Post-Election Predictions for the Healthcare Industry

It’s been nearly a month since Donald Trump won the election to become the next President of the United States. In those four weeks, industry experts and healthcare executives have been projecting and planning on what the win means given President-Elect Trump ran on a platform to repeal PPACA and transform Medicare. The overall tenor of the election was a demand for change and eliminating the way Washington has always operated. Pragmatism and practicality of a new process in Washington will be the focus. Based on the contention of parties, the potential for reaching across the aisle may never be higher. That could result in some higher quality compromises versus the gridlock we have seen in the past.

While no analyst and expert can predict the future of our Healthcare industry with complete certainty, there are signs we can point to as indication of what the Trump Administration may work toward as the presidency is handed over. While complete repeal is highly unlikely, the Trump Administration will need to enact on a first 100-day plan to instill credibility on this campaign promise.  To that end, the experts of the Healthcare Practice at HighPoint Solutions have predicted the following changes and their impact to providers and payers.

What ends up eliminated from the PPACA?

  • Subsidized co-ops because of their high risk of failure due to start up effort and costs
  • Many of the government subsidies
  • Exchanges (as currently administered)
  • Minimum benefit requirements, giving greater flexibility to the plans and more choices to the individual market

What ends up reviewed and revised?

  • Medicaid expansion because of the high cost and demand for ongoing/increase federal subsidy
  • Underwriting processes (again) to eliminate the exorbitant rate increases due to the risk pool imbalance with those in individual plans versus those in commercial plans

What is likely to be invested in further and/or newly added?

  • Federal insurance license changes allowing for competition and selling over state lines
  • Popular benefit elements such as kids on parents’ policies, pre-existing conditions, etc.
  • Continued progression of healthcare/insurance into a retail-like sector
  • Ongoing transition of risk from payers to providers and cost sharing with consumers
  • More performance-based measures beyond cost to quality and satisfaction
  • Increased transparency to drive competition for overall delivery and insurance improvements
  • Evidence-based decision making (expanded use of data and analytics) to eliminate unnecessary utilization and increase patient safety

How will these impact payers and providers?

  • Transparency data will need to be readily available and accurately produced, thus investment in data management will be paramount for both payers and providers.
  • Provider contracting activities will spike since payers will work aggressively to expand their provider networks across state lines, thus system readiness to capture and maintain provider data (e.g. contracting, credentialing, demographics, etc.) will be vital. 
  • Benefit configuration will tax payers since more choices will be offered to improve affordability, thus capturing greater market share.
  • Consumerism and choice will be paramount, so an increased focus on the customer experience and service will be key through digital services, extended operating hours, and accessibility.

The past eight years have seen some of the greatest regulation-driven change in our country’s attitude and attention toward healthcare delivery. Many of these were long overdue, and yet many created further obstacles to the ultimate objective of affordable, attainable, quality healthcare for all. As we enter into December, we’re advising our clients to not act in a wait-and-see mode. (Too many made that mistake during the ICD-10 mandate.)

We encourage everyone to fasten their seat belts. The ride in 2017 is about to get bumpy and cause trepidation for payers and providers alike. We stand ready to help on this journey.