Trend #1

There is broad consensus that the number of uninsured Americans, which declined in 1999, will grow substantially over the next several years because of structural shits affecting both private and public coverage systems. 

Response: This means that self-pay collections will be come an ever more costly, important and significant portion of the receivables management process.

Trend #2

Employer sponsored insurance coverage is widely expected to continue its decline in the face of overall economic downturn and in response to significant increases of insurance premium costs. Most employers will increase employee cost-sharing to offset premium cost increases. Some employers will discontinue coverage altogether, particularly small employers. 

Trend #3

The very nature of insurance appears to be changing, with both employers and insurers showing increased willingness to change products to reduce costs. The immediate effect of most of these new models is to eliminate primary care as a defined insurance benefit, purchased instead as out-of-pocket. This could be a profound change in healthcare and would affect the core of financing and relationships between primary and specialty caregivers. 

Trend #4

Prospects for Medicare/Medicaid reform and medications as a comprehensive benefit are very limited as a result of insufficient funds to finance prescribed drug reform and a lack of a consensus on the structure of long term Medicare and Medicaid reform. 

Response:  Providers who can demonstrate cost- effective  prescription drug alternatives have a dramatic opportunity to demonstrate real financial value to existing and prospective patients.

Trend #5

Depending on the methods used, it is possible to project an increasingly severe shortage of physicians in the US. Because of substitution of non- physician professionals, primary care supply will remain relatively stable, while shortages emerge in medical specialties. A deficit of more than 200,000 physicians is projected by 2020. 

Response:  Specialists must plan now for increases in patient loads without expectation of increased revenues.

Trend #6

While the expected use of managed care has lowered hospital admissions significantly; it has not resulted in either higher utilization of ambulatory care services or lower ER visits over the past 15 years. These trends are expected to continue unchanged over the next decade. The intensity of the average visit HAS increased, and the number of prescribed medications per visit HAS increased 60% over the past decade. 

Response:  Automating the script writing process should show increasing returns for the investments made. The greatest single factor affecting utilization changes have been changes in payment policy, NOT changes in need OR in technology.

Trend #7

Most hospitals are dramatically scaling back their vertical integration strategies following disastrous experiences over the past decade. Instead hospitals have now been focusing on horizontal integration. However cost containment pressures are strapping their ability to consistently meet their commitments to such partnerships.

Meanwhile, ambulatory care providers are also increasingly pursuing horizontal linkages and partnerships designed to improve quality, lower costs, and strengthen their hand in negotiating relationships. These horizontal linkages and partnerships are resulting in exciting early successes in care delivery. 

Response:  Networks or communities of provider groups that can provide useful comparative information and detailed revenue and expense information provide the building blocks of competitive advantage.