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2015 Industry Outlook

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Avalere hosted its 2015 Outlook webinar last week, which featured Tanisha Carino, Lindy Hinman, Ellen Lukens and Josh Seidman.

The panelists were brought together to discuss key policy trends and issues to watch for this year. Here are some of their top takeaways.

For Managed Care

  • Exchange enrollment is stable, growing and tracking Avalere’s projection models to reach 10.5 million enrolled by the end of 2015.
  • The 2015 theme for Medicaid health plans will be opportunity and growth, but with that growth will come greater scrutiny. Also, stay tuned for CMS’ “mega regulation,” which might put pressure on the Medicaid market to better align with the Marketplace and Medicare.
  • Plans continue to explore innovative quality based contracting and other mechanisms to better manage the cost of specialty medicines.

For Providers

  • Accountable Care Organizations served 7.8 million beneficiaries in 2014. It’s expected that CMS will provide additional flexibilities and offer other opportunities to join the ACO program.
  • Last year, post-acute care represented 16.5 percent of Medicare spending and includes skilled nursing facility care (SNF), home health, inpatient rehabilitation and long-term hospital services. Twenty-two percent of SNFs are now participating in CMS’ bundled payment demo, and we predict that most will move into the risk-bearing phase.
  • Consolidation will continue in the provider marketplace, although it looks to be slowing down as systems integrate and maximize the providers they’ve acquired to date.

For Life Sciences

  • Value determinations will be increasingly linked to cost and patient reported outcomes. Diverse stakeholder views put greater pressure on life sciences companies to have robust evidence generation strategies and engagement platforms.
  • Market trends suggest increased cost-sharing to patients, the use of narrow networks and greater use of specialty tiers in formulary design.
  • The growing prominence of performance measures tied to provider reimbursement and the shifting nature of decision-making through integrated delivery networks is changing the nature of market access, requiring targeted outreach and focused value messages.

Listen to the archived version of the webinar.

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