Contentious Negotiations Highlight 2019 Payer & Provider Trends

HealthcareDive takes a look at changes and trends it anticipates in the coming year, mainly due to political ripples from Washington (for instance, a judge’s declaration that the Affordable Care Act is no longer constitutional) and emerging consumer preferences.

Their snapshot of a few big trends for the payer and provider crowds to watch for in 2019 on the PROVIDER side include:

1. Narrowing gaps in population, behavioral healthcare The trend more broadly fits into the push to recognize and act on social determinants of health.
2. Doubling down on digital As more payers hop aboard the telemedicine train and more services are covered, hospitals will continue see costs fall.
3. Price transparency still a question mark Many are hoping the days of the $629 hospital bill for a wet towel and a Band-Aid are coming to an end, but it’s not likely to happen in 2019.

And, on the PAYER side:

1. Contentious negotiations and contract disputes As insurers have bulked up in scale after blockbuster mergers last year, Fitch Ratings expects relationships between providers and payers to be even more contentious during contract negotiations even in a value-based payment setting.
2. Value-based momentum Many hospitals are engaging in contracts that offer incentives or alternative payment models for reaching certain quality measures, but very few are taking on full risk, or both the upside and downside risks within a contract, according to Moody’s.
3. Medicare Advantage still lucrative, popular As the population ages, it presents a growth opportunity for payers.
4. Medicaid managed care growth As more states expand the program, it puts pressure on the remaining holdouts.

Lots to take in, but clearly a clarion call for aggressive technological upgrades leading to platform modernization of healthcare payment and remittance data systems — including incorporation of AI systems.

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