The top health care stories of 2016—and why they mattered

In our annual review, the Daily Briefing team identifies the industry's 10 most important stories this year. And as usual, we're counting down to what we consider the top story of the year.

Think we missed a big story? Tell us what you think was important in 2016 in the comments section below or on Twitter.

10. More than buzzwords: Telehealth, consumer-focused health care take on larger strategic roles

If you follow health care long enough, you notice that some trends generate a lot of buzz—but never actually seem to change the system. In 2015, I might have counted telehealth and consumer-focused health care among those buzzwords. But in 2016, that changed. 

This year brought clear signs that telehealth is on the rise. For instance, Kaiser Permanente announced that more than 50 percent of its interactions between patients and physicians are now virtual, NewYork-Presbyterian brought virtual visits to the ED, and new alternative payment models—such as Comprehensive Primary Care Plus—promised to give providers more financial flexibility to offer telehealth services.

Providers in 2016 also took steps to compete for patients through consumer-focused care like never before. From planning to eliminate the waiting room to going all in on price transparency, health systems responded to the reality that—no matter what happens to the Affordable Care Act—consumer-focused health care is here to stay.

Sam Bernstein

More from Daily Briefing and Advisory Board:

May 18: An Amazon for telehealth? American Well unveils new doc marketplace

Sept. 26: A playbook for the consumer-focused health system

Dec. 7: Congress passed the ECHO Act—what does this mean for telehealth?



9. The health care world learns what 'ransomware' is

2016 was the year the term "ransomware" went from being known by just health IT professionals to being a top-of-mind problem for the health care C-suite. Several hospitals this year fell victim to such attacks, in which hackers encrypt an organization's files and demand ransom for a decryption key.

In some instances, hospitals managed to recover their data without paying the ransom. In others, hospitals paid tens of thousands of dollars to return to business as usual.

And the incidents that received press coverage may have been just the tip of the iceberg. An April HIMSS Analytics survey found that about 50 percent of hospitals had been targeted by ransomware in the previous year. That means hospitals this year also had to do more to protect themselves from ransomware attacks, and Advisory Board's Phil Beyer recommended that leaders take a four-step approach to doing just that.

Josh Zeitlin

More from Daily Briefing and Advisory Board:

Feb. 18: LA hospital pays hackers ransom to regain access to IT network

May 18: How to deal with ransomware attacks—before and after clicking

Nov. 3: How to manage a ransomware incident response in minutes



8. A year of hope and uncertainty in oncology

In January, President Obama gave a State of the Union address that was reminiscent of a certain West Wing episode. "For the loved ones we've all lost, for the families that we can still save," Obama said, "let's make America the country that cures cancer once and for all."

Obama that night announced the Cancer Moonshot to accelerate cancer research. That effort—led by Vice President Biden—has resulted in numerous projects that involve stakeholders ranging from the National Cancer Institute to NASA and Amazon, as well as several proposals to achieve 10 years' worth of progress against cancer in just five years. And earlier this month, Congress approved $1.8 billion for the moonshot initiative as part of the 21st Century Cures Act.

2016 has also seen increased hype around immunotherapy treatments, which harness a patient's own T-cells to target tumors. It's been a year with many promising signs for the treatments but also signals that scientists still have much to learn. Some patients are experiencing severe side effects, and as the New York Times notes, although "immunotherapy has been stunningly successful in some cases, it still works in only a minority of patients."

Josh Zeitlin

More from Daily Briefing and Advisory Board:

June 22: Have you optimized your cancer program's online presence?

Sept. 29: Experts: Immunotherapy is promising, but 'don't believe everything you hear'

Sept. 9: Seven ways to provide timely care for oncology patients



7. CMS expands its star ratings to include 'overall quality'—and hospitals push back

CMS originally had planned to release its first-ever overall hospital quality star ratings in April—but held off amid pushback from providers and lawmakers, who expressed concerns about the ratings' methodology.

The agency finally published the ratings for more than 3,500 hospitals in July, and sure enough, several provider groups were unhappy about it.

American Hospital Association President Richard Pollack said the methodology was over-simplified and could "unfairly penaliz[e] teaching hospitals and those serving higher numbers of the poor." The Medicare Payment Advisory Commission raised concerns as well, and even Mayo Clinic CEO John Noseworthy—whose organization was awarded five stars—said the ratings were too reductionist and needed to be changed.

Considering that lawmakers made several bipartisan pushes this year to scrap or reform the ratings, it's safe to say their future is uncertain going into 2017.

Sam Bernstein

More from Daily Briefing and Advisory Board:

Oct. 27: Mayo Clinic got 'five stars'—but its CEO still doesn't like how CMS rates hospitals

Nov. 30: Hospitals in more 'stressed' cities have worse CMS star ratings, study finds

Dec. 16: Overall Hospital Quality Star Ratings: Answers to your frequently asked questions



6. DOJ moves to block insurer mega-mergers

The health care world in 2015 was buzzing about Anthem's plan to acquire Cigna, as well as Aetna's plan to acquire Humana. If both deals were to go through, four of the nation's five largest insurers would become two companies.

This year, the Department of Justice (DOJ) made it clear it doesn't want that to happen. DOJ in July filed lawsuits challenging both mergers, and the challenges are now working their way through the courts.

What happens next year will have major implications for hospitals, which worry about losing bargaining power with insurers and have argued against the deals.

Sam Bernstein

More from Daily Briefing and Advisory Board:

July 22: Humana is pulling out of at least eight states' ACA exchange markets

Aug 16: Aetna to drastically scale back its 2017 ACA exchange business

Nov. 22: DOJ, Anthem lawyers give opening arguments in merger trial

5. The Zika response

Zika spread throughout the Americas in 2016, captivating the world's attention. The virus was linked to an increase in cases of microcephaly in Brazil, and the World Health Organization (WHO) in February declared the neurological disorders linked to the virus a "public health emergency of international concern."

While there's still much researchers don't know about the virus, 2016 was a year when health care providers, researchers, and other stakeholders came together to learn and to fight the disease as quickly as possible.

For instance, Texas Children Hospital and Houston Methodist Hospital in February developed the first rapid test for Zika, while CDC released multiple travel advisories, dispatched mosquito control teams, updated blood-donation guidelines, and established a causal connection between Zika and microcephaly. Not everyone's efforts were lauded: Public health researchers expressed alarm that it took Congress until late September to provide $1.1 billion for efforts to combat Zika.

As of December 14, CDC data showed more than 4,600 laboratory-confirmed cases of Zika in the United States, including nearly 1,100 cases in pregnant women. And in October, CDC Director Tom Frieden painted a bleak picture for the future. "Here's the plain truth," he said. "Zika and other diseases spread by Aedes aegypti [mosquitos] are really not controllable with current technologies. So we will see this become endemic in the hemisphere."

Sam Bernstein

More from Daily Briefing and Advisory Board:

March 1: On Zika's trail in Brazil

Aug. 31: There's a lot we don't know about Zika. Here's how hospitals are responding anyway.

Oct. 28: Zika is here to stay in the US, CDC director warns



4. Drug costs yet again are front-page news

Rising drug prices came in at No. 3 on our list last year—and the topic is near the top again this year.

In 2015, the once-obscure former Turing Pharmaceuticals CEO Martin Shkreli became a household name for raising the price of the decades-old drug Daraprim. This year, controversy focused on drugs and companies that already were far better known.

Mylan came under fire for increasing the price of the EpiPen by about 400 percent since it acquired the lifesaving medication, and the rising price of insulin (made by several drugmakers) drew headlines as well.

Meanwhile, during the presidential campaign, Donald Trump and Hillary Clinton both called for the United States to allow importation of prescription drugs and to allow Medicare to negotiate drug prices. And earlier this month, Trump told TIME he doesn't "like what's happened with drug prices" and is "going to bring [them] down," although he did not specify how he would do so.

That gets to another similarity between 2016 and 2015: Lawmakers and other federal officials talked a lot about drug prices, but they made few (if any) changes in laws. We'll have to wait to see whether 2017 will be any different.

Josh Zeitlin

More from Daily Briefing and Advisory Board:

March 18: 5 drug spending trends to pay attention to

Nov. 18: 4 key questions to ask when building your retail pharmacy strategy

Dec. 21: How hospitals are fighting Rx price hikes



3. A 'singular' moment: The first decline in life expectancy since 1993

The dip in life expectancy reported by CDC in December may have seemed small: In 2015, the center said, life expectancy at birth was 78.8 years, compared with 78.9 years in 2014. The decline amounts to about 37 days.

But researchers and public health officials expressed alarm: This was the first recorded decline in life expectancy since 1993, and the data showed increases in death rates for eight of the 10 leading causes of death, including heart disease, diabetes, suicide, and unintentional injuries (which includes drug overdoses—a major 2016 health care story in its own right).

Princeton University economist Anne Case said of the new data, "I think we should be very concerned. This is singular. This doesn't happen." And CDC Director Tom Frieden blamed the troubling trends on the obesity epidemic, which he said was contributing to higher rates of heart disease.

Sam Bernstein

More from Daily Briefing and Advisory Board:

Jan. 7: Study: Nine-in-10 patients receive another opioid prescription after painkiller overdose

May 25: How physicians can help curb the opioid epidemic

Dec. 6: Five areas where your diabetes program may be falling short

Dec. 9: CDC: Life expectancy is down for the first time since 1993



2. MACRA sets the stage for the future of value-based care

Early in 2016, we learned about a new value-based care milestone: The Obama administration in March announced that Medicare had reached its goal of making 30 percent of payments to providers through alternative payment models (APMs).

That was just one development in a year full of payment and delivery system reform news. A few of the highlights: CMS' mandatory bundled payment model for joint replacements went live; the agency floated a Medicare Part B Drug Payment Model (and later scrapped the idea); CMS proposed mandatory bundled payments for heart attack treatment and bypass surgery; and the agency rolled out a new Medicare-Medicaid ACO Model.

Oh, and CMS released a 2,398-page final rule to implement new value-based payment programs under the Medicare Access and CHIP Reauthorization Act (MACRA).

This year made two things clear: The shift toward value-based payments generally has bipartisan support—MACRA passed the House 392-37 and passed the Senate 92-8—but it is definitely not without controversy. Hospital groups have called on CMS to slow down the pace of payment reform, and nearly 180 lawmakers, including the likely next HHS secretary, argued in a letter to CMS that mandatory payment reforms are illegal.

So the trend toward value-based care seems likely to continue heading into 2017, but there's also some uncertainty about what the details will look like.

- Josh Zeitlin

More from Daily Briefing and Advisory Board:

Oct. 18: What the MACRA rule means for providers—in 2018 and beyond

Nov. 28: Your questions about the MACRA final rule–answered

Dec. 21: CMS launches three new mandatory bundled payment models



1. Trump wins the presidency, putting the ACA on life support

The Republican sweep of Congress and the White House could fundamentally change health policy. That much is certain—but so, too, is that there are many unanswered questions about what President-elect Trump's election victory will mean.

What will happen to Medicaid? Republicans have called for block-granting the program to the states, but whether they'll have the votes to pass major changes remains to be seen.

What will happen to Medicare? Ryan has called for transitioning Medicare to a "premium-support" model, but Trump earlier this year said he would keep the program "the way it is" if elected.

And what will happen to the Affordable Care Act (ACA)? We should get an initial answer in early January, when Republicans have said they'll start the process of partially repealing the law. But whether they'll be able to get the Democratic support needed to pass a replacement plan remains to be seen.  

The answers to those questions will almost surely be among our top stories of 2017. But for now, the massive change in the air makes President-elect Trump's election our clear top story of 2016.

Josh Zeitlin

More from Daily Briefing and Advisory Board:

Nov. 10: The 12 post-election questions every health care executive should be asking

Nov. 29: Trump's picks to lead HHS, CMS: What you need to know

Dec. 9: Eighteen health systems call on Trump, Congress not to 'reverse course' on value-based care


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