Outside the Box: Five big changes coming to health care in 2020

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Health care affects every American. It dominates political debate, changes the course of lives, and is a major factor in where people choose to live, what jobs they choose to take, or not leave, and how they budget.

It’s an industry where nearly everyone sees a need, or professes to see a need, for change. So what’s most likely coming this year? Here are five of our predictions.

Trend 1: Political push for price transparency

Until now, price transparency has been a largely scattershot, state-by-state affair, helpful to neither provider nor patient. Take Pennsylvania, which requires hospitals to post pricing online for every procedure and medication offered. At one large academic medical center, this translates to a spreadsheet 14,000 items long, arranged by an eight-digit accounting code and often accompanied by abbreviated descriptions of the services at hand.

How this helps patients calculate the tab on their gall bladder operation is anyone’s guess.

But in November, the U.S. Department of Health and Human Services issued new rules that would bring aggressive uniformity nationwide. It’s mandating that hospitals make public all charges, from negotiated fees to what they’ll accept in cash, and in an easily searchable format with “plain language” descriptions.

That plain language is especially important given the changing reality in healthcare. The past decade has seen an explosion in enrollment in high-deductible health plans and medical expenses now account for half of all American consumer debt.

The growth in consumer responsibility for these costly, necessary treatments is not going to continue without some equal push to make comparison shopping something less than a heroic act.

While anticipated legal challenges may impact the final rule in 2021, it is clear that meaningful price transparency is a policy priority. This means health systems will require a grand leap forward in using technology to provide consumers with the same sort of experiences they’re having in retail, travel, banking, and other aspects of their lives.

Trend 2: Health care, a consumer product

Go to many health websites, and you’ll find wares built more for provider than patient. They tend to be cursory and not particularly intuitive to navigate, defeating the purpose of a seamless resource.

With multiple generations now accustomed to handling all of life’s matters online, it’s not an enviable position. Especially in an era of rising deductibles, when patients are being asked to take heightened stewardship of their own care.

A recent Guidehouse/Centric Digital analysis of 1,400 provider sites found they lagged well behind the rest of the commercial world. More troubling is that they also remain in the rearview mirrors of competitors such as retail pharmacies and specialty providers hoping to pick off the low-hanging fruit of traditional medicine’s market share.

New disruptive payers, health retailers and disease-management companies are digital natives that have never built anything online without thinking about how it serves the customer. Contrast that with the look, feel and ease-of-use of any hospital or health system’s websites, which are too often built around the needs of providers.

Health-care consumers are increasingly likely to judge the quality of their care based on the service experience they receive. A clean, easy-to-use website may not feel like a bellwether, but for traditional medicine, it’s a sign that even more competition is on its way.

Trend 3: Emergence of new disruptors, big and small

Disrupters are not only small startups; some are enormous brands. Nowhere is that more evident than at Walmart WMT, +0.39%, the country’s largest retailer and the biggest private employer in many states, which recently opened its next-generation health center to provide basic services, “all at low, transparent pricing, regardless of customers’ insurance status.”

Not to be outdone is Amazon AMZN, +0.56%,  which, along with J.P. Morgan Chase JPM, +0.79%  and Berkshire Hathaway BRK.B, +0.46%, has just begun to offer employees its own health-insurance plans through the triumvirate’s new service, Haven. The idea that Amazon might check its ambitions in health care there, at merely offering insurance, is to deny the history of Amazon’s growth up to this point.

Then come the budding enterprises offering services like home-lab testing and phone-based X-rays. These days, if you need a flu shot, you can simply get one at O’Hare Airport while you wait for your flight, rather than having to book an appointment.

All these trends suggest massive change is coming to medicine, leaving traditional hospital systems at a Blockbuster moment. Before the rise of Netflix NFLX, -0.47%, the one-time video Goliath possessed the technology to launch its own streaming service. Yet executives feared they would merely be cannibalizing their dominant retail stores. The decision did not age well.

But where there is disruption, there is also opportunity.

Trend 4: Robotics transformation

Health care is full of repetitive tasks, some of which have pushed more and more doctors and nurses out of the business for good. As of late, the industry has become rightfully focused on implementing evermore intelligent bots that can address some of these tasks, complementing the work of full-time employees.

Financial firms at the forefront of robotic-process automation, or RPA, are already seeing average savings of 50%-75%. Some banks have cut the time it takes to process loans by two-thirds, thanks to robotics.

Relative to that level of implementation, health care is only beginning to tip-toe into these waters. In a recent HFMA/Navigant survey, 15% of health-system executives say they are targeting this technology to improve efficiency. The number of executives expressing interest in a similar survey a year ago: 0.

Just buying a bot isn’t enough, of course. Health care is riddled with stories of new tech going from savior to saboteur because of a lack of follow-through. But the hunt for help will certainly increase over the next year.

Trend 5: Recognizing the unintended consequences of convenience

Consumers now have seemingly endless options to obtain care at their doctor’s office, a retail clinic, via telehealth or through another modality. The cost of convenience may be continuity.

Patients already view their relationship with medicine and insurance as confusing and burdensome. The future may make it more so. It’s not inconceivable that a family of five may soon be using 20 separate single-use providers.

Like the anecdote about getting a flu shot while waiting for your connecting flight, or the entrance of disruptors like Amazon and Walmart, there are more and more companies offering more and more single-point solutions. And none of them communicate well with one another.

This interoperability has been a focus within health care for half a decade. What may change this year, given increasing impact of those new entrants, is the clear realization that without addressing interoperability, health care will never reach its integration goal.

Financial-services companies have long recognized this challenge, creating compelling reasons to use their products while aggregating data from other transactions to give users a comprehensive view of their financial health. Similarly, they identify areas of consumer “leakage,” and aggressively bolster services to reduce it.

It’s just one more example of the change coming to the medical marketplace. And how the search to account for that change will dominate in 2020 and beyond.

Dr. Harry Greenspun is partner and chief medical officer for Guidehouse. David Burik is a partner for Navigant, a Guidehouse company.

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