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Value, results center stage in health care

Jim Frederick
8/22/2015

“A profound, and likely irreversible, impact on the business of health care.” That’s the effect the Patient Protection and Affordable Care Act already has had in the five years since its passage and enactment into law, PricewaterhouseCoopers said. And it’s altering the way doctors, hospitals, pharmacies and clinics deliver patient care; the way public and private health plans and patients, themselves, pay for that care; and the way insurers and even pharmaceutical companies market their products and services.


In a report titled “Healthcare reform: Five trends to watch as the Affordable Care Act turns five,” PwC’s Health Research Institute asserted that the reforms spawned by the ACA have left “an indelible mark on the $2.9 trillion health sector.” Those reforms are forcing industry leaders to “rethink strategies to remain relevant in a post-ACA world” as they roil every facet of health care and drive a gradual but sweeping transformation of the way health services are provided and paid for in America.


“By energizing five fundamental shifts … the law has given rise to a new health economy predicated on value,” PwC’s institute declared in its report. “Not since the Telecommunications Act of 1996 has a piece of legislation sparked such significant changes in a leading sector of the economy.”


The HRI cited five powerful trends that “have ignited this transformation.” Among them:




  • A massive shifting of risk among different health provider sectors as the ACA drives “new payment models that reward outcomes and penalize poor performance.” With federal and state governments now pushing such new concepts as shared savings and pay-for-performance onto hospitals, physician groups, pharmacies and other health stakeholders, HRI said, “the ACA has accelerated a shift in risk away from traditional insurers and onto providers, pharmaceutical companies and even consumers;”


  • A “back to basics” movement that’s “making primary care once again the critical touchpoint.” Besides elevating the role of primary care physicians, that movement also is elevating the critical importance of pharmacists, retail clinicians and other health professionals who extend and supplement the role played by family practice doctors in a team-based, more collaborative network of front-line care;


  • A surge of new, innovative companies that are rushing “to meet the demand for lower-cost, consumer-oriented care options in the post-ACA era,” according to HRI;


  • A shift in the health insurance industry “from wholesale to retail” as insurers adapt to the demands of consumers, federal and state health administrators and employer-sponsored health plans for a more transparent, menu-driven and market-style approach to the dizzying array of insurance options offered through the public and private health exchanges spawned by the ACA; and


  • The emergence of states “as key players in the reconfigured healthcare landscape.” Given wide latitude by the ACA in how they implement health reform and coverage plans for those seeking insurance, the states have influenced everything “from the design of exchanges to the decision over whether to expand Medicaid,” the HRI report said.


For all health providers in the new continuum of care, innovation will be key. “Paramount to remaining relevant in a post-ACA system is the willingness to innovate: to develop strategies that meet the demands of new healthcare consumers, to pursue alternative business models, to adapt new technologies and to take on new roles and activities,” HRI admonished.


In this special report, DSN takes a closer look at PwC’s research, the changes sweeping the nation’s massive healthcare system, and the impact those changes are having on pharmacies, physicians, health systems, insurers, pharmaceutical manufacturers and consumers themselves.


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