2014 Healthcare Predictions, Part Three

Before we took off for the holidays, we wrangled our top contributing editors and asked them one question: “What are your healthcare predictions for 2014?” Here are some of their responses. (Read part one here, and part two here.)

Steve Love, president and CEO of the Dallas-Fort Worth Hospital Council:

– Unfortunately, sequestration for providers will continue and could worsen with debt ceiling discussions in early 2014.

– With over 1 million Texans caught in a coverage gap where they are not eligible for either Medicaid or the insurance marketplace, we must develop a “ Texas plan “ in 2014 to help many of the uninsured, especially working uninsured as it clearly is the right thing to do for these individuals.

– There will be a permanent Medicare physician fix to replace the flawed SGR system in 2014. However, how it will be funded remains a looming question for other providers.

– The noise around the insurance marketplace will lessen and by the final quarter of 2014, people will be more comfortable with utilizing the insurance marketplace.

– The current shift in insurance coverage from “ defined benefit to defined contribution “ will certainly create higher deductibles ( self-pay ) and subsequently higher bad debt exposure for providers in the latter part of 2014 continuing into 2015.

– Coordination of care, evidence based outcomes, and discharge follow-up  will continue to intensify in 2014.

Chase Lewis, senior manager in tax and strategic business services at Weaver:

C-Suite executives, business owners, and other high-earning taxpayers are going to be in for sticker shock on April 15th. This will be brought on by the combination of increases in the highest marginal tax rate, the increase in the top tax rate for capital gains and qualified dividends, the new net investment income tax, the new Medicare tax on wages, and the return of phase outs for itemized deductions and personal exemptions.

Those earning over $400,000 face percentage rate increases on a variety of income from 4.6 percent to almost 9 percent. These taxpayers could be facing a year over year total tax increase from anywhere between 5 and 10 percent.

Of course, this was all put into legislation last year and there has been little fanfare recently. Taxpayers are allowed to pay 2013 estimated taxes based on their 2012 tax bill. Thus, the effects of the 2013 tax increases will not become apparent for most until they are writing a check to Uncle Sam in April.

Gary Carini, professor of management and associate dean for graduate business programs at the Hankamer School of Baylor University:

In 2014, our organizations will be challenged in ways we have never seen. But, this ought to be good news! Why? We all “got” the notion that there are changes. Understanding this, then, gets us to the next step: an epidemic of ideas. Consider the following seven predictions for this next year that reflect what could be and lead to this epidemic of ideas:

– new conversations with new and existing co-workers that yield creativity.

– new efficiencies, as we just can’t do more without first doing less.

– new and compelling organizational visions.

– new insights that may catch you off guard in a good way.

– new employees with strategic perspectives and tactical solutions.

– new opportunities to improve the patient satisfaction way beyond expectations.

– new healthcare delivery modalities based on rigorous research.

Changes to the industry and to your job that started several years ago will not settle down. While it’s normal to resist changes, and we all do, the next step is to use our intellect to understand them and focus on new ideas – it’s a time to create! And, the benefit? Happiness and creativity are linked. When you are creative your brain triggers a happiness emotional response. Happiness, in turn, drives further creativity. Decades of research show this cause and effect link.

It’s worth reframing 2014 from one of possible angst to one of great and unique interactions that will drive a truly remarkable year.

Bruce Sammis, CEO of Lockton Dunning Benefits:

– The public exchange Healthcare.gov will continue to be a lightning rod for critics of ACA. Front-end enrollment process will improve but the transfer of data to the carriers will be a significant challenge. There will be a major push to delay the proposed 2015 automatic enrollment requirement.

– The battle for relevance will intensify between providers and payors to determine who will be the party that leads the organization of the next wave of high-performance medical networks.

Competition between healthcare providers will intensify and consumers will be directed to the highest value products through tiered networks and transparency tools.

Dan Prescott, senior vice president of Prescott Pailet Benefits:

– While exchanges and the enrollment will continue to be anything but perfect, they will work better than they have in the past and enrollment will edge upward, however much slower than the government predicted.

Employers will struggle with the complexity of the healthcare reform laws and small business will see rate increases in 2014 that will stagger many and force some out of the health insurance market.

– We will continue to see modifications being made to the healthcare reform laws in an effort  to make it more palatable.

–  The smallness of the penalty in regards to the individual  mandate will have minimal effect on Americans who chose not to enroll in 2014.

– There will be increased pressure in Rx and pharmaceutical companies next year. The Pharmaceutical companies will be asked to provide lesser expensive alternatives and lesser cost current drugs.

– Whatever the problems with enrollment are now, even messier problems could arise when it comes to administering claims in 2014.

–  The mess which is now called the Affordable Care Act, or “Obamacare”, will get messier as businesses, large and small, are forced to cash the checks President Obama and the law have written.

The individual cost of medical insurance will significantly increase due to the rules of the new law, namely the guarantee issue requirement regardless of one’s health status.

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