A Continued Shift Toward Value-Based Health Care


While the outcome of the 2017 presidential election is expected to usher in a new era for U.S. health care, the painstaking and challenging work of shifting to value-based care will likely continue even if the Affordable Care Act (ACA) is repealed, according to the PwC Health Research Institute’s annual report.

The report, published in December 2016, observed that President Donald Trump, along with a number of leading Congressional Republicans, have said they intend to repeal the ACA and replace it with a mix of tax credits, health savings accounts, high-risk pools, state Medicaid block grants, and a transfer of regulatory control from the Federal government to the states. The study also pointed out that President-elect Trump has called for reforming the U.S. Food and Drug Administration and modernizing Medicare.

While acknowledging that the goals of Republicans can be seen as representing a break with the health care reform efforts of Democrats, researchers pointed out that the overarching mission of transforming the health care industry to offer more value-based care has been underway for years, through Democratic and Republican administrations. Specifically, they noted, policy-makers from both parties are committed to ensuring that health care is affordable and of high quality, and that health care providers and insurers use patient-centric approaches and promote consumer choice.

The report’s authors predicted that 2017 will be a year dominated by this continued shift toward value, albeit with a greater emphasis than in recent years on free market approaches.

The most significant change in health care policy that is likely to occur in 2017 is the start of the process of repealing and replacing the ACA, the report said. Yet according to researchers, a review of Republican efforts to repeal the law since it passed in 2010 shows that any dramatic moves would likely be followed by a transition period for some provisions. They pointed out, for example, that President-elect Trump has indicated that he wants to keep popular parts of the law, including the requirements that insurance coverage cannot be denied based on health status or age, and that these requirements could in turn cause premium costs to increase.

The report also speculated that there could be changes in drug pricing in the coming year, as the public demand for drug pricing accountability, pushback from drug purchasers, and the potential for new price control regulations are prompting pharmaceutical company executives to embrace voluntary codes of conduct to rein in the kinds of pricing practices that have led to Congressional shaming and executive resignations.

In addition, the report observed that although the U.S. health care industry lags behind other industries like retail and telecommunications in deploying emerging technologies such as artificial intelligence, drones, and virtual reality, 2017 is the year to prepare for the eventual arrival of these technologies and their effects on business models, operations, workforce needs, and cybersecurity risks. For example, the report said, a consumer-operated tricorder could perform work now handled by primary care medical professionals, increasing efficiency. Moreover, new technologies could revolutionize pharmaceutical supply chains, or be used to collect data and issue warnings on the spread of infectious diseases.

 

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