While the healthcare system in the United States, and abroad, is a complex ecosystem with an array of interdependencies that are influencing the way the market is evolving, four major trends are having a strong impact circa 2018.
- Shifts towards “Value-based Care”. Particularly in the U.S., the healthcare system is faced with significant rising costs due to a very large portion of its population moving into retirement age. In response, the U.S. government, the largest payer in the healthcare ecosystem, is taking steps to shift reimbursements towards “value-based payments.” A central tenet of this approach is to encourage a shift in industry focus from “paying for procedures” to “paying for outcomes”. While the business impact of this trend is to transfer increasing amounts of financial risk from payers to providers and patients, the theory is that it will also result in more targeted and effective treatment and care plans.
- The need to protect profitability. As the movement towards value-based care shifts more financial risks to providers, many are taking steps such as scaling up through M&A, opening practices in desirable geographies and investing in specialties to protect their profitability. For example, hospital systems are opening urgent care facilities in suburban and rural areas, drug companies are merging and/or buying retail pharmacies, and healthcare payers are partnering with health systems to help promote wellness programs.