Health Care Predictions 2017 Preparing for another upheaval

As with every year in the past five years, the health care industry is preparing for yet another upheaval of daily operations and financial streams.

With the uncertainty looming over the industry in light of some of the ideas and promises coming from President-elect Donald Trump’s administration, all eyes from New Jersey are on Capitol Hill and the potential changes, which could include a repeal or replacement of the Affordable Care Act.

In addition, the gubernatorial race may slow the pace of change and adoption of policies in the state throughout the coming year.

Health care leaders around the state talked about the issues and concerns they will be focused on in 2017, as well as their predictions of things to come.

Cathleen Bennett

Commissioner, N.J. Department of Health

The sea change that has been going in health care will continue, and our health care partners will find new and innovative ways to work together. Telemedicine will grow in popularity in 2017 as more pilot projects spring up around the state. Videoconferencing and other electronic communications will be increasingly used to connect health care providers and patients. DOH proposed a $290,000 initiative to help connect veterans with telemedicine. And the progress we’ve made in childhood obesity rates among preschoolers will extend to older children, as our partners continue to focus on the idea of “Making the Healthy Choice the Easy Choice.”

Bill Castner

Senior vice president, Horizon Blue Cross Blue Shield of New Jersey

The sponsors and supporters of out-of-network reform will see their years of hard work pay off next year, when they arrive at a solution that protects consumers from surprise medical bills and ends the type of price gouging New Jerseyans can no longer afford.

Raymond Castro

Senior policy analyst, New Jersey Policy Perspective

The likelihood of major legislative changes that will be made in ACA’s replacement, which could result in the loss of billions of federal dollars in New Jersey, will quickly start to affect decisions and planning throughout the entire health industry. The same is true about the actions that will be taken by the Trump administration through the federal regulatory process to reduce federal incentives, supports and consumer protections. 

Legislators and candidates for governor will start to debate how New Jersey can best respond to those major changes over the next few years. Will New Jersey reinstate its old standards and consumer protections, adopt the ACA protections that are repealed at the national level, or some combination of both? And how could the state, with its limited resources, continue to support the thousands of New Jerseyans who might lose their health coverage?

Robert Garrett

Co-CEO, Hackensack Meridian Health

The Affordable Care Act will continue to dominate the headlines as we wait to see if the incoming administration follows through on its promise to “repeal and replace” it. Since the passage of the ACA, the entire health care landscape changed including everything from reimbursement models to treatment methods. Our industry has worked very hard over the past eight years to ensure we are in the best position to comply with the law, while continuing to successfully serve our patients. As we move into this next administration, we are well prepared and ready to ensure we continue to deliver world-class quality, patient-centered care at the most affordable cost to all those we serve. 

In the new year, we will remain focused on how we can successfully meet the needs of all the communities we serve, and continue to enhance our ability to be innovative in the delivery of care. The establishment of the first private school of medicine in partnership with Seton Hall University will continue to be a top priority for our institution as we work to address the critical physician shortage that the state and nation currently face.  Also, our strategic partnership with Memorial Sloan Kettering will be transformational in how cancer care is delivered in the state of New Jersey and beyond. This will be accomplished by creating a single standard of care by making available over 800 clinical trials to cancer patients throughout the Hackensack Meridian and Memorial Sloan Kettering Networks.

Brian Gragnolati

CEO, Atlantic Health System, and executive committee member, American Hospital Association

On drug costs: I personally believe that competition helps drive down prices. As long as we can assure safety, I’m all in favor of figuring out multiple ways for us to create more competitive markets to drive down costs without impacting access to medication. If looking at drugs broadly can be achieved without compromising safety, and it will improve cost and access, then I think that’s something that should be seriously considered. I think that, given the order of magnitude of health care as percentage of the GDP, and given when I’ve heard from the Trump administration that health care is a top focus, it wouldn’t surprise me if this is something that emerges.

On the ACA: I think it is going to be nearly impossible to terminate the ACA midyear. I think the year is going to be predictable in terms of what’s happening on that side. A lot of coverage provisions are going to take more than a year, if they are simply terminated, to go into effect. 2017 is more predictable. I’m more worried about 2018 and 2019, to be quite frank. It’s not clear what will happen going forward.

Debbie Hart

CEO and president, BioNJ

With New Jersey’s gubernatorial election slated for November 2017, we look forward to working with the candidates to ensure that they are aware of the industry’s economic impact on the state as well as the need to support the life sciences ecosystem — allowing companies to develop therapies and cures in a timely fashion for patients in need.  

Meanwhile, like the rest of the country, we will be assessing what a Donald Trump presidency will mean for the industry and for patients. We want to ensure that, as the value of drugs and access to them are considered, that patients can secure the medicines they need with the fewest possible hurdles.

John Lloyd

Co-CEO, Hackensack Meridian Health

2017 will be a pivotal year for the health care industry, as the fate of the Affordable Care Act hangs in the balance. I expect technology to continue to drive change across the health care industry and empower more patients to take control over their personal health. Health care providers will continue to use telehealth to improve overall quality of care, helping to revolutionize the way care is delivered across communities. This has been a dynamic time for health care, and I’m confident that we will continue to adapt and adjust accordingly to safeguard the health and well-being of our patients and the overall industry. I am hopeful that any reform will continue to provide health care coverage for all Americans.

At Hackensack Meridian Health, we are changing the state of health care, through innovation, technology and education. In the coming year, our organization will continue to focus on population health management — which includes integrated patient care, reduced costs and increased quality — across our entire health care system. Regardless of what policy changes are implemented at a federal level, population health management will continue to drive health care leaders, and impact decision-making across our industry. 

Mark Manigan

Member, Brach Eichler

In order to stem the tide of rising health insurance premiums, plans and employers will continue to develop and implement narrow network-based insurance products, like Horizon’s OMNIA or Aetna’s Liberty plan.  Consumers will have more skin in the game, whether through tiering, higher patient cost-sharing obligations or diminished out-of-network benefits.  Health care providers will also have more skin in the game by virtue of ACOs or other shared savings products, bundled payment programs or risk-based structures. These trends will create pressure on health care provider margins at a time when significant investment in human and IT infrastructure will be required to stay ahead of the curve. Add a dose of uncertainty related to President-elect Trump’s health care plan, and you have a continued, if not intensified, rationale for health care provider consolidation, which I expect to continue in New Jersey on both a horizontal and vertical basis.

Barry Ostrowsky

CEO, RWJBarnabas Health

Health care is the biggest employer in the state, and candidates for the gubernatorial election will want to discuss things that support or harm the industry, because it’s a great source of jobs. I tend not to think policies will be made during the election. I guess we could see resolutions on some of the bigger issues, but we are just plowing ahead and managing ahead without anticipating any breakthroughs of policy.

We are going to see a continuation of consolidation in New Jersey with more transactions among institutional health care providers and more of these affiliations for clinical programmatic support. Both consolidation and programmatic affiliations will be very much geared toward ensuring New Jersey will be able to deliver all the care residents need. People won’t have to travel to (Philadelphia) or New York. I think it’s going to be another year of enhancing New Jersey-based health care providers.

We view 2017 as the year in which our clinical program expansion is going to be very obvious to all who live in our service areas. The organizations that are looking cross-border to bring in well-known providers into New Jersey are hopeful that the clinical platforms those providers have can be in some form or fashion transplanted to the affiliate in New Jersey. That’s not always easy to do and requires the out-of-state provider to make significant investment in New Jersey. Many times, that provider is looking for referrals to their home base. These services will not work if the out-of-state providers don’t connect with the folks in New Jersey and invest in maintaining a consumer focus.

Bill Pascrell (D-Englewood)

U.S. House of Representatives, 9th District

The ACA: We’re going to put a strategy together, as we did through the 62 attempts to repeal the Affordable Care Act. (HHS Secretary nominee Tom) Price always brings up the issue about people in his district whose premiums have gone through the roof. There is a movement that started before the ACA: paying for the consequences rather than the doctors. We need to do this. The ACA was never put together to reduce cost, which is an impossibility. It was put together to stop the spiking of health care costs.

Prescription drugs: We are trying to address this on a bipartisan level. We want to make sure we keep the good things that are necessary. They are going to have a tough time coming up with a good plan. I hope that we change it — there are certain changes that are absolutely necessary — and that somebody will come to their senses and not make a political football out of it, which it already is.

Betsy Ryan

CEO and president, New Jersey Hospital Association

The ACA: We took cuts to pay for the coverage. If you are going to repeal without replacing, you must return the (Medicare disproportionate share) funding reduction, because we simply cannot take the loss of cover and the reduction.

Property tax: More than 50 percent of our members are sitting in litigation right now; there are 35 property tax lawsuits in the courts. There are (about) three that have come to short-term agreements, but we need legislation to protect them from legal challenges.

Ward Sanders

President, N.J. Association of Health Plans

Dialogue will shift from the ACA’s three R’s (reinsurance, risk corridors and risk adjustment) to the ACA’s new two R’s (repeal and replace), all of which is likely to dominate health care dialogue well into the future. The New Jersey Legislature will enter its ninth year of debate trying to tackle the problems of price gouging and surprise out-of-network billing. The sponsors have made much progress of late and we predict that the state will arrive at a solution that has the support of majorities in both houses and the governor. Meanwhile, passage and implementation of telemedicine legislation will improve access to care for consumers. Lastly, the cost of drugs will continue to vex consumers and policymakers, but much of the state dialogue will be around pharmaceutical company-backed bills that avoid the root problem (pharmaceutical company pricing) and seek to lower out-of-pocket expenses for drugs while increasing premiums.

Linda Schwimmer

CEO and president, New Jersey Health Care Quality Institute

The ACA: Repeal and then what? I think this is “the” issue. To just repeal and delay would be a reckless thing to do. Uncertainty and insurance do not mix. We need a clear replacement plan in place before we start to dismantle a system which may not be perfect, but is providing health coverage to millions of people.

Charity care and Medicaid funding: If the ACA is repealed, hospitals are going to face a lot uninsured patients coming their ER for care. This is a huge issue for the state budget and for the fiscal survival of hospitals, especially those who see a large number of patients covered through Medicaid.

Telemedicine: The pending bill should move this year and will improve access and convenience for patients in the state.

Joseph Vitale (D-Woodbridge)

New Jersey Senate, 19th District

The Legislature will pass out-of-network reform protecting consumers from surprise medical bills, and telehealth legislation that will transform the delivery and access to primary, specialty and behavioral care.

The Trump administration and Republican Congress will propose changes to the ACA, steep cuts to Medicaid and block grants to states that will undermine access to health care for middle class and underserved communities.

I am going to establish two separate stakeholder working groups. The first will prepare for a legislative response to any potential or actual change in the way the federal government supports or influences New Jersey’s health care delivery system. The second working group will address our state’s ongoing opioid epidemic. It will be charged with examining our current efforts, offer additional ideas and establish a comprehensive strategy blueprint.