The health care industry is in for another roller-coaster year in health policy, as Republicans in Congress set their sights on reforming Medicare, Medicaid, and the Affordable Care Act—all while the industry faces looming challenges from hackers and the still-raging opioid epidemic. Here are the five biggest health care trends to watch for in 2018.
1. The GOP will try to scale back Medicare and Medicaid funding—but will they succeed?
Paul Ryan in December made clear that reducing federal entitlement spending on programs such as Medicare and Medicaid will be a top priority for Republicans in 2018. During 2017's health reform debate, Republican congressional leaders proposed shifting Medicaid's funding structure from its current, open-ended commitment to states to capped, per-beneficiary funding —a move CBO projected would lower federal Medicaid spending by 35% in 2036.
However, as Andy Slavitt, the former acting Administrator of CMS, in a USA Today column wrote, "There's less appetite for deep Medicaid cuts in the Senate and even less in the electorate." Slavitt added that if "Ryan is serious about reforming Medicaid, his best bet would be a bipartisan panel to recommend solutions that reduce long-term costs while improving care."
As for Medicare, House Republicans in a fiscal year (FY) 2018 budget resolution last year proposed to transition Medicare to a premium support model, where the government would contribute a certain amount toward a senior's health care premiums. House Republicans in 2016 also considered raising the Medicare eligibility age, but research has showed such a change could actually increase total health care spending.
2. Value-based care is here to stay.
Although the Trump administration in 2017 took steps that slowed the shift toward value-based care—such as canceling three planned Medicare mandatory bundled payment models, scaling back a fourth, and scrapping a cardiac rehabilitation incentive payment model—the health care industry in 2018 is expected to continue its trajectory toward outcome-based models. For example, Hamza Hasan, practice manager for the Advisory Board's Medical Group Strategy Council, wrote CMS will further implement MACRA in 2018, "using the coming year as an on-ramp to the more stringent performance standards of 2019." (Advisory Board is the publisher of American Health Line.)
CMS in 2018 also is expected to advance its proposal to redefine CMS' Center for Medicare and Medicaid Innovation (CMMI) and broaden the types of payment models the center oversees. For instance, Sarah Donovan, vice president of client solutions at Avalere, during a webinar this month said, more value-based agreements with Medicaid are likely on the way—as both the government and manufacturers have signaled interest.
3. The GOP spent seven years trying to repeal 'Obamacare.' Will they try one more time?
The Affordable Care Act (ACA) has been a point of contention among lawmakers since it was enacted, but industry experts are split on whether that debate will continue in 2018. Elizabeth Carpenter, a senior vice president of policy at Avalere, said some Republicans feel they already won the battle over the ACA by repealing the individual mandate.
However, other experts say Republicans will likely continue their efforts to repeal and replace the ACA. For instance, Slavitt wrote, "Sen. Lindsey Graham (R-S.C.) still burns a candle for repealing and replacing the ACA." PwC's Health Research Institute predicted Republicans will likely "pursue health reform in 2018 through a more fragmented approach"—similar to the way the White House, federal lawmakers, and other government officials have relied on executive orders, legislation, appropriations, or other avenues to reshape the ACA. In short, the health industry should be prepared for another year of "uncertainty," according to the PwC report.
4. Ransomware, medical device hacks, and other cyber threats are on the rise.
HHS CIO Beth Killoran in 2017 said HHS experiences an estimated "500 million cyber hack attempts each week," but the department isn't alone in facing an onslaught of threats from cybercriminals. According to the PwC Health Research Institute, cybersecurity vulnerabilities are only getting more prevalent: The number of medical device vulnerabilities being reported to the Department of Homeland Security's Industrial Control Systems Cyber Emergency Response Team increasing 525% from 2016 to 2017.
The first week of 2018 brought a warning regarding two major computer hardware bugs potentially affecting billions of devices. But there are measures the health care industry can take to protect themselves against these threats. . Generally, PwC recommends health care organizations "create and test cybersecurity breach and remediation plans." In regard to the latest threat, the National Health Information Sharing and Analysis Center (NH-ISAC) recommended health care organizations test patches in a lab setting to determine their real-world effect.
5. The US opioid misuse epidemic rages on.
In 2018, policymakers, industry stakeholders, and U.S. residents will continue to grapple with the country's opioid misuse epidemic. CDC data show 2016 was the deadliest year on record for opioid-related deaths, resulting in more than 42,000 deaths. Data for 2017 is not yet available.
Tom Kraus, senior vice president of commercialization and regulatory strategy at Avalere, said FDA Commissioner Scott Gottlieb in 2018 is expected to consider more aggressive and radical steps to address the epidemic, including mandatory training for providers and limits on prescribed dosages. According to PwC, the health care industry is expected to join the federal government as well as state and local health officials in its efforts to stem the opioid misuse epidemic. Industry collaboration will center on ways "to prevent opioid misuse, improve treatments for chronic pain, and support patients struggling to recover from opioid addiction," according to the PwC Health Research Institute.