Like most of the recent years, 2019 was a tumultuous one for healthcare. CMS continued to refine and change its quality requirements as well as introducing new avenues for reimbursement. Politicians argued over the future of the Affordable Care Act. Opioid lawsuits cast renewed focus on the ever-present issue of addiction.

Amid the noise and chatter, healthcare organizations continued to look for new ways to ride the regulatory wave, leverage technology to improve care, better understand what patients really want, and maintain consistent financial stability.  

Throughout 2019, athenaInsight covered these trends and more, focusing on the insights and innovations that are helping healthcare leaders succeed in these areas and beyond.

Here are our top stories from 2019.

1. Infographic: State-by-state breakdown of opioid regulations 

In 2018, 9.9 million Americans misused prescription painkillers, an indication that the opioid epidemic is not going away, and states will continue to grapple with the best way to rein in this issue. Regulations like ID checks, daily prescription limits, and ongoing education for physicians continue to be rolled out in many, but not all states — and they are having an impact on prescribing patterns.

The data shows that relatively simple strategies like assessing patients for risk of substance use disorder before prescribing can make a huge impact. And many states are making it easier for providers to check what previous opioid prescriptions their patients may have received through daily updates from the national Prescription Drug Monitoring Program.

The bottom line is that these approaches are making a difference in the way physicians and patients think about prescribing and using opioids.

2. Private equity likes the look of healthcare

With U.S. healthcare spending at $3.65 trillion in 2018, it’s no wonder that private equity (PE) organizations are increasingly turning their attention to healthcare. With expertise in business operations, PE firms are often able to quickly help healthcare organizations improve revenue cycle management and back-office services through technology and sometimes economies of scale by linking various practices and vendors.

And this influx of money, accompanied by equity offerings for physicians, can be a great deal for the team. Practices often become more profitable, agile, and innovative, all with less administrative hassle for the physicians, who can focus on care rather than practice management. Although there are some potential pitfalls, there is no denying PE is positioned to make a significant impact on healthcare in the coming years.

3. No-show effect: Even one missed appointment risks retention

Data from the athenhealth network show that even a single missed appointment can increase patient attrition by 70 percent And that is even higher for older patients and sicker patients — exactly the ones who most need to maintain continuity of care and a relationship with their PCP. The impact is substantial in both financial and clinical terms.

Knowledge is half the battle, the saying goes, and practices that know these numbers can focus their attention on preventing no-shows and on keeping patients actively engaged and loyal. Most practices have success with email, text, and phone reminders, which data show significantly reduce missed appointments. Still others are adding services like transportation, weekend and walk-in appointments, and online scheduling — whatever is necessary to get the patient in the door.

4. Best practices for getting started with value-based care

Value-based care is the buzzword du jour, but it isn’t always clear for health systems, practices, and providers just how to get started. Many who are well down the road with value-based care suggest it all has to start with vision and commitment on the part of leadership — a vision they can share with employees of better, more accessible, more sustainable care.

From there, most recommend a focus on risk stratification and care management informed by that risk. Tailored care management plans based on patient population and risk level are the key to effective value-based care, our experts say. Once these elements are in place, practices can build the kind of care team that makes sense for their practice approach and patient panel. But, all stress that the real key is making sure that you have the right technology underpinning these efforts, or, in the words of one provider, “you’re just sunk.”

5. Technology is there — healthcare has to learn to use it

Innovative and technology-savvy neurologist Allen Gee sat down with athenaInsight to discuss the reality of telehealth tools and how they can and should be used to expand access to care. Gee’s philosophy is that telehealth, information sharing, and remote monitoring technology are developed enough to support many healthcare implementations — organizations just have to be willing to adopt them.

Gee paints a picture of colleagues consulting virtually across states, patients in rural areas able to access specialty care, and machine learning that helps filter and contextualize vast amounts of health data, zeroing in on what actually matters in the moment of care.

6. Quick quiz: What do patients really want?

Everyone’s talking about consumerism in healthcare, but what does that really mean? What are patients actually looking for from their consumer-grade healthcare experience? It turns out that they value online scheduling over availability, accessibility over continuity, and online access and payments over all — and are more than willing to switch practices if they don’t get what they want.

Successful practices are using these preferences to maintain patient loyalty, enhance outreach, reduce administrative burden, and improve revenue cycle management.

7. Will new Medicare Advantage services lower healthcare costs?

In 2018, CMS significantly broadened services and care that could be covered by Medicare Advantage (MA) plans. As payers scrambled to understand the changes, most plans began adding new benefits in 2019.

Taking a much more expansive view of “primarily health related supplemental benefits,” MA plans can now offer assistance with transportation, meals, home-safety modifications, adult daycare, and more. Finally, reimbursements are catching up with the idea that an ounce of prevention is worth a pound of cure, and often that prevention has to take place in the home.

8. Top painkillers for prior authorization headaches

In 2017, 87 percent of providers indicated that prior authorization requirements had increased in the past year. Many report this as a significant administrative burden on the practice, as well as an obstacle to timely and appropriate care for patients.

But there is hope. Increasing automation of the prior authorization process has paid off for many practices, speeding up and standardizing submissions while relieving staff of this responsibility. Furthermore, centralizing prior authorization, educating specialized staff, and working closely with payers to avoid some prior auths entirely are all strategies that successful practices have employed to reduce this headache.

9. 3-minute case study: COPD care simple as red-yellow-green

As the third leading cause of death in America, Chronic Obstructive Pulmonary Disease (COPD) is a huge issue for most practices, accounting for a significant number of their most chronically ill patients.

VillageMD has created a unique COPD treatment program that assigns each patient an acuity score and sets their treatment plan accordingly. And it supports each patient with education around adhering to medication and recognizing an exacerbation, which prevents costly and disruptive hospitalizations. Initial results have shown a 30-40 percent reduction in hospitalizations so far.

10. The athenaInsight Flu Dashboard 

For three years now, athenahealth has tracked flu-like symptoms across the country, identifying hotspots and trends. And we have compared year-over-year trends in symptoms and vaccination rates, to help shed light on what the coming flu season may hold.

With increasing concern about the flu, and flu season seeming to arrive earlier and earlier, there is a reassuring trend toward early vaccination among both adults and children. There also has been a small but steady increase in flu-like symptoms reported each year. Patients and practices alike seem aware of the very real dangers of the flu, and are moving to get out in front of them.