logo for U.S healthcare targeted insights 2016

For the third consecutive year, Decision Resources Group analysts on the U.S. Managed Markets team are poised to predict the hottest healthcare trends in areas that have significant business implications for pharmaceutical companies, health plans and other healthcare stakeholders.

But before we move forward, let’s look back at 2015—the second straight year this team took to their crystal balls. In 2015, the team was dead-on right with a prediction 71 percent of the time; we forecasted trends correctly 88 percent of the time.

Among the correct predictions, and the subject matter experts who made them:

Prediction: Medicare Advantage could be the next place where the Centers for Medicare & Medicaid Services tests quality-based models (Bill Melville). Result: CMS announced in 2015 that it would pilot a value-based insurance model for Medicare Advantage in several states.

Prediction: Healthcare mergers and acquisitions will continue at a rapid pace, particularly in the hospital system sector (Sarah Wilson). Result: There were several mergers that will change market dynamics, including Providence Health & Services’ proposed merger with St. Joseph Health, SSM Health’s acquisition of Tenet’s Saint Louis University Hospital, and WellStar’s proposed acquisition of Tenet’s Georgia hospitals.

Prediction: Any future Republican-led Medicaid expansion will require payment of premiums for beneficiaries earning between 100 percent and 138 percent of the federal poverty level (Ric Gross). Result: Ohio’s 2015-2017 state budget includes a provision that requires the Gov. John Kasich administration to seek a waiver from the federal government to allow Ohio to require that Medicaid beneficiaries contribute monthly installments to health savings accounts, regardless of their income.

Even though the team wasn’t always dead-on, they were often directional or partly right, correctly predicting certain trends. For example:

Prediction: Consumer-driven health plan enrollment has been increasing about 5 million lives annually, and we expect that growth trend to hold true in 2015 (Jenny Kerr). Result: CDHP enrollment increased by 2.2 million lives through July 2015, according to Decisions Resources Group commercial enrollment data. Employers are implementing different strategies to manage costs, including narrow networks and private exchanges. Still, large employers such as Dell are planning to completely replace their existing health benefit plan structure with a CDHP and have begun preparing employees for the transition.

Prediction: As much as 10 percent of the U.S. population could be receiving healthcare directly through an accountable care organization by year’s end (April Wortham-Collins). Result: There are nearly 21 million attributed patient lives in ACOs as of Dec. 15, 2015, and more than 6% of the population is receiving healthcare directly through an ACO, according to Decision Resources Group’s ACO database.

So where did we go wrong? Once again, predicting what the federal government will do proved difficult:

Prediction: There will be no permanent fix for the Medicare physician reimbursement formula (Bill Melville). Result: After years of false starts, Congress passed and President Obama signed a permanent fix to the physician reimbursement rate issue.

Watch this space in coming weeks as the U.S. Managed Markets team takes on 2016. And if you’d like to review the 2015 predictions in their entirety, please visit https://decisionresourcesgroup.com/downloads/u-s-healthcare-2015-targeted-insights/

Carolyn McMeekin is Vice President of Global Market Access and MedTech Insights. Follow her on Twitter at @CarolynMcMeekin


View all of the 2016 Targeted Insights Series here.

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