Looking back on another year of rapid change in healthcare, there’s a lot to digest—both for the industry, as it continues to grapple with cost pressures, and for the patients who are increasingly bearing the brunt of those cost increases. Many of the top stories and trends for 2019 will be familiar—concepts like value-based care have been around for a while—but some of the rapid change we might have expected a year or two ago hasn’t materialized yet. So, read on to look back over the healthcare landscape of 2019 and what we might expect in the year to come.

  1. Opioid settlements bring accountability. The opioid crisis that has ravaged America for the past ten years may be abating, but the legal and financial repercussions are just beginning. Currently, there are thousands of lawsuits wending through the courts, directed against pharmaceutical companies, members of the supply chain, and even individual doctors. Many of these have been consolidated into two large legal actions and are being heard in U.S. District Court. Separately, 48 state attorneys general brought suits against opioid maker Purdue Pharma and other drug companies, accusing them of dumping opioids into the market. Over the last year, settlements amounting to more than $12 billion have been announced, with billions more pending, and Purdue was forced into bankruptcy. Much of this money will be used to address and mitigate ongoing damage from opiate addiction and abuse.
  2. Mysterious vaping illness results in dozens of deaths. After years of unchecked growth and little regulation, the vaping industry came under intense pressure this year after dozens of users came down with a mystery illness that, by late 2019, had resulted in more than 50 deaths. At first researchers were baffled by the illness, but a consensus began to emerge near the end of the year that the culprit was vitamin E acetate, which is often used as a “thickener” for vape liquid. Specifically, the Centers for Disease Control & Prevention singled out THC-containing vape mixes that were mixed by amateurs at home. While no official action has been taken, look for continued pressure on the industry, especially as medical organizations lead the charge to regulate or ban vaping products that are aimed at youth.
  3. New rules proposed to bring down healthcare costs. While there hasn’t been much new legislation on healthcare since the Affordable Care Act, Washington has continued looking for ways to provide relief to strapped consumers. In 2019, the Trump administration issued two new rules that are aimed at providing consumers with more information or leverage. The first rule is aimed at increasing transparency in healthcare pricing by mandating that hospitals and healthcare networks make their standard fees available online, as well as a proposal that would require health plans to share information on pricing and cost-sharing. This rule immediately attracted push-back from the hospital industry, so implementation was delayed until 2021—but expect additional legal action from the industry. According to hospital associations, being forced to disclose their negotiated prices would decrease competition and increase overall cost. The administration’s second proposed rule would allow limited importation of drugs from Canada, with the hope that U.S. consumers would benefit from cheaper Canadian drugs. Drug re-importation has been vehemently opposed by the U.S. pharmaceutical industry for years, as the industry claims that it increases risk to consumers with potentially tainted drugs. This proposed rule is in the comment period, but it’s worth noting that Canada itself also opposes the rule and, if it does take effect, it will likely be several years at least before U.S. consumers noticed any change in their prescriptions.
  4. Value-based care marches on—sort of. A lot of attention has been paid in recent years to the rise of value-based care, but in 2019, the rubber hit the road. At CMS, new entrants into Medicare accountable care organizations declined and the agency was forced to delay implementation of one of its newly announced value-based physician care payment model (Primary Care First). On the health plan side, providers and payors have been struggling over who assumes risk, with the effect that true value-based care isn’t being advanced despite marketing claims. Still, this is the trend for the future, so look for continued developments in the coming year.
  5. Affordable Care Act lives to fight another year. Even as new rules come out of Washington to bring down healthcare costs, there remains a concerted effort—both in the court system and statehouse legislatures—to bring down the Affordable Care Act. The law, however, has proved surprisingly resilient, even as elements of it like the mandate are chipped away. For 2020, about 8.3 million people signed up for plans on the ACA exchanges, a slight decline from the year before, and the core provisions of the law (especially coverage for pre-existing conditions) remain highly popular.
  6. Deadly measles outbreaks. After decades of progress against infectious diseases like the measles, thanks to widespread vaccination, the measles roared back in 2019. For the first 11 months of the year, the CDC reported 1,276 cases of the measles. The vast majority of these cases were in clustered populations that resisted vaccination, leading to an urgent national debate on improving education on the benefits of vaccination.

References

[1] Advisory Board. Overwhelmed by all the multi-billion dollar opioid settlements? Here’s everything you need to know.

[2] Centers for Disease Control and Prevention. New CDC Report Provides First Analysis of Lung Injury Deaths Associated with Use of E-cigarette, or Vaping, Products.

[3] Modern Healthcare. Trump administration unveils new price transparency rules.

[4] CNN. Trump administration proposes allowing importation of certain drugs from Canada.

[5] Modern Healthcare. Year in Review: Transition to value-based care in name only.

[6] Healthcare Dive. ACA 2020 enrollment stable but dips slightly.

[7] Centers for Disease Control & Prevention. Measles Cases and Outbreaks.