By Tony Schueth, Editor-in-chief
If 2015 was any indicator, 2016 will continue to be a year of innovation and change in health care and health information technology (health IT). We expect to see developments in how prescription drugs are prescribed, the organization and delivery of care, and requirements on the legislative and policy fronts. Some will be new while others will build on what has gone before. With that as a backdrop, here are the top 10 trends the Point-of-Care Partners (POCP) team foresee for 2016.
1. Alternative delivery and payment models. It seems like the world is awash in new value-based payment and delivery models aimed at improving outcomes and quality while lowering costs. The list includes integrated delivery networks, accountable care organizations and patient-centered medical homes (PCMHs). All rely on health IT particularly electronic health records (EHRs) to capture and exchange patient and administrative information, prescribe medications, coordinate care and develop and report on quality and payment metrics. The latter will be the criteria on which organizations will be paid and how they divvy up resulting savings. In 2016, we will see such organizations continue to try to integrate systemwide technology solutions as new providers are added to their networks. This will require more interoperability on the part of EHRs, better information exchange across disparate sites of care and more training on the part of users. Also in 2016, organizations will begin evaluations and pilots to assess the role of technology in improving patient outcomes and lowering costs.
2. Biosimilars. In 2016, well see more biosimilars introduced into the US health care market, driven by the lower price tag for these expensive pharmaceuticals. EHRs will take on new and expanded roles in coordinating patient care using biologics and biosimilars, and tracking therapies administered or dispensed to patients. For EHR developers, 2016 will be the year they start to see glimmers of interest for added functionality to track and trace batch and lot numbers of pharmaceuticals in the physician office because physicians are the major reporters of adverse drug events. EHRs increasingly will be called upon to build biosimilars into clinical decision support. At the same time, EHRs and pharmacy systems will need to keep abreast of evolving state laws concerning biologic and biosimilar substitution. Even though biosimilars have just been approved for the US market, states have already begun addressing substitution. This is important because a dispensed biologic may be different than what was prescribed. According to the National Conference of StateLegislatures, in 2013 and 2014, eight states enacted the first round of such biologics and biosimilars laws. As of January 4, 2016, bills or resolutions related to biologics and/or biosimilars were filed in 31 states.
3. Electronic prescribing of controlled substances (EPCS). EPCS will continue to grow steadily, and more states will take up the cause. It is now legal at the federal level and in all states and the District of Columbia. EHR vendors are ready for EPCS, as are most pharmacies. Many of the bigger barriers no longer exist; physicians simply need to get past having to use a second factor for authentication and start prescribing controlled substances electronically. We see them doing so in New York, where electronic prescribing (ePrescribing) is mandated. However, more policy levers may be needed. In Minnesota, ePrescribing is mandated but there are no penalties for nonuse. Will toothless legislation have an impact? As it pertains to ePrescribing of noncontrolled substances, it has, as Minnesota has ranked first in the past couple of Surescripts analyses. But thats not the extent of it. Physicians will have to ePrescribe controlled substances if they are to meet ePrescribing, cost and quality targets set by public and private payers. And we expect other states to follow New York and Minnesotas lead.
4. Electronic prior authorization (ePA). Vendors in 2016 will expand implementation of ePA and prescribers will increase adoption as we begin to see the fruits of efforts started in previous years. Legislation that had 2015 deadlines pushed payers and providers to consider different options. In the short term, stakeholders opted for portals and solutions not integrated with work-flow or core operating systems, allowing each to check the box. However, everyone recognized these solutions as suboptimal. Building more integrated solutions, however, takes investments of time and resources that must be budgeted and prioritized. In 2016, we will see the results of some efforts begun in 2015 and the start of others that will bear fruit later this year and into next.
5. Implementation of the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA is a new acronym that physicians and EHR vendors will need to understand in 2016. This legislation did away with the sustainable growth rate formula for determining Medicare payments for health care providers services. More importantly, MACRA rolls up the disparate quality reporting systems of the Centers for Medicare and Medicaid Services (CMS) into the Merit-Based Incentive Payment System (MIPS). Now the Medicare EHR incentive program (meaningful use) will be part of a single program based on quality, resource use, clinical practice improvement and use of certified EHR technology. What the requirements will be, as well as their timelines, incentives and possible noncompliance penalties, will be of immediate interest to providers, vendors and policy makers. It will be interesting to see what and how much gets locked into place by regulation before administrations change next January.
6. The death of meaningful use. A major topic of discussion in 2016 will be the death of meaningful use (MU) as a federal program and driver of EHR adoption and functionality. Physician groups told Congress and the CMS that MU is unworkable and needs to be replaced. The federal government got the message loud and clear. In January, CMS Acting Administrator Andy Slavitt announced the end of MU as we know it. However, MU is not dead, as some thought (or wished). Rather, it is being integrated as a component of MIPS, along with other elements. The details and implementation will consume a lot of attention in 2016. (For more about POCPs thoughts on what will happen, see the article in this edition of HIT Perspectives.)
7. Medication adherence. Greater attention will be focused on medication adherence in 2016, as everyone looks to reduce costs and improve the quality and safety of patient care. The cost of nonadherence has been estimated at $100 billion to $300 billion annually, including expenditures for avoidable hospitalizations, nursing home admissions, and premature deaths. Plus, half of the 3.2 billion annual prescriptions dispensed in the US are not taken as prescribed. Now that use of ePrescribing is becoming ubiquitous, pharmaceutical companies, payers and others are evaluating ways it can be leveraged to increase medication adherence. In fact, the opportunity to encourage patient adherence to prescribed therapies has long been discussed as a major potential benefit of ePrescribing technology. One early study showed ePrescribing increased first-fill rates by 11%, but this just scratches the surface of the opportunity. The Office of the National Coordinator for Health Information Technology has funded tests of this concept, and we expect more interest in 2016.
8. Continued automation of specialty medications. The industry will begin to look at ways to reduce the costs of specialty medications leveraging health IT. Specialty drug spend alone is enough to get peoples attention. Specialty medications represent the fastest-growing cost in US health care, expected to jump two-thirds in 2015 and account for half of all drug costs by 2018. Specialty medications can cost $2,000 per month per patient, with those at the high end costing upward of $100,000 to $750,000 per year. 2016 will mark renewed interest in better automating specialty prescribing, which is ripe for process improvement and has spotty, partitioned computerization so far. Look for NCPDP to continue to address data elements that are critical to the safe, appropriate and timely ePrescribing of specialty medications.
9. Telemedicine. Telemedicine is here to stay. It will help alleviate the shortage of primary care physicians as well as improve outcomes, access and cost efficiencies. Other drivers include the growing demand for convenience, innovation and a personalized health care experience. Policy makers have been listening. According to one analysis, 29 states and Washington, DC have enacted legislation mandating that private insurers offer reimbursement for telemedicine at equivalent levels with in-person services, provided the care is deemed medically necessary. Many of the laws enacted in 2015 have taken effect in January. Medicare, Medicaid and the Department of Defense have expanded their coverage for telehealth services. The growing number of retail medical clinics and employers with on-site medical facilities also are looking to offer telemedicine services in 2016. Now health IT vendors will need to provide more and better interoperable systems to capture and exchange patient data related to telemedicine visits within and across sites of care and payers.
10. War on drug abuse. America will continue the war on prescription drug abuse in 2016. According to new statistics from the American Society of Addiction Medicine, drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers and 10,574 overdose deaths related to heroin in 2014. And the numbers are growing. Stemming this tide will be a priority in 2016. It will result in more state laws like New Yorks I-STOP (Internet System for Tracking Over-Prescribing), which requires ePrescribing of all medications and consultation by most prescribers of the states prescription drug monitoring program (PDMP) registry when writing prescriptions for Schedule II, III and IV controlled substances. We expect other states will build on the New York precedent by requiring that providers and pharmacists consult the database before prescribing or dispensing a controlled substance. (PDMP consultation is optional in the vast majority of states.) The federal government is collaborating with stakeholders to see how PDMPs might be better able to exchange prescribing information within and across states. EHR developers will need to ensure their products contain features enabling their physician customers to be in compliance with state requirements for PDMP consultation.