Five Healthcare Predictions for 2016

This past year brought some major mergers and acquisitions, for example, Pfizer and Allergan, Aetna and Humana, Centene and HealthNet. There were an abundance of hospital failures resulting from states not expanding Medicaid. Both nonprofit and academic hospitals are acting more like for-profits.

2015 was a year of significant activity on all fronts – innovation, mergers, new business models and the move to digital organizations. In North Highland’s work with healthcare providers and payers around the country, we saw a number of trends that we predict will strongly impact the industry in 2016, which we also recently shared with the Nashville Business Journal.

How businesses prepare for and react to those trends will result in winners and losers. The following are the top five healthcare trends and our predictions for whom in the industry stand to win as a result:

1. The shift from fee-for-service to value-based care:

This trend will not only increase in 2016, but will accelerate. Now is the time to prepare for this shift. Those who are positioned to do so will be on the winning side.  Those that don’t will have only survive as narrow niche areas.

2. Providers are becoming payers and vice versa:

Blues plans are buying physician practices. Academic and not-for-profit hospitals and hospital system are establishing ACOs and clinically and financially integrated networks. The winner will be those that can both care for the patients and manage the financial risks.

3. There is more data than ever before:

Meaningful use is over. More than $30 billion later, the industry has more data than ever before.  The winners are those who are able to harness that data to provide better value and improve both the patient experience and healthcare outcomes.

4. The increase in consumerism:

The rise of high deductible health plans has caused much change. Patients’ demands are higher as they are more aware of what services they receive for their $3000 – $5000 deductible. Increased price transparency and market competition for this “first dollar” from the patient is changing consumer behavior. Couple this with the trend towards value-based care and the rising importance of HCAP scores for providers and Star Ratings for payers. As a result, those who are positioned to address the patient/member experience will be in the winning column.

5. Culturally competent healthcare in emerging America:

The Hispanic population is the fastest growing demographic in our country.  They are younger, live longer and are more loyal than other demographics. Yet, a 2015 national survey of healthcare executives commissioned by North Highland found that more than three in five have not evaluated the financial opportunity of Hispanic healthcare, or don’t know whether their organization has conducted such an evaluation yet. Forty-nine percent of those surveyed also said it is a priority —an indication that most are not preparing for or focusing on this area. The obvious winners in this category are those that are.

For more predictions and trends for the year ahead, download our full 2016 Industry Outlook. How is your business positioned to address these trends in the coming year?



Ricardo Martinez, M.D., FACEP is the Chief Medical Officer at North Highland. He has served in senior roles in academics, government and business. He provides thought leadership and front-line involvement in transformation efforts of healthcare organizations becoming high-performing enterprises. Key areas of focus are physician leadership and engagement; developing team-powered value-based clinical processes to add real value and eliminate wastes; activating patients to ensure that shared clinical care plans are most effective; and enabling technology that supports, extends and improves the performance across the delivery system.

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