This essay, which we have previously written about important healthcare developments, will be different from them, in part because of the forthcoming presidential election. Since 2016, the commercial and governmental sectors of the healthcare ecosystem have seen a change in the market environment. Administrative agency streamlining, downsizing, and outsourcing; the rise of state-level action in place of federal action on a number of issues; the relaxation of rules for commercial insurance or Employee Retirement Income Security Act plans, administrative simplification, and the US Food and Drug Administration’s (FDA) efficiency in drug reviews and approvals, have all contributed to the progress to date.

Federal action on several important economic sectors, including but not limited to,therefore, this article integrates cost, quality, and access to care to take a broad look at the three main themes of market dynamic (i.e., commercial), state-, and federal (i.e., government)-level changes as they affect healthcare trends. While some of these patterns have been active for some time, they have not always been obvious. In the event that President Trump is re-elected, it is anticipated that the year 2020 will mark a turning point for important economic sectors. Some developments in healthcare are likely to continue with grassroots support even without the election’s outcome.

Healthcare consumerism and transparency have been on the rise recently, but in 2020 they’ll probably gain even more relevance. There are no indications that consumer costs will stop rising. Due to necessity, consumers have come to understand that they must take a more active role in making sure they receive the most for their healthcare dollars. They are taking a more active role in requesting transparency and choice in their healthcare. The success of healthcare providers will depend on their capacity to satisfy consumer demands and expectations. To provide customers with the best options in terms of quality, accessibility, and affordability, providers will need to manage the healthcare supply chain.
Negative-Risk Contracts
Healthcare organizations keep moving forward with the adoption of value-based care pricing models. Due to the success of programs that reward healthcare providers for providing high-quality treatment, some providers are now considering severely increasing their level of financial risk as a means of achieving success over the next three to five years. With higher downside risk agreements, providers will be responsible for the day-to-day financial obligations of their patient group.

Given the continuous decline of rural hospitals, clinicians will need to increase home and telehealth options when deciding how to manage higher-risk. When creating plans to manage their sickest clients, providers will need to take improved transparency and the significance of social determinants of health into account. Treatment at the site of service is a growingly significant component.
Taking on upside and downside financial risks through value-based contracts is still years away, but this trend will become more significant in healthcare, according to a recent survey of healthcare leaders done by HealthCare Executive Group and Change Healthcare.

According to a TransUnion Healthcare report, customers’ out-of-pocket expenses for inpatient services rose by an average of 14% between 2017 and 2018.2 For an inpatient visit, patients’ deductibles and copays averaged $4659 in 2018, up from $4086 in 2017. The average outpatient OOP costs increased by almost 12% between 2017 and 2018, from $990 to $1109. The average out-of-pocket expense for a visit to the emergency room in 2018 was $617, which is 7% more than the $577 expense in 2017.
There are many different ways that consumerism manifests in daily life. For instance, healthcare businesses of all stripes are giving their value communication initiatives more weight. Employers emphasize their benefit packages as a component of their value to employees, and manufacturers invest more in their stakeholders as well as in the development of value-based scientific and marketing materials. Despite this, there hasn’t been much useful study on the prospects and problems of these communications, or on the value of communication between participants and their target audience.
Due to the ongoing rise in healthcare prices, insured individuals now foot a larger portion of the tab for their medical care through premiums and OOP expenses. There is a demand for more information and openness about healthcare prices as a result of the rising overall cost to consumers. With the Centers for Medicare & Medicaid Services (CMS) requiring hospitals to publish their standard charges online and health plans to use metrics such as patient-reported outcomes and consumer experience, among other market changes, this demand has led to the additional information needed for consumer comparison shopping.

Hospital closures have been on the rise since late 2017 as a result of payment pressures.3 This market trend, particularly in rural areas, heralds a new problem with healthcare access that might be partially solved by telehealth and the expansion of community-based clinic services that include retail pharmacies as health locations. As part of a comprehensive population health plan, addressing social determinants of health assumes increased significance for both rural and urban areas. Conditions in the community where people live, learn, work, worship, and play and which have an impact on a variety of health, functional, and quality-of-life outcomes and hazards are referred to as social determinants of health.
Trends at the State Level Are Getting More Important
State legislatures have been more confident to take action when Congress has been powerless to do so as a result of the multiyear transfer of federal controls over certain healthcare-related decision-making. As a result, legislation requiring pharmacy benefit management registrations is becoming more prevalent, and in the majority of states, quicker clearance processes that let prescription medications be used more widely (such as naloxone) are tackling rapidly evolving public health crises like the opioid crisis. Additionally, the Affordable Care Act’s (ACA) regulatory modifications have aided state-level participation in healthcare reform. Less federal oversight of state affairs appears likely given the current “healthcare for all” movement and a few federal court decisions that support additional ACA reforms or its repeal. As is apparent, we all need to get as much information as possible about our healthcare! Knowledge is power, and what better topic to have knowledge about than our health?