Next year will be big for healthcare. We felt small tremors in 2014 of the seismic changes underway. In 2015, I predict five changes to the core of the U.S. healthcare system: insurance, pharmaceuticals, supplies, medical services and payments. Let’s take a look at each of these trends, what they mean for the healthcare sector, and what they mean for you.
Walmart becomes your healthcare insurer
This October, Walmart tipped its hand by launching a healthcare insurance exchange online. However, the insurance products currently sold on its exchange do not have Walmart as the carrier, which will change in 2015. Walmart’s public announcements thus far provide a clear preview of the insurance plan’s future design. Primary care through retail clinics and $4 generic drugs at the pharmacy will drive traffic into stores. For specialty care, the plan will leverage the Centers of Excellence program that Walmart already offers to its 1.2 million insured employees.
Startups sell into big pharma and become profitable
Despite a 5x increase in venture investments, most digital health companies are not profitable. Digital health CEOs should look at pharma as its paying customer. Despite their vast differences, pharmaceutical manufacturers are starting to pay tech startups to solve their complicated problems. One major issue pharma wants your help with is accessing and selling to physicians. In person detailing by trained sales representatives has been the core of pharma’s sale strategy for decades.
Amazon undercuts the medical supply chain
Amazon sells a dizzying array of products. Catheters and surgical gloves are not on the market yet, but they will be soon. Doctors and practice managers are just like the rest of us, they love Amazon Prime for their homes, so why not for their practices?Amazon will first target small practices and cutout group-purchasing organizations that take an undeserved cut of savings that could be passed on to physicians.
Hospitals become a channel for peer-to-peer lending
If you understand the flow of payments in healthcare, you can predict the trends. Consumers and employers are purchasing insurance plans with high deductibles. As a result, the first dollar that hospitals earn is now coming from consumers. Actually, the first $17,000 is coming from consumers. With an average income of $55,000, most American consumers simply can’t pay their medical bills.
When they don’t pay, it hurts providers financially. What consumers don’t pay shows up as accounts receivable on hospital balance sheets and eventually turns into bad debt. Since many hospitals are financed by debt and their credit worthiness is partially determined by the health of their balance sheet, the problem of getting patients to pay is urgent.
Latinos become the most desired healthcare segment in the U.S.
There are 54 million Latinos living in the United States, constituting 17 percent of the population. Politicians have taken notice and are paying attention to Latinos as an important voting demographic. Healthcare providers are beginning to do so, too. Latinos have been disenfranchised by the U.S. healthcare system because of legal status, English language skills and financial constraints.
Fewer than 4 percent of healthcare providers speak Spanish and most do not know how to approach the cultural and economic diversity within the Latino population. Even native English speakers can’t make sense of PPOs vs. HMOs. As a result, Latinos are 1 out of every 5 uninsured individuals in the U.S. and leverage healthcare services differently than other demographic cohorts