The continued uncertainty and risk the healthcare industry will face in 2018 will motivate healthcare organizations to boost their efficiency across functions, according to the PwC Health Research Institute’s new report, “Top health industry issues of 2018: A year for resilience amid uncertainty.”

[Get an update on what PwC says are the 6 major issues facing healthcare in 2019]

The report highlights 12 trends that will impact the healthcare industry in 2018, including the rise of artificial intelligence, a move to secure the Internet of Things, disaster preparation and the increasing complexity of health reform.

PwC’s Health Research Institute provides new intelligence and analysis on trends affecting health-related industries. The Health Research Institute research is independent and not sponsored by businesses, government or other institutions.

Following are 12 issues the PwC Health Research Institute has identified will come to the fore in 2018, demanding the attention and innovation of healthcare C-suite executives, clinicians and other healthcare professionals.

1: Meet your new coworker, AI

Employees function best when they can practice at peak performance. Business executives overall told PwC in the report that they hope to be able to automate tasks such as routine paperwork (82 percent), scheduling (79 percent), timesheet entry (78 percent) and accounting (69 percent) with AI tools. Thirty-nine percent of provider executives told PwC they were investing in artificial intelligence, machine learning and predictive analytics.

Three-quarters of healthcare executives plan to invest in AI in the next three years but many lack the ability to implement this kind of technology, according to PwC. Only 20 percent of respondents said they had the technology to thrive with AI.

2: Health reform isn’t over, it’s just more complicated

Politicians and policymakers at the state level may be making key decisions in 2018 if many healthcare reforms are enacted. The overarching trend, indeed, has been toward state autonomy in healthcare policy. Healthcare organizations, especially ones doing business in multiple states, should strengthen compliance and local advocacy efforts, PwC said.

“In an unsettled policy environment, health organizations should focus on understanding how potential policies would specifically affect their business projections, and construct volatility ranges for those policies,” PwC wrote. “They should work to understand fixed costs and federal and state policy decisions’ impact on margin.”

3: Medicare Advantage swells in 2018

Organizations need to inform older adults about Medicare Advantage before they hit 65. Only 28 percent of consumers ages 50 to 64 surveyed by PwC Health Research Institute said they were familiar with Medicare Advantage.

“The federal government is ramping up reviews of Medicare Advantage plans,” PwC wrote. “To avoid penalties, health insurers should manage risk by focusing on members, paying particular attention to services such as timely member notifications, an adequate network, and up-to-date provider directories.”

4: Healthcare’s endangered middlemen

Rather than merely being a pass-through serving a contracting function, healthcare intermediaries may evolve. They could boost pricing transparency and take charge of more of the value chain, and that means holding manufacturers responsible for drug efficacy, propelling population health by combining pharmaceutical and clinical data, and assisting individual patients in better managing their care.

“Healthcare purchasers should regularly re-evaluate contracts with industry middlemen,” PwC wrote. “They also should demand greater transparency and prioritize models based on outcomes – which drive better clinical management – not merely seek the best price by volume.”

5: The healthcare industry tackles the opioid crisis

Keeping a close eye on patients and discovering social factors that sway their behavior could help stop new opioid addictions. Using care management programs from other areas, such as cancer, could help manage at-risk opioid patients.

“Combining public and private health data may reveal new insights and areas of focus,” PwC wrote. “In Massachusetts, data sharing across many government agencies has made it easier to find at-risk opioid patients.”

6: Securing the Internet of Things

There will be more cybersecurity breaches, and hospitals and health systems must be prepared. 

“The financial and reputational cost of a breach affecting patient health can far exceed the lost revenue from business disruption,” PwC wrote.

While 95 percent of provider executives believe their organization is protected against cybersecurity attacks, only 36 percent have access management policies and just 34 percent have a cybersecurity audit process, the report said.

7: 2018 is the year of strategic patient experience

Organizations need to educate both patients and clinicians how to use available tools and integrate them into care then administer the data they generate, PwC advised.

“73 percent of provider executives say balancing patient satisfaction and employee job satisfaction is a barrier to efforts to improve the patient experience,” PwC wrote. “But the two have the potential to go hand in hand. The Cleveland Clinic saw major improvements in patient experience measures after conducting programs to engage employees in the mission of caregiving.”

8: Price transparency moves to the state house

With a sharp eye on value and their brand, businesses need to make pricing decisions carefully and strategically, PwC advised.

“Without the expectation of value, set pricing may force manufacturers to readjust, as was the case when Sanofi was forced to cut the price of one its products in half after Memorial Sloan-Kettering Cancer Center decided it would not use the drug,” PwC wrote. “With regulations varying from state to state, manufacturers and payers should track each state’s requirements so they can navigate regulations, strategically decide which environments to do business in, and figure out whether legal responsibilities allow flexibility.”

In efforts to tackle transparency and price controls, some states are placing measures on the ballot or introducing legal challenges. This change generates new alliances, such as consumer groups uniting with health insurers.

9: Social determinants come to the forefront

This year, the Centers for Medicare and Medicaid Services granted $157 million to 32 healthcare organizations in its two-track Accountable Health Communities Model. The five-year demonstration will examine advanced payment and delivery models, such as becoming a hub to align community organizations or helping patients connect with such organizations.

“States are pushing value-based reimbursement models for Medicaid amid probable funding changes in 2018 and may look to Section 1115 ACA innovation waivers that let them test models such as pay for performance or accountable care,” PwC wrote. “Providers should brace for more risk sharing for this population, which is disproportionately affected by social disadvantages.”

Taking social responsibility has aided some healthcare organizations in maintaining and recruiting employees. 84 percent of providers said workforce development and management is important to their success in the next five years, PwC reported.

But 78 percent of provider executives say they do not have the data to recognize patients’ social needs; and while clinicians do gather standard demographic information in EHRs, social and lifestyle information is spottier, PwC said.

10: Real-world evidence a growing challenge for pharma

Businesses need to seek partners that already have broad patient consent to share data – many health systems have invested in data infrastructure and aim to use this as a market differentiator, PwC said. Some digital pharmaceutical undertakings – for instance, web-linked pill bottles – gather their own data. These kinds of IT tools could be a natural play for pharmaceutical companies with existing digital investments to take patient engagement tools to market.

“Drug companies may choose to partially sidestep the thorny task of grassroots data collection and aggregation by using secondary data sources,” PwC wrote. “For example, OptumLabs, owned by UnitedHealth Group, includes clinical and claims data on 150 million individuals gathered from partners including co-founder Mayo Clinic.”

11: Disaster preparation

Healthcare organizations need to go the extra mile with disaster preparedness to keep healthcare going, such as keeping generators and critical systems in an underground concrete site.

“Have a virtual backup to traditional services, understanding that virtual care can provide medical assistance in the event of damaged facilities,” PwC wrote. “Remember that disasters can cause population shift, so consider capital planning carefully.”

Organizations need to establish current levels of resilience and plan for what comes next. After significant damage, market share loss must be considered. Also to be studied: The impact of a credit rating downgrade should a facility’s population makeup change after a disaster.

“Form a plan to handle the disaster’s aftermath with patients, employees, insurers, vendors, credit rating agencies, and investors and creditors as critical audiences,” PwC advised. “Plan to combat bad or false information on social media during and after a disaster, as patients and employees may be scared off.”

12: Tax reform moves forward

Financial reporting systems will have to be updated to capture different information as new tax provisions go into effect. Based on any final tax reform passed by Congress, businesses need to audit their systems to determine required changes.

“Companies should continue to model proposed provisions’ effects and develop action plans to mitigate risks and take advantage of potential opportunities,” PwC wrote. “Organizations with advanced insight into reform’s impact will build enterprise resilience, positioning themselves to respond to changes more quickly once they take effect.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com