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Top 5 Things to Know About Healthcare in 2020

1. The Federal Government is Expanding Its Role in Healthcare
This year in 2020, healthcare will begin a significant transformation. A recent call-to-action by the American College of Physicians (ACP) is demanding a reform of the entire healthcare system.

To make healthcare accessible to all Americans, the presidential candidates are suggesting options for alternatives. One proposal suggests a national health plan, also known as Medicare-for-all. Another choice is a government-administered public option health plan.

Medicare-for-all
A nationwide Medicare-for-all health plan is based on the premise that every citizen has the right to access healthcare. The scope of health services would extend beyond those currently covered by Medicare, and include all services necessary to diagnose, treat, and rehabilitate a medical condition.

Another feature of the national health plan is the elimination of cost-sharing, copayments, deductibles, and other expenses. The program also contains provisions for long-term care. If such a policy were to take effect, private insurers would cease to exist.

Public Option
An alternative route could be a public option, where individuals can choose between private and public healthcare programs. At this time, there’s no consensus for the conditions of a public option program. However, private insurance providers would have to compete with the coverage available through a government-administered option.

According to the Kaiser Family Foundation, 68% of Americans are in favor of a public option. Comparatively, 56% are in favor of a Medicare-for-all plan, and nearly half favor both choices.

2. Resolutions are Underway for Prescription Drug Shortages
Shortages of prescription drugs have been jeopardizing patient safety, delaying medical treatment, creating operational inefficiency, and increasing healthcare expenses. Antimicrobial, cardiovascular, central nervous system medications, and chemotherapy drugs, for example, are in continuous short supply. This year, the government is working with pharmacy organizations to find long-term resolutions to end drug shortages.

Mitigating Emergency Drug Shortages
Shortages of emergency drugs have been a national issue for years. There are many different reasons behind the supply disruptions. However, quality concerns represent an overwhelming majority of the problem.

This year, some of these issues may finally be addressed through the Senate’s Mitigating Emergency Drug Shortages (MEDS) Act. However, the House of Representatives has to approve the Act before it can take effect. Below are some of the conditions proposed by the MEDS Act.

Establishment of national security risk assessment standards during drug shortages
 - Requiring manufacturers to share the cause and duration of drug shortages
 - Public disclosure of the location of manufacturers
 - Plans to ensure drug availability during manufacturing disruptions

The American Society of Health-System Pharmacists (ASHP) aims to end the problems associated with the shortage of prescription drugs in 2020. By collaborating with the House of Representatives, the ASHP hopes to eliminate barriers that could prevent the resolution of prescription drug shortages. This year, the ASHP will work with state and federal pharmaceutical organizations to push for legislation that addresses drug shortage issues.

The Drug Shortages Task Force
New rulings promoted by the Food and Drug Administration (FDA) will combat drug shortages. In response, the FDA has created a Drug Shortages Task Force to analyze the problem and suggest lasting solutions. The task force is composed up of healthcare industry professionals, pharmaceutical companies, patient representatives, and government members.

So far, the FDA has already initiated the process by supporting new technologies that could help end drug shortages. The Emerging Technology Program will encourage pharmaceutical companies to adopt innovative approaches to manufacturing.

Additionally, the FDA suggests a combination of solutions that include:
 - Enhanced data sharing to notify the FDA of drug shortages promptly
 - A risk management plan that identifies weaknesses in the manufacturing supply chain
 - Extension of drug expiration dates

The task force will help ensure that the FDA evaluates every possible solution for providing an uninterrupted supply of prescription drugs in the future.

3. Electronic Health Records Will Become More Accessible
The creation of a data-driven healthcare ecosystem has been in the spotlight since 2019. This year, the proposed legislation is likely to promote further interoperability within the healthcare system. Driving these changes is the Office of the National Coordinator of Health IT (ONC), which has already submitted a ruling for interoperability.

This ruling will give patients electronic access to their health records. Driving these changes is the Federal Health IT Strategic Plan. Objectives for leveraging digital healthcare opportunities from 2020 to 2025 are outlined below.

 - Promote collaboration between the federal government and the private sector
 - Increase product and price transparency
- Enable individuals to access their health information through the technology of their choice.

The interoperability of electronic health information ruling would make Electronic Health Records (EHR) data available to app developers. Currently, developers lack access to Application Programming Interfaces (APIs) necessary to create EHR-based applications.

Limited access to EHR data makes it nearly impossible for developers to bring high-value apps to market. By making APIs open source, developers could create more innovative apps that enhance patient care. Additionally, the plan strategizes to achieve the following:
 - Help patients gain a better understanding and more control of their healthcare data.
 - Enable individuals to readily obtain advice on federal, state, and regional healthcare regulations.
 - Integrate security and privacy controls to protect personal data.

Identifying individual patients will be integral to resolving privacy concerns. Patient matching, a process of comparing an individual’s data from a variety of different sources, will be essential to avoid compromising healthcare privacy.

4. Maternity Health Bundles are Entering the Market
Another issue in the spotlight in 2020 is maternal and infant health. After receiving the title of the worst country in the developed world for maternal healthcare, the US government and insurers are responding. Cigna, Humana, and UnitedHealthcare have already started to introduce maternal health insurance bundles. Now, Medicaid plans are testing a similar approach.

The CMS, or Centers for Medicare & Medicaid Services, is focusing on promoting policies for maternal care in rural areas. Recommendations for improving maternal healthcare in rural communities include the following:

 - Increasing incentive programs for maternal health training
 - Recruit existing healthcare professionals to practice in rural areas
 - Standardized regulations for practicing maternal health providers
 - Develop collaborating network models in regions with low patient volumes, allowing communities to work together

The HRSA, or Health Resources and Services Administration is developing universal maternal health safety protocols, or “safety bundles,” to improve consistency nationwide. Additionally, the Health Care Transformation Task Force (HCTTF) is identifying initiatives that could improve access to maternal care. Elements of the proposed comprehensive care model are listed below.

 - An expanded care team that focuses on perinatal health
 - A labor and delivery model based on individual needs
 - Outcome-driven payment changes to encourage high-value care. This payment model would transition away from the fee-for-service model that doesn’t currently hold providers accountable.

Value-based payment and comprehensive care models will address current inadequacies in the maternal care system, resulting in lower costs and better outcomes.

5. Value-Based Payment in the Public and Private Sector
According to the Institute of Medicine, nearly one-third of US healthcare spending was wasted on unnecessary services. Now, the HCTTF is committing to aligning the interests of the public and private sectors. The HCTTF’s goal is to have 75% of their members using value-based payment arrangements in 2020.

Patients have been looking forward to the arrival of value-based care for several years. Now, healthcare payment models are finally shifting away from fee-for-a-service models and more toward value-based payment plans. These programs reward healthcare providers for the quality rather than the number of services they provide.

Driving the payment model shift is the increased availability of consumer data. This information is enabling healthcare providers to base their pricing arrangements on predictive insights. Additionally, the CMS is rewarding insurers through value-based programs.

The state of North Carolina is leading the journey toward a value-based payment system and strives to make 70% of the state’s healthcare payments value-based within the next five years. By establishing an Accountable Care Organization (ACO), North Carolina has been able to prepare itself for the shift. Other states are likely to follow soon, as health IT continues to facilitate improvements in patient care.

Conclusion
The US healthcare system is experiencing significant changes this year in 2020 that will ultimately improve the quality of care. By aligning financial incentives, lawmakers and industry organizations hope to achieve better outcomes, improve prescription drug availability, and reduce cost barriers that compromise Americans’ health.

Federal and state governments will play an increasingly significant role in setting the foundation for change. By the end of the year, the federal government is likely to decide on a new universal healthcare system based on a Medicare-for-all or public option model. Health technology and access to consumer health data will facilitate further strides toward enhancing patient care while enabling value-based payment arrangements in the years to come.