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Predictions: What’s in Store for 2020?

by Chilmark Team | December 19, 2019

As we rapidly approach the end of the year it is time once again to look forward to a new year, a new decade. While we will not yet forecast out through the decade ahead (still pondering that), below is our collective look at the health IT market and what we expect to occur in the coming year. Holding to tradition, we offer a baker’s dozen.

 

Big Tech will be assimilated by the healthcare Borg.

We were seeing signs of this in late 2019 with Google’s partnership with Ascension and Mayo, Amazon’s release of its medical transcription service and earlier, Apple’s partnership with Aetna for Attain. All the talk of disruption is just that – talk. Let’s move on.

Commercial payers get serious in 2020 on value-based care (VBC).

To date, most commercial payers have been dragging their feet on VBC, hindering broader adoption and scaling of population health management models. Recent results from the likes of Humana, rapid growth in Medicare Advantage, and direct, self-insured employer contracting will break the log-jam. But remember, VBC remains highly localized. Certain regions of the country will see very rapid growth, e.g. North Carolina which has a very proactive payer in BCBS-NC, while others will see modest growth – BCBS-GA is the antithesis of North Carolina.

The healthcare AI industry will confront a growing amount of pushback similar to the Google-Ascension kerfuffle even when complying with HIPAA and other regulations.

They will increasingly have to demonstrate transparency in partnerships as well as the ability to concretely address bias in products and we may see new review boards with external actors to oversee AI activities (something Google just nixed in their DeepMind relationship).

Despite several big break-ups, pharma companies will continue to seek-out health IT partners for monitoring, adherence, and engagement.

As prices continue to rise, especially for specialty pharmaceuticals, payers will put pressure on pharma to justify the value of such therapeutics. Today, however, pharma companies do not have the wherewithal to directly track medication usage, drive adherence, and correlate such use with patient-reported outcomes. Thus, they are left with no alternative but to find and partner with novel health IT vendors that can collect such data.

The Amazon Care Clinic will prove to be a backdoor pilot for Haven.

Haven, formed by Amazon, Berkshire Hathaway and JP Morgan, back in January 2018, has been a black box for its entire lifespan, while speculation has been furious. Amazon Care, a virtual care clinic for Amazon employees announced in September, will prove to be a pilot for a larger Amazon virtual care offering run by Haven, using the health data and diagnostic models provided by the NHS as the backbone for AI-driven healthcare recommendations. Initial roll-out to Haven partners begins in 2020. Broader market roll-out will wait till 2021-22.

Solutions for value-based care remain heavily services-oriented in 2020.

Localization and change management issues continue to hinder efforts to provide readily scalable, out-of-box PHM/VBC solutions to serve the US market. Consulting firms love it, software firms, less so.

In 2020, we are likely going to see an uptick in growth of health applications built with smart assistants such as Alexa, Google Assistant, and others.

The Passive-Aggressive Grandmother skillset for Amazon Alexa will not tell you to stay in bed, it’s just saying it would be good for you, you don’t need to listen, it’s fine, and then it will order drone-delivered chicken soup directly to your home.

Social determinants of health (SDoH) remain in the spotlight in 2020.

Yes, SDoH was a hot topic in 2019, but this is one buzzword that will not fade quickly. The transition to VBC keeps SDoH in the spotlight as information on the effectiveness and ROI of SDoH-centric solutions becomes more public. While demand for those solutions continues to grow, there is no single vendor that provides the entire solution set. Healthcare organizations (HCOs) will be left to cobble something together – an effort that only those with the resources and risk exposure (e.g., large HCOs with significant capitation) will attempt.

Remote patient monitoring (RPM) hits a snag with stricter regulatory review.

To date, the FDA has been fairly hands-off with regards to RPM, focusing more on clinical validity then privacy. But small companies are now creating health devices that track a terrifying amount of information (check this out). It’s only a matter of time before a new player mishandles data, creates a leak, and forces a re-evaluation of legislation regulating protection and ownership of the information.

Unintended consequences of price transparency arise.

While price visibility is a cornerstone of functioning capitalist markets, existing interests come first in healthcare. If either the provider executive order or payer RFI survives legal challenges and the rulemaking process, only higher prices could result. Patients will equate higher prices with higher quality and opt for the priciest options. Provider organizations will find the highest negotiated rates and use them as their floor in future negotiations with the payer.

Despite new info blocking rules in 2020 and more FHIR Resources, interoperability challenges persist.

If the history of HIPAA enforcement is any guide, toothless warning letters will be the primary enforcement action for new information blocking rules released under TEFCA. In addition, the big bump up in normalized FHIR resources in late 2020 will do little to truly breakdown the walls between health systems and their sharing of medical data. Interoperability remains a business issue, not a technical one.

Behavioral health comes to the forefront.

Virtual health platforms are seeing strong growth in the employer market and are expanding into behavioral health as well e.g., Livongo’s acquisition of MyStrength. In 2020, expect providers to also begin aggressively adopting such solutions to better address multi-chronic patients in VBC contracts. Within the telehealth space, expect further consolidation as the major players (American Well, MDLIVE, Teledoc, etc.) acquire behavioral health specialty vendors as well.

Medicare for All (M4A) dies on campaign trail but the public option lives on.

This screwed up healthcare industry, which is nothing but a cabal of special interests, will be able to kill M4A but not the public option. Too many regions of the country and subsequently a large sector of the population, do not have sufficient insurance options, leaving the one or two options they do have the ability to bankrupt them. Consumers/voters have had enough and welcome a public Medicare option in 2020 as a reasonable alternative to create competition in those markets that have little.

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