2019 Healthcare Trends

2019 Healthcare Trends
A Guide to Payor-Focused Solutions &
Market Response
1

Key Trends in Healthcare
1. Shift to Value-Based Payment
2. Deinstitutionalization of Care
3. Care Management
4. Growing MA market
5. Data-Driven Organization
6. Digital Health Transformation
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2

Shift to Value Based Payment
Real-World Revenue Impact of MACRA has
arrived.
The Medicare Access and CHIP Reauthorization Act (MACRA)
was passed in 2015 but is only now beginning to have a real
impact on revenue for healthcare providers.
How is the market responding?
Bundled Payments for Specialists
• Several major health plans expanded bundled offerings in 2018,
with UnitedHealth Group finding savings of $18,000 per procedure
for spinal surgeries and hip/knee replacements in their program.
Amitech has been instrumental in helping one client implement the
first set of bundled payments for a state-wide payment improvement
initiative
Alternative Payment Models for PCPs
• Standard, per-patient payment arrangements, regardless of utilization
of care. Alternative payment models incentivize preventive health
care, as fees are not associated with costs of treatment. Studies have
shown that 63% of reimbursements need to be in a capitated model
to have an impact on medical costs. Amitech helped a payor to
develop incentives to close gaps in care for PCPS and track the
metrics as part of CPC and CPC+ program
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3
51.70%
37.20%
00
40.90%
25.40%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
2016 2018 2021
FFS Payment is Declining
Actual Forecast
Source: Change Healthcare Survey, BCBSA Study, State of Value-Based Care in 2018, ORC
International
https://www.healthaffairs.org/do/10.1377/hblog20180810.481968/full/
http://content.healthaffairs.org/content/36/9/1599
Average Medical Cost Savings
With Value-Based Care:
5.6%

Deinstitutionalization of Care
Pressure to Manage Costs is Pushing Care out
of Traditional Settings.
The growing demand to improve efficiency and cut costs in
healthcare is driving care out of traditional, high-cost settings
(hospitals, specialty treatment centers/suites) into less formal
and more affordable options.
The Rise of Retail Clinics
• Largely driven by convenience and sensitivity to cost, the growth of
retail clinics has skyrocketed in the last decade. It is projected that
their appeal to consumers will continue to grow as they cement their
status as credible providers of care with powerful brand recognition.
It is suggested that 29.8% of ER visits can now potentially be
treated successfully at a retail clinic
Shift to Lower-Cost Facilities
• Ambulatory surgical centers, physician’s offices and even patient
homes are increasingly replacing the dominance of traditional care
settings for treatments, procedures and post-acute care. ASC
surgical volume in 46 of the 50 largest markets in the US grew 10%
from 2015 to 2016
Telemedicine
• Today’s patient is increasingly comfortable with virtual care
alternatives including video chat and mobile applications, which
serve as an effective, convenient and low-cost option. Amitech
developed a remote monitoring service for diabetes that allows
caregivers, family members and healthcare providers s to monitor a
patient’s/loved one’s health status through a portal
©2019&Amitech&Solutions&– Proprietary&&&Confidential4
US Retail Healthcare Clinic Projected
Growth
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202999/
-https://www.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/10-key-
trends-for-ascs-and-outpatient-surgery-in-the-next-10-years.html

Care Management
Rising Focus on Quality & Value Makes
Promoting Wellness and Care Management a
Win-Win for Payors
By helping members become healthier and preventing the
onset of sickness and disease in the first place, payors face
lower risk of incurring expensive costs while commanding
more in reimbursements as a result of better outcomes.
Innovation in Patient Engagement
• Amitech helped one client find success in this area by
developing a breakthrough mHealth application. Biometric data
gathered from members’ phones and wearable devices
combined with their lifestyle, health and wellness goals to
deliver a personalized experience
Predictive Analytics
• Data analytics and machine learning are being used to predict
high risk patients, identify patients with chronic conditions for care
management and offer additional support for improving overall
health and wellness. Amitech developed an application and
algorithm to assess the risk level of diabetic patients upon
admission to the hospital. Based on the risk score, the application
allowed the clinical team to follow specific protocols designed to
manage the diabetic condition of the patient
Focus on Wellness
• A broader consideration of social determinants of health like food
and housing is hitting the mainstream as several major plans are
investing in community health. Amitech is working with a
Medicaid Plan to combine behavioral heath data with social
determinants of health and medical claims to identify gaps in
care and provide better coordination of care
Source:(Milken(Institute
$0
$10
$20
$30
$40
$50
$60
$70
$80
Cancer Heart&DiseaseHypertension Mental
Disorder
Diabetes Pulmonary
Conditions
Stroke
Avoidable Chronic Conditions Treatment
Costs Projection for 2023 in Billions – Total
$217.6B
Avoidable&Chronic&Conditions&Treatment&Costs&Projection&for&2023

Growing MA Market
A Unique Combo of Factors make the
Medicare Advantage Market a Key
Opportunity for Growth
The baby boomer enrollment boost, rare bi-partisan support
and comparably favorable margins make the Medicare
Advantage Market a key opportunity for growth. Plans are
taking notice.
Acquisitions & Expansions
• Recognizing the opportunity in this market, some plans are
shifting from serving employers as a growth strategy to a more
aggressive focus on acquisitions and expansions. Anthem gained
approx. 170,000 more MA members with the purchase of
HealthSun and America’s 1st Choice in 2017 & 2018
Investment in Member Engagement & Experience
• The new generation of enrollees in MA plans differs not only in
relative volume compared to previous generations but also in
their level of sophistication and expectations for technology and
user experience. Plans are acting accordingly with significant
investments and innovation in these key areas
Proactive Risk Management
• The importance of favorable star-ratings in the MA market is
driving an increased focus on data analysis strategies that can
identify areas of high risk for regulatory noncompliance
0
5
10
15
20
25
Jan.&2015 Jan.&2016 Jan.&2017 Jan.&2018 Jan.&2019
Millions
MA Market Growth
Total&Enrollment
Source: CMS.gov
https://www.modernhealthcare.com/article/20190116/NEWS/190119927

Data-Driven Organization
The Healthcare Industry is Catching up to
Tech & Finance on the Value of Data and
Analytics.
More and more healthcare leaders are embracing the value of
data-driven organization and decision-making. Realizing its
full potential in healthcare requires a thoughtful balance of
People, Process, Culture and Technology.
Modern Data Management
• Data is being collected and considered from a wider pool of sources
than ever before including medical claims data, clinical data,
behavioral heath data and social determinants of health for better
decision making. Amitech is building a modern Big Data platform for
a Managed Medicaid Plan to create a trusted, holistic view of
members across the care continuum
Advanced Analytics
• Advanced Analytics can help pinpoint drivers of costs and help monitor
intervention programs to reduce cost of care. For one client, Amitech
built an analytics model to identify patients that contribute to
disproportionate costs. We worked with the client to prioritize
interventions for “super-utilizers” and achieved a 60-75% reduction in
post intervention admissions
AI/ML/RPA
• When an Amitech client wanted to reduce readmissions for patients
with multiple co-morbid conditions, we developed a Machine
Learning model to predict risk of readmission before discharge and
minimize 30 days readmission risks. The model helped to bring down
overall costs and provide higher quality care
Blue Hill Research 2017
Forrester’s Business Technographics® Global Data And Analytics Survey, 2017
Forrester’s Q4 2017 Global Business Intelligence Business Case Online Survey
Forrester’s Business Technographics® Global Data And Analytics Survey, 2014

Digital Health Transformation
Bridging the Gap Between
Member/Patient/Provider Experience and
Expectations
Wearables, telemedicine, virtual monitoring, AI-based claims
management—all just a few examples of digital solutions that
are working to bring a more personal, individualized and end-
to-end experience to healthcare. Organizations finding
success are taking a holistic approach to modernizing how
value is delivered to customers at every turn.
Borderless Care
• The growing demand for consumer choice and control is forcing
the issue of interoperability and interdependency between digital
platforms and solutions. For one client, Amitech helped
implement a “talk to a doctor online” telehealth digital platform
which integrated with their EHR
Member Experience
• Investments in digital platforms for a fully integrated, omni-
channel digital experience. Improvements are being made in
critical, member-facing functions, such as enrollment for those
purchasing individual insurance and self-service capabilities.
Amitech created both a biometric data interchange interface
solution and a digital platform called AHConnect to create a new
way for caregivers and healthcare providers to remotely monitor
a diabetic patient’s health in real-time
mHealth
• IoT medical devices and wearables are producing vast amounts of
data that can reduce common challenges around communication
and compliance between patients and providers . Amitech
developed an mHealth platform using IoT and built-in rules
based on behavioral science to provide users with a personalized
and realistic wellness improvement experience
Source:(https://patientengagementhit.com/news/patient5engagement5technology5comes5to5forefront5in5
healthcare
https://patientengagementhit.com/news/patient5mhealth5adoption5high5but5prolonged5patient5use5limited
Amazon accounts for
43% of all US retail
sales
Up from 25% in 2012
Airbnb logged 80
million guest arrivals
in 2016
Doubled from 40
million the prior year
Uber/Lyft represent
15% of San Francisco
weekday vehicle trips
12x more Uber/Lyft
trips than taxi trips

Healthcare Transformation
HealthCare Transformation will not happen
without the close coordination of these
quadrants and circles across the organization
• Outer quadrants represent the 4 technology pillars
Platform, Data Analytics, Application and Digital
Experience
• Your “Balanced Maturity Level” across these pillars is critical
to success
• The inner middle circle represents the “non-technical”
components that are largely overlooked and if not
addressed will dramatically limit your results
• The center circle is your TARGET. Your transformation is all
about and driven by improved outcomes, experiences and
cost controls
If you focus on the right combination you’ll
hit the target!

About the Author
AMIT BHAGAT
Amit Bhagat is a recognized industry thought leader, speaker and
management consultant with a passion for applying advanced data analytics
and change management strategies to solve the most pressing and
persistent challenges in healthcare. Amit’s expertise lies at the intersection
of data analytics and operations to improve organizational performance,
create new operating models, help implement large organizational
transformations, and develop new ways of improving profitability and
growth.
Amit has twenty-plus years of experience in helping clients succeed by
developing information management, governance, business intelligence,
advanced analytics, organizational design and performance management
strategies and solutions. In an era of increasing change, Amit has worked
extensively with clients in healthcare organizations to develop and
implement growth strategies as well as drive measurable improvement in
their operational performance by combining complex and innovative
information-based technology solutions, culture, people and processes, all
working in concert.
As CEO of Amitech, Amit leads the firm’s client facing strategy and business
development, and enjoys working with client executives in an advisory
capacity to solve complex problems facing today’s healthcare industry.
Amit holds a Master of Business Administration with a concentration in
Finance and Strategy from Washington University in St. Louis, Olin School
of Business, and a Bachelor of Engineering in Electrical and Electronics
Engineering from the Birla Institute of Technology, India.

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11
At Amitech, we believe healthcare can and should be better. With a
single-minded focus on value, we combine people, process, culture
and technology to drive real and lasting change. We partner with our
clients to deliver data analytics and digital transformation strategies
and solutions to make healthcare more proactive, higher quality and
less expensive for everyone.
Amitech Solutions
One CityPlace Drive, Suite 282
St. Louis, Missouri 63141
1.866.870.8920
amitechsolutions.com

2019 Healthcare Trends

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