What’s Next for Healthcare in 2016?

By Eliot Asyre and Tamara StClaire

Eliot Asyre and Tamara StClaire
Eliot Asyre (left) and Tamara StClaire

The national healthcare conversation in 2015 focused primarily around topics such as patient engagement and population health – and we expect many more conversations around these topics in 2016. However, we predict several other topics – and challenges – may also come to the forefront this year, particularly in terms of pharmacy cost, the growth of well-being programs, influence of government-sponsored programs and patient monitoring. This is just a short list, but we believe these trends will affect business, employees and healthcare institutions for years to come.

Skyrocketing Pharmacy Costs

We’ll see a double-digit growth in pharmacy expense as new specialty drugs come to market. Pharmacy is not only becoming a more costly component of healthcare benefits, but it’s also the most visible to participants. When an individual is going through an annual enrollment period, they’re likely concerned about getting needed prescriptions on day one. Cost is a big deal, and specialty drugs are especially expensive. Employers don’t have a lot of options except for cost shifting or cost sharing. We see a trend toward employers sharing more of that cost with employees – somewhere in the range of 20-25 percent, making the cost of prescription drugs an issue for employers and employees. By 2020, we expect that employers will spend 50 percent or more on specialty prescriptions.

The Focus on Wellness Shifts to “Well-Being”

The way employers look at wellness is also expanding. As a result, the conversation is shifting to “well-being.” The term implies a more comprehensive approach. Well-being recognizes the importance of engaging employees more holistically across their health, wealth and career, and even into their social and spiritual lives, local communities, work environment and culture.

Increased Government Influence

Government-sponsored programs affecting the workforce will continue to evolve in the U.S. and abroad. Small and mid-sized employers in the U.S. may stop offering traditional health insurance benefits and offer increased compensation and encourage employees to purchase insurance on the Affordable Care Act’s public marketplaces. Employers may also begin to expand the list of perks they offer in lieu of health and retirement benefits, based on generational personality and expectations. More employers are restructuring their workforce with more jobs being part-time and not eligible for benefits. This presents a twofold problem for employees and their families: lower wage earnings as well a loss in employer-provided health benefits.

Proactive Patients

Medical devices will also rapidly permeate everyday life, allowing providers to monitor patients remotely and unobtrusively, and provide a greater opportunity for non-emergent interventions. Patients and physicians will have better systems to monitor conditions as well as responses to treatment regimes. The result: Opportunities to intervene more quickly to change treatment patterns and control deteriorating situations.
What trends have you seen in health and wellness this year? What are your predictions for the New Year?

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10 thoughts on “What’s Next for Healthcare in 2016?

  1. Pamela Owen January 6, 2016 - Reply

    Completely agree with this assessment and prediction. Employer health benefits tend to be viewed as a commodity where costs are shifted rather than truly mitigated or even eliminated through health improvement and waste reduction. Employees are patients at some point. The investment of taking a patient-centered approach to providing health benefits will yield a return on investment through improved health, well-being and productivity, while reducing costs, absenteeism and presenteeism.

    • Tamara StClaire January 6, 2016 - Reply

      Thanks for reading and weighing in, Pamela! Your point that employees are patients at some point is spot on – and we need to prevent employer health benefits from being perceived as a commodity.

      Happy new year!
      Tamara StClaire, chief innovation officer, Commercial Healthcare, Xerox

  2. Robyne Rieger January 10, 2016 - Reply

    A 2016 study, published in Medscape provides insight to the lack of influence wellness plans have on employees. The net is the rewards to employees are so insignificant that employees are not engaged or motivated…and the continued cist shifting to the employee (or focus on wellness or cost sharing), results in greater costs for employees & bigger profits for ins companies.

  3. Alain Roy January 11, 2016 - Reply

    Good post. I think your assessment of ‘Proactive Patients’ is one of the best opportunities for changing how healthcare is delivered. I think we’ll continue to see developments in initiatives like ImagineCare, which uses inputs from devices, claims/HRA data and social media (sentiment data) along with predictive analytics to deliver alerts in real time.

    • Tamara StClaire January 27, 2016 - Reply

      Thank you for the compliment, Alan! Patients are absolutely becoming more proactive in their own care, and the huge amount of data available to us today through wearable technology, social media, etc. is incredibly valuable if used correctly.

      Tamara StClaire, chief innovation officer, Commercial Healthcare, Xerox

  4. Dale Creed January 12, 2016 - Reply

    It has always appeared to me that “Health Insurance” is unlike any other type of insurance, and yet we discuss it (politically at least) as though it is just another business that can cover “medical care.” Some of which did not exist 15 or 20 years ago even in specialized centers.

    I’ve always been confused how one can “shop” for “care” as though for a commodity…it doesn’t seem likely to happen in an emergency (“Stop, let me see if another ambulance is covered/cheaper/better…whatever.”)

    The opaqueness of costs from any of the involved entities is another challenge for all–consumers/employees, businesses, insurance companies, even governmental agencies if they lack negotiating power.

    Transition continues and EHR will be needed. Imagination will also be needed!

    • Tamara StClaire January 27, 2016 - Reply

      Hi Dale – thanks for reading this article! One thing is certain: EHR and imagination are two very important ingredients to the recipe.

      Tamara StClaire, chief innovation officer, Commercial Healthcare, Xerox

  5. JH Mitchell January 25, 2016 - Reply

    People complain about the Affordable Care Act BUT we had to do something, insurance costs were rising so high we could not afford it. The uninsured were using the emergency rooms as their healthcare and the costs were then spread among the insured. Big insurance companies were having their way with us and charging whatever they felt like whenever they wanted to do so. There had to be some action and oversight so that the consumer had some controls. I know Insurance companies and some Businesses are trying ways around these new health care laws so they do not have to cover their employees like part time hours etc., but I believe people who are really sick and need medical care are much better off because of this law.

  6. Jackie Holtzman January 27, 2016 - Reply

    We need to all start stepping back and really look at the healthcare situation. It is not “health”care at all. It is “sick”care. This nation needs to really start to look at healthcare by preventing a problem from happening to begin with and if there is a current problem then fix the root cause of the problem and not just fix the symptoms. Wouldn’t we be much better off in the long-term if we understood why the body does what it does? There are reasons for diabetes, heart disease, high blood pressure and so on. These are all called diseases of affluence. Sitting in a cube or office all day is a huge part of the problem. What can we do? Move more, more often and move in a way that is healthier for our body’s cells! This is different from exercise. Exercise is a subset of moving. Exercising one hour a day cannot reverse the physiological effects of being sedentary for 15 hours a day. A book entitled “Move Your DNA” by Katy Bowman is great in explaining the science behind all of this and what we can do to get ourselves back on the road to health. I am currently in the process to be certified to teach these concepts and will be sure to be in touch with Tamara when I am certified. Both Xerox and employees will benefit.

    • Tamara StClaire January 27, 2016 - Reply

      Hi Jackie – thanks so much for reading and sharing your perspective! I certainly agree that the industry needs to shift away from “sick care” and move towards preventative medicine. The book you reference sounds very interesting… Best of luck in your certification process!

      Tamara StClaire, chief innovation officer, Commercial Healthcare, Xerox


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