By Brad A. Roberts, MD, PCMS representative on the CMS Board of Directors
At the July 12 Colorado Medical Society Board of Directors meeting, board members heard from Paul Presken with the Colorado Health Institute on nine emerging themes in health care. Paul’s environmental scan analyzed trends in the Colorado health care system and national trends that will impact the state. Nearly all of them were related to health care costs. His report preceded a board discussion on what should be included in the 2020 CMS operational plan.
Here are the emerging trends he identified:
- Health care costs for consumers have reached a tipping point. The most obvious example of increased attention on health care costs is Gov. Jared Polis’s Office of Saving People Money on Healthcare, headed by Lt. Gov. Dianna Primavera.
- Prescription drug costs are increasing and legislators are crafting bills to control them. Prescription drug costs continue to outpace inflation at a rate of two to nine times for brand-name oral drugs and generic oral drugs, respectively. Bills were passed in 2019 to address costs and more are coming in 2020.
- Hospital costs are in the crosshairs. Bills to add transparency and control of hospital costs were also passed in 2019 as hospitals are subject to increased scrutiny for profit margins.
- Payment reform is affecting physician payment. Health plans are increasingly moving from up-side risk only to up-side and down-side risk arrangements and government programs like the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) are starting to have an impact.
- The physician workforce is shifting. 2018 marks the first time there were fewer physician owners than employees in the United States: 45.9 percent vs. 47.4 percent, respectively. This has been slowly changing over time and it looks like the trend will continue.
- Colorado has expanded substance use and regulation and is seeing the effects. Colorado continues to “experiment” with legalization. Colorado now has some of the highest rates of substance use in the country, with the third-highest rate of illicit drug use in the country, the nation’s highest rate of youth vaping, and a three-fold increase in cannabis-related ER visits, according to a UCHealth study. Overdose deaths from opioids have declined significantly in the past year but deaths from cocaine and methamphetamine have risen.
- Investment in technology and disruption of current models are growing. Venture capital firms invested record amounts in health care technology in 2018, and investment focused on “disruptive” technologies that hold significant promise.
- The business community is and will continue to be engaged. Pressure from the business community is increasing and specific to Colorado. Locally, employers in Summit County “finally had enough,” and formed Peak Health Alliance to negotiate lower insurance premiums directly with providers. This will increase thanks to a new law allowing for health care cooperatives in Colorado.
- The government has an increasing role as a payer. The 2019 Colorado legislature passed laws exploring options for increasing the state’s role in providing coverage, including a current effort to develop a proposal for an option for a state-sponsored health care plan.
Watch for more on these trends in 2020.