By Anna Yakovenko, Practice Manager and Jodi Askew, Senior Analyst
What are the biggest market trends that will affect your organization in 2018? Below, we share two market trends shaping the health care sector this year: the continued rise of telehealth and state-led changes to Medicaid.
These are just a few of the of the forces shaping the health care industry in 2018, so join us on Wednesday, March 7 for a webconference where you'll learn the three most important policy trends we're watching in the year ahead, see how hospitals are faring under pay-for-performance, and get an update on the growing outpatient market.
Look out for health reform changes—on the state level
One of the biggest questions for 2018 will be how the Trump administration uses CMS' waiver authority to reform health care at the state level—and the program where changes are most likely to happen is Medicaid.
Currently, states can request federal waivers to drive three major types of reform:
- Payer-led managed care: States can request to shift beneficiaries to managed care with per-capita spending limits and/or home-based care alternatives. At least 39 states have already utilized waivers to undertake these reforms.
- Consumer-focused insurance design: Several states have already used waivers to change Medicaid coverage and eligibility options. These have included premium requirements for certain beneficiaries, lock-out periods for those who don't pay premiums on time, and work requirements. There have already been legal challenges to some of these waivers—and in the coming year, we expect more states to file these waiver requests (and more legal disputes).
- Provider-focused delivery reform: At least 16 states have used waivers to change the way states receive and use federal money to deliver care. Under this type of reform, states are given federal funding in exchange for testing new delivery or payment reforms that will save federal government money in the long-term.
Telehealth continues to grow—as does reimbursement
2018 is shaping up to be another strong year for the telehealth market and should continue to be a bright spot for organizations that have invested in this growing service.
In a 2017 survey of U.S. providers and health care executives, 51% of respondents identified telehealth as a "top" or "high" organizational priority—and for good reason: From 2006 to 2015, year-over-year Medicare reimbursement for telehealth services has grown by from just $2.5 million to $17.6 million. The trend shows few signs of slowing, as telehealth claims increased by 33% from 2015 to 2016 and Medicare payment for these services increased by 28% over the same time frame.
Recent legislation has delivered more good news for telehealth programs: CMS in the 2018 Physician Fee Schedule added reimbursement for remote patient monitoring, and for the first time has included CPT codes for telemedicine. Additionally, President Trump last month signed into law the CHRONIC Care Act, which will allow Medicare Advantage plans and ACOs to expand coverage for and provide telehealth services for certain procedures, such as home dialysis and stroke assessments. The law also calls on the HHS secretary to solicit feedback on services that could potentially be covered as telehealth benefits in the future.
Next, join us to learn more market trends for 2018
These trends are just a few pieces of the puzzle. Join us on Wednesday, March 7 for a webconference where you'll learn the three most important policy trends we're watching in the year ahead, how hospitals are faring under pay-for-performance, and get an update on the growing outpatient market.