At the beginning of 2012, HealthLeaders-InterStudy released an Executive Briefing outlining what we thought would be the 10 top trends for 2012. Now that we're midway through the year, we have revisited those trends to see how clear our crystal ball was.

Mergers & acquisitions on steroids. Clearly, it didn't take a rocket scientist to predict this one, and the M&A trend prevalent in 2011 has continued into 2012. Notable deals include WellPoint's plans to purchase Amerigroup Corp.; DaVita's deal with HealthCare Partners, the large California-based medical group; and a number of under-the-radar purchases of physician groups and hospitals across the United States. Scale is important, and with the accountable care movement picking up steam every day, hospital systems are making investments to more easily assemble all the pieces of a total-patient-care package.

Me, myself and I. This trend involved a focus on the individual market in advance of the formation of health benefits exchanges. While that is definitely occurring, it's also important to note that the individual insurance market remains volatile and insurers continue to struggle to price products appropriately. But pricing is only one of the many wrinkles health plans will have to iron out in preparing for exchanges. Marketing, underwriting and providing care management will also be on the worry list.

Anything but fee-for-service: New ways to pay. Even before the federal government set loose the floodgates on ACOs for Medicare patients, the private sector was working on ways to move away from fee for service. Simultaneously, physicians were growing weary of the volume-based business they found themselves in. The result is a groundswell of movement toward shared-savings contracts in which providers bear financial risk in treating their patients, but can also share in the rewards of treating them well. Cigna says it has more than 30 accountable-care programs ongoing and expects to have 1 million enrolled in these programs by 2014. Aetna, WellPoint and UnitedHealth are working on dozens of partnerships that could begin to tilt the system toward more value-based contracting.

Medicaid-apalozza underway. It was easy to predict continued expansion of managed care within Medicaid. What was hard to foresee was the curveball thrown by the Supreme Court when it ruled that states could opt to accept the millions of new Medicaid enrollees (or not) via the Affordable Care Act. Now we'll likely have to wait until after the November elections to see exactly which states are in or out. In the meantime, MCOs continue to grow their shares in the Medicaid market, and even partial expansions under the ACA could significantly boost membership levels.

Managed Medicare in the catbird's seat. Demographics are on the side of this trend with baby boomers aging into Medicare at a rapid clip. Unlike their older brothers and sisters, these newly eligible Medicare beneficiaries aren't necessarily afraid of managed care. And being the game changers that they are, boomers are also used to demanding quality, which may mean good news for the Medicare star ratings program. The star program has largely been ignored by seniors enrolling in Medicare plans, but that could change with the influx of younger age-ins. It's possible Congress could do away with the star program altogether, especially because it rewards average plans (getting 3 or higher out of a score of 5), but if it survives, boomers may help make health plans more accountable for quality, just as the accountable care organizations will be held more accountable for seniors.

Save for a few details, we were mostly on track with those first five trends; stay tuned for a take on how well we predicted the remaining five in an upcoming blog posting.

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