State health insurance exchanges lead off a top ten list of healthcare industry issues for 2013 issued Wednesday by PwC's Health Research Institute. The group's annual list of what to watch in healthcare this year also includes two issues that were the list in 2012: population health and pharma.
In a statement, Kelly Barnes, PwC's health industries leader says the millions of American who will be covered under the Patient Protection and Affordable Care Act will affect healthcare organizations already faced with a trifecta of full implementation of the PPACA, new consumer behaviors, and economic pressures to cut costs.
"By this time next year, the major provisions of the health reform law will be in effect, and the health industry has a lot of work to do before then," says Barnes. "It's now a foot race to 2014. The evolution of healthcare that has been in effect over the past several years will become a full-scale transformation in 2013."
State health insurance exchanges must be ready for open enrollment in October. Ceci Connolly, managing director of HRI, says there is a lot of work going on behind the scenes with payers who are looking to participate in the exchanges.
So far Aetna has said it will participate in at least 15 exchanges, including Connecticut, where four additional insurers have also agreed to also take part. As the federal government approves states' plans for exchanges, it's likely that more payers will announce plans to participate.
Whether state-run, federally run, or state-and-federally run, healthcare exchanges fundamentally shift the way healthcare is offered. It's this reason that HRI lists State's on the frontlines of the Affordable Care Act" as its number one issue for the industry this year.
The two other issues that appear on HRI's list from 2012 are population health and the pharmaceutical industry, though the concerns are different. On last year's list, population health was seen as a core reason for systems working together, namely Highmark's investment in West Penn Allegheny Health System and Optum, which bought into a company managing 2,300 physicians.
This year, population health remains a focus because PwC predicts more collaboration between insurers and providers in 2013.
In the pharmaceutical industry, HRI's report states the industry is poised for reimbursement challenges:
"Though pharmaceutical and medical device companies play a pivotal role in health outcomes, they will have to prove it to earn it by demonstrating their value and comparative effectiveness."
Other issues to watch in 2013, according the HRI, include changing consumer behaviors, the medical device tax, and caring for the dual-eligible population. The full report may be downloaded from PwC's HRI website.
Also included in the report is a survey of 1,000 consumers on a range of healthcare topics including what 50% believe is the biggest obstacle to improving the U.S. healthcare system: politics. More than half—60% rank doctors as "the best hope" to improve the nation's system, ahead of hospitals and insurance companies.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.