Looking Backward and Forward at How Industry Insiders View Trends

by Clive Riddle,  February 10, 2011

As part of the annual Future Care Web Summit, attendees as well as MCOL members participate in an e-poll on health care business trends for the coming year. The Tenth annual event concluded two weeks ago, and we’re ready to share results from the survey along with a comparison to responses from previous years for questions that have been asked each year.

Respondents were asked which of the listed health care business trends they thought would have the single greatest overall impact in 2011. This question has been posed annually. Here are the responses for the past eight years:

Trend	2011	2010	2009	2008	2007	2006	2005	2004
Advances in health care technology	8.0%	6.2%	3.4%	11.8%	7.5%	16.6%	13.6%	11.9%
Consumer Driven health plans	7.3%	7.0%	3.4%	13.4%	18.5.%	21.0%	22.7%	14.4%
Compliance issues	4.4%	7.0%	1.1%	0.8%	3.4%	0.8%	0.9%	5.9%
Effects of the Recession	13.9%	26.4%	57.3%	NA	NA	NA	NA	NA
Health Care Reform Initiatives	49.2%	37.2%	21.3%	23.6%	11.0%	28.1%	13.6%	4.3%
Increased consumer cost sharing	11.0%	5.4%	9.0%	33.9%	40.4%	25.8%	38.2%	35.6%
Population Health initiatives	3.6%	5.4%	3.4%	12.6%	7.5%	3.0%	5.5%	23.7%
Other	2.2%	5.4%	1.1%	3.9%	11.6%	4.5%	5.5%	4.2%
Grand Total	100.0%	100.0%	100.0%	100.0%	100.0%	100.0%	100.0%	100.0%

One can certainly see the ebb and flow of certain trends over time: the peaking of consumer driven plans and consumer cost sharing after the introduction of HSAs; the realignment of all factors taking back seat to the Great Recession in 2009; and the recent passage of health reform.

While respondents were generally consistent this year regarding these responses by their organization type, there were a few notable exceptions:

• 25% of vendors viewed population health initiatives as the top trend, compared to 1% of all other respondents. 
• 12.5% of providers viewed advances in health care technology as the top trend compared to 4.2% of all other respondents
• 18.7% of providers viewed the effects of the recession as the top trend compared to 9.7% of all other respondents

This year, we asked respondents to rate the ultimate anticipated impact in the marketplace of these selected health reform provisions:

• Accountable Care Organization Development (ACO)
• Health Plan Medical Loss Ratio Regulation (MLR)
• State Health Insurance Exchanges (Exchange)
• Extension of Dependent Care Coverage (Depend)
• EHR Development - Meaningful Use (EHR)
• Health Insurance Guaranteed Issue/ Elimination of Pre-Existing Conditions (Guarantee)
• Expansion of Medicaid Coverage (Medicaid)
• Mandated Coverage Provisions for Business and Individuals (Mandate)

Here’s how these provisions stacked up against each other:

Provision	Significant	Moderate	Little	None/Won't Happen	Unsure
ACO	30.6%	32.1%	23.3%	5.8%	8.0%
MLR	28.4%	38.6%	19.7%	4.3%	8.7%
Exchange	34.3%	36.5%	19.7%	4.3%	5.1%
Depend	22.0%	30.1%	44.1%	2.2%	1.4%
EHR	35.7%	32.8%	23.3%	3.6%	4.3%
Guarantee	37.5%	33.8%	19.8%	5.1%	3.6%
Medicaid	39.5%	41.7%	13.4%	1.4%	3.7%
Mandate	40.1%	35.0%	13.1%	7.3%	4.3%

The Mandate, under attack in federal appeal courts, was drew the highest level of response of any provision in both the Significant and the None/Won’t Happen categories.

Lastly, we asked respondents to rank these stakeholders as winners or losers for the coming year. It would appear Consumers and pharmaceutical organizations are viewed as the biggest winners, and employers and physicians are viewed as the biggest losers.

Stakeholder	Better Off	Same	Worse Off
Consumers	37.0%	26.8%	36.2%
Employers	15.3%	29.9%	54.7%
Health Plans	31.9%	31.2%	37.0%
Hospitals	24.8%	34.3%	40.9%
Physicians	21.2%	29.2%	49.6%
Pharmaceutical	34.6%	42.6%	22.8%

Being that respondents are a bit negative, tending to rank most stakeholders as “worse off” each year, we’ll examine “worse off: responses from a historical perspective for each stakeholder:

Worse Off	Consumers	Employers	Health Plans	Hospitals	Physicians	Pharmaceutical
2011	36.2%	54.7%	37.0%	40.9%	49.6%	22.8%
2010	65.9%	58.1%	55.0%	49.6%	41.1%	20.9%
2009	68.5%	67.0%	54.0%	61.4%	44.8%	35.2%
2008	75.3%	47.4%	12.8%	41.0%	50.0%	16.9%
2007	71.7%	34.9%	11.0%	45.2%	46.9%	29.2%
2006	69.7%	44.7%	45.5%	41.7%	11.6%	17.3%
2005	62.7%	42.7%	34.5%	38.2%	15.5%	25.5%
2004	78.0%	53.8%	33.1%	25.4%	14.4%	15.3%
2004	74.5%	61.8%	35.8%	31.2%	21.0%	13.9%

The historical perspective illustrates how dramatically respondents feel consumers change of fortune as occurred with health reform, compared to everyone else. Also interesting are the mood swings regarding health plan fortunes, and how physicians were seen as taking a turn for the worse starting in 2007.>/p>

For the 2011 Future Care e-poll, there were 137 respondents, consisting of 23% payors, 48% providers, 9% vendors and 20% others.