
Regardless of whether Amazon does enter the pharmacy market and how they do it, the moves made by CVS and Walgreens mean that things are already changing. The only question now is: How will consumers benefit?
Price Transparency Comes to Prescriptions
Another factor driving change in the pharmaceutical space is consumer demand for price transparency. Forced to bear more of the costs of their healthcare due to the emergence of high deductible health plans (HDHP), patients are now more financially incentivized to compare costs and understand their options. Price transparency — particularly the costs of prescription drugs, which are usually expensive and notoriously opaque to consumers — is becoming more important to patients.
Steve Rasnick, President of Health Care Administrators Association, believes that cost consciousness is a key driver in the demand for price transparency. In an article for Future of Health Care, he notes that the prevalence of high-deductible plans means “patients are asking more questions about the true cost of care and the value of a particular test or scan and the information it can give a clinician versus the cost of knowing.”
Currently, some insurers provide price transparency tools that allow patients to find out how much their medical treatments cost, and those tools delineate which parties are liable for which expenses, and for how much.
The true power of price transparency is that it focuses the patient’s decision-making not just on price but, more importantly, on value. Beyond pricing signals, patients are also interested in tools that provide key information about doctors (such as reviews and ratings) that can help them make healthcare decisions. Veronica Hawkins, the Vice President of Government Accounts at Medical Mutual, believes that the availability of such information will allow consumers to make more informed decisions about their medical care.
This retail-based approach to healthcare will shift power back into the hands of consumers, who are then able to choose healthcare providers, services, and treatments in a value-conscious way.
As we wrote about in November, we at PokitDok are trying to drive this move toward true price transparency with our Pharmacy APIs. Specifically, our tools provide doctors with real-time visibility into a patient’s financial liability at the point of care so they don’t unnecessarily burden patients with expensive prescriptions, and give patients access to that same information so they can price compare treatment options before they access a pharmacy.
2. Telehealth Solidifies Its Position as a Mainstream Method of Healthcare Delivery
Jim Molpus at HealthLeaders media wrote in November that telehealth has moved from being a novelty to a service delivery model that’s now high in demand. He points to research conducted by American Well which showed an exponential increase in the demand for telehealth: While only 17 million Americans wanted telehealth visits in 2015, there are now 50 million who would be willing to switch primary care providers to get access to telehealth.
Here are three signs that telehealth will continue to appeal to American patients and care providers in 2018:
Updated Telehealth Legislation In Almost All US States
The high demand for telehealth is reflected in state legislation. Dave Muoio at Mobi Health News reports that most states, except Connecticut and Massachusetts, have updated their telehealth legislation in the past year.
The change in legislation varies according to the state. For instance, Texas loosened its telehealth laws in a bid to increase utilization rates and competition between providers. On the other hand, Alaska introduced telehealth laws for the first time in order to regulate the space in their state.
Regardless of the nature of the updates to legislation, one thing is clear: The mainstream adoption of telehealth has pushed state legislatures to create or refine the regulatory frameworks for the remote delivery of medical care.
The U.S. Department of Veterans Affairs Is Expanding Its Use of Telehealth
In line with the increased public confidence in and demand for telehealth, the VA is expanding its “anywhere to anywhere” healthcare for veterans. Last year, more than 700,000 veterans benefitted from the use of telehealth services, which allowed the VA to serve patients more efficiently and effectively. VA telehealth programs covered a wide range of specialties, from dentistry to dermatology.
In August, Federal News Radio reported that the VA will remove all geographical barriers to administering medical care to veterans via video and will “allow all VA providers to administer telehealth services to veterans anywhere in the country.”
To facilitate this expansion of service, a new tool called VA Video Connect will be launched to help VA telehealth providers administer the program. Patients will be able to use a new app, the Veteran’s Appointment Request, to easily schedule appointments on their smartphones.
The hope is that these tools will help the VA whittle down its long queue for medical services and provide more veterans with access to medical care more quickly. VA Secretary David Shulkin tells Wired that telehealth, particularly with the use of the VA video tool, can help “redistribute” VA healthcare services from hospitals with high capacity to patients who don’t have easy access to medical providers.
Speciality Telehealth Services Are Growing
Another heartening signal is the rise of specialty telehealth services.
For instance, Amy Lerman at Law360 [registration required] writes that the adoption of telehealth is growing in the field of behavioral health services. Lerman notes that the American Psychiatric Association (APA) regards telepsychiatry as “a core tool of daily clinical practice.”
According to the APA Telepsychiatry Toolkit, the growth of telepsychiatry can be attributed to patient demand for medical services that are affordable, convenient, and easily accessible. What’s more, evidence shows that telepsychiatry does work. “Its effectiveness is comparable to in-person care in terms of therapeutic engagement, quality of care, validity/reliability of assessment, and clinical outcomes,” says the APA.
State legislation has changed to mirror the increased demand for telemental health services. In the 2017 Appendix to its 50 State Survey of Telemental/Telebehavioral Health, Epstein Becker Green reports that “states have started to expand regulatory frameworks with respect to psychologists and other types of non-physician behavioral health providers.”
This trend of offering mental healthcare via live video is certainly something that can further push telehealth into the mainstream.
3. Competing Networks Duel for Blockchain Market Share
As we mentioned in our mid-year review of our 2017 healthcare trend predictions, this past year saw the development of many working blockchain applications in the healthcare space. Our own implementation of blockchain in healthcare, DokChain was one of them.
Still, there is a conceptual hurdle that remains for many people in healthcare. The average person continues to have trouble visualizing what, exactly, a blockchain is. “For many people, the blockchain concept remains difficult to grasp — which makes it one of the most misunderstood technologies of 2017,” says the team at Research and Markets, which published a report on healthcare IT blockchains in July that predicts trends through 2025. One key point in the research is that blockchains hold “the potential to save billions of dollars by optimizing current workflows and the disintermediation of some high-cost gatekeepers.”
The next step for existing healthcare blockchain projects, says Mike Orcutt at MIT Technology Review, is the creation of “a custom-built ‘health-care blockchain’” — and the question is who will build that? While many of us agree that the blockchain will be a solution for improving interoperability between different healthcare systems, the challenge now is to develop a blockchain that can handle the specific needs of the entire healthcare industry.
In other words, one blockchain will emerge as the industry standard. This battle will be won on the basis of the network’s real functionality and the players operating the network.
2017 also brought about a trend that could shake up this competition in unpredictable ways. In 2017, initial coin offerings went mainstream, and crypto projects began to garner attention from both the big names in venture capital as well as speculative coin traders. The first company to ride the ICO wave in healthcare was Patientory, which raised $7.2 million over three days in late spring, StartupHealth reported in June.
The ICO model of fundraising could pour significant fuel into the healthcare IT blockchain race, as it could accelerate the growth of seed-stage ventures and introduce consumer hype around certain projects — which may or may not be ready for the spotlight when it shines on them.
Hype curves aside, PokitDok and companies developing healthcare blockchain technologies will ultimately compete on the basis of how well their networks perform, and who adopts those networks. Look for some initial results to shake out in 2018.
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Tags: API, Blockchain, Enterprise, Health Innovation, Healthcare predictions