Welcome to 20/20

A MATRIX Minute from MATRIX Group Benefits, LLC

In less than twelve months, we can all look back to the start of the year with 20/20 hindsight, and say “I saw that coming.” What “that” will be is hard to say for sure, but there are a few things on the horizon that we can anticipate during the new year. Some of the things that we should expect include:

1. Continued advancements in specialty, orphan, and biologic drugs and faster approvals by the FDA. Whether the efforts of the federal government to curb prices by the manufacturers will be successful remains to be seen.
2. Continued acquisition of medical practices by insurers as they continue to expand their influence in the healthcare delivery space. Whether anyone will view the ownership of medical practices by insurers as a conflict of interest is unknown.
3. Continued litigation of insurer and plan sponsor practices to limit benefit payments for excessive charges by providers resulting in more litigation by providers against the insurers and benefit plan sponsors.
4. Continued political jockeying regarding legislation to regulate surprise medical bills and more campaign rhetoric advocating Medicare For All or some variation of it.
5. Expansion of digital health and increased patient information/education regarding medical conditions and treatments, service providers and quality, and consumerism that focuses on pricing, benefit coverage, and patient financial liability.
6. Increased emphasis on healthy lifestyles and preventive care by plan sponsors in an effort to improve the early identification of health risk factors and the emergence of early stages of disease. These efforts are likely to include providing access to optional/voluntary programs outside the benefit plan at discounted prices arranged by plan sponsors or paid by plan sponsors on a reimbursement basis.
7. Increased focus on provider disclosure and transparency of services, quality, and prices that is clear and understandable to a person who does not have a background in the medical healthcare delivery provider industry.
8. Increased focus on creating narrower provider networks as payers attempt to leverage volume for deeper price concessions. With the narrower networks plan sponsors may face the challenges of how they handle medical needs that are outside the scope of services of the narrower network or that may be available within the narrower network but are considered insufficient or unsatisfactory for the patient situation. 
9. Expansion of domestic “medical tourism” to direct patients to designated directly contracted medical centers of excellence for treatment of certain medical conditions.

Happy New Year. How good will our 20/20 hindsight be in twelve months?