Looking Back – Assessing Our 2016 Predictions

by | Dec 16, 2016

bmurrycardAs has become a tradition here at Chilmark Research, it is time once again to look back at our predictions for 2016 and make an honest assessment of just how accurate we were. We do like to go beyond the blatantly obvious predictions that seem so prevalent – we push the boundaries. While this is a good exercise for us and hopefully insightful for you, it does create some challenges in assessing how on target our predictions were. But alas, no pixels were killed in this exercise, no harm done and we take what we learn and move on.

Without further ado…

HIT: Cyber-security Hacks Increase as Value Escalates
No lack of cyber-security hacks and breaches during 2016 as the value of personal health information (PHI) far exceeds the cost to obtain it.

MISS: EHR Vendors Begin Taking Big PHM Market Share
At the top-end of the market, Cerner and Epic are definitely making some in-roads. In the ambulatory market, athenahealth and eClinicalworks are gaining some traction. However, none of these vendors have really taken the market by storm and there are a slew of other EHR vendors still pulling a PHM solutions suite together (e.g., Allscripts, NextGen) and others seemingly out-to-lunch (e.g., Meditech, Evident, PracticeFusion).

MISS: Telehealth Matures, Consolidates
In a sense we were partially right on this one as telehealth services continue to grow. But we were wrong on two other counts: In the total market for ambulatory health services, telehealth still makes up an exceedingly small percentage. Second, we have not seen any significant consolidation in this sector – maybe 2017 will be the year.

MISS: Physicians Flock to Direct Primary Care
Yes, there is growth in the number of physicians that are choosing to take the path of DPC and that may accelerate under a Trump administration, yet most small practices are simply opting to sell their practice to the highest bidder among local HCOs as those HCOs seek to build out their clinically integrated networks (CINs).

HIT: APIs Gather Steam but FHIR APIs Doesn’t Become Mainstream —
The promise of FHIR has yet to be realized as the standard does not become “official” until 2017. As we predicted, no major EHR vendor released a comprehensive set of production-ready FHIR profiles and resources in 2016.

HIT: CCM Code Underwhelms
CCM code adoption by primary practices in 2016 was poor. The administrative burden combined with the patient co-pay provision was more than most, small practices wished to deal with. In April 2016, CMS put forward CPC+, which if it gains APM status under MACRA, will see far stronger adoption.

MISS: Increased Attention on Referrals Transactions
Standalone referral management market still hasn’t really materialized with a lot general inertia to keep the status quo (e.g., fax machine). Today, only a very small percentage of overall initial referrals are electronic (10%-15%) and closed loop referral remains in PowerPoint from a full feature standpoint with new updated info sent back to referring physician.

MISS: Digital Health Investing Sees Steep Decline
Investment firms continue to pour inordinate amounts of cash into the digital health sector. This being a $3T plus market, a few billion in investment for 2016 is still pretty modest in the grand scheme of things.

HIT: Data Governance, Ethics and Consent Stymie Interop
No doubt, connecting disparate systems in support of interoperability is a Herculean task. That being said, technology is not the main culprit behind the lack of interoperability today – it is cultural.

HIT: Pharmaceutical and Med Device Companies Expand Outcomes-based Pricing
Last year we gave a caveat to this prediction: “Yet, we will only see very limited expansion in 2016 due to challenges associated with measuring and attributing outcomes to a given therapy. The ability of today’s heath IT systems to effectively measure such outcomes will be a key sticking point.” This was spot-on and will continue to hold true in 2017.

MIXED: CCJR Sets the Direction and Care Coordination Benefits
Half right only because CMS had to go with a stick approach after initial enrollment was tepid.  Care coordination still dominated by readmissions programs and the 30/90/120 day follow-up periods that are utilized for various readmissions programs including CMS.  Very rare to see true continuous care coordination that is longitudinal and open-ended across a cohort of patients or specific geographic region.  It is almost entirely episodic, event-based, and limited follow-up duration.

HIT: PGHD Meets Wearables with Mixed Success
As we stated in the original prediction: “To the chagrin of many, 2016 will not be the year we see this industry leverage these data to augment risk scores, conduct proactive engagement, or do much beyond following marching orders from DC.” Don’t hold your breath expecting an uptick in 2017.

MIXED: Mergers and Acquisitions Accelerate While Facing Increasing Scrutiny
M&A activity continued throughout 2016, especially among healthcare providers as large HCOs seek to build out their CINs to create more comprehensive care networks. The M&A activity we were expecting in the HIT market and in particular across EHRs failed to materialize.

Final Score
Hits: 6
Misses: 5
Mixed: 2

While this may be a great batting average for the MLB, for an analyst firm, not so good – we’ve done better. Next week we will post our predictions for 2017. With a new administration coming in under the mantra of repealing ACA – 2017 predictions will be interesting to say the least.



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