2018 trends to watch include ACA uncertainty, cyberthreats, patient experience: PwC

Executive looking out window
The constant drama on the hill over healthcare reform is going to continue into 2018 so healthcare executives and the entire industry will be in a permanent state of health policy change, said Benjamin Isgur, leader of PwC's Health Research Institute. (Getty/Tom Merton)
Ben Isgur
Benjamin Isgur

To face challenges that lie ahead in 2018, healthcare organizations must rely on the resiliency they've built up amid the upheavals of 2017, including the ups and downs of Congress' attempts to repeal and replace the Affordable Care Act.

Those issues include even more uncertainty over healthcare reform, new threats to data security, the need to tackle the social determinants of patients’ health and a greater focus on the patient experience, Benjamin Isgur, leader of PwC's Health Research Institute, said in an interview. 

FierceHealthcare caught up with Isgur to talk about the management consulting firm's annual trends report.

Healthcare reform becomes more complicated

The constant drama on the hill over healthcare reform will continue, which means healthcare executives and the entire industry will be in a permanent state of health policy change, he says. Despite the uncertainty and risk, healthcare leaders must build their organizations to be resilient and become more efficient.

Indeed, the report notes that 2018 will likely bring efforts to reduce and cap federal Medicaid spending, expand access to lower-premium health insurance, loosen ACA consumer protections, soften the individual and employer mandates and repeal ACA taxes and fees.

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“We may not have a clean change to the ACA. It may be thousands of little changes in different states,” he said, adding that those changes may also occur from directives from federal agencies and administrative actions with insurance company subsidiaries.

Healthcare leaders must devote resources to follow and analyze the changes as they take place and help with scenario planning, he said. “They may have to revisit cost efficiencies and operational efficiencies." 

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It also means quality metrics will become even more important. Isgur said the federal government won’t be alone in pushing for value-based care The private industry and large employers will also drive that effort. For example, he said, large employers may be more willing to pay for an employee to another state for heart surgery at a center for excellence.

New and emergency threats to Internet security

Isgur also said that organizations can expect more cybersecurity attacks and new ransomware threats. Hospitals are especially vulnerable to ransomware attacks like the “WannaCry” virus that hit the U.S. in 2017. The virus allows intruders to gain access to files, encrypt them and demand payment in cryptocurrency in return for access to the files

The report recommends that leaders prepare for hacks with remediation plans so they can respond quickly if their networks or devices go down.

RELATED: Should hospitals pay up following a ransomware attack? The answer is far from simple

“Health systems have a risk of having some equipment go out of commission or their operations to go down, so they must think about bolstering their cybersecurity,” Isgur said, noting that some organizations are pre-buying cryptocurrency in the event they need to pay hackers if ransomware is put on their systems.

Greater emphasis on social factors that influence health outcomes

The country’s shift to value-based care also means that hospital and system leaders must think outside the four walls of their institutions and look at how they can address social factors that affect health, such as education, income and housing, Isgur said.

The report notes that organizations that pay greater attention to these social factors can affect care utilization patterns, strengthen prevention and shift services from higher-cost emergency rooms and hospitals to lower-cost primary care settings.

Some providers have expanded their care teams to include nutritionists, behavioral health specialists, social workers and community health workers who are trained in addressing nonmedical health-related issues.

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Hospital CEOs must develop relationships with leaders in the community so they have a voice on not only how their organizations are run but also on how their cities are designed and how their populations have access to food and nutrition. For example, Isgur said patients can’t manage their diabetes and health if they live in an unhealthy household with no access to food and vegetables.

The report also recommends that organizations form data-sharing partnerships so they have the analytics necessary to match patients with the support services they need.

A strategic focus on patient experience to change behavior and improve outcomes

Up until now, hospital leaders have primarily focused on the results of the HCAHPS patient satisfaction surveys and how they could improve the physical experience of the patient, such as better food selections and headache-free parking and wayfinding.

While these are all important parts of the patient experience, Isgur said organizations must look at the bigger clinical picture.

RELATED: Hospital Impact—Beyond the buzzword of patient experience: How one practice asks, listens and acts

The year ahead will require hospital leaders to redesign the patient experience to improve outcomes, which is especially important as the industry moves toward paying for value instead of volume, the report noted.

Therefore, Isgur said, CEOs must broaden their view of the patient experience beyond typical operational factors and instead focus on care pathways.

This will require organizations to “make every interaction count,” according to the report, and connect experience measures to utilization data to determine how they can bring dissatisfied patients back and invest in services that will increase patient satisfaction.