The Future of Health Care: Managed Care to Population Health

Federal and state regulations have driven change in health care from the volume of care delivered to the value of care provided. Yet, regulations are only part of the story. Major technology, commercial, and social drivers are making changes in health care that place the patient at the center and reorganize the communication and information avenues to change the dynamic of care itself and how it is delivered. As a result, the original intent of managed care to place the patient at the center of a market-based delivery system is being realized.When managed care was conceived, health care was delivered by silos that practiced in general vacuums leading to coordination of care inconsistencies and producing problems with handoffs between sites of care. The patient experience was variable and provided the majority of provider complaints. Outcomes of care were, and are, a priority but difficult to achieve without coordinated communication. Medicare and the Affordable Care Act (ACA) required a change but could not direct patient-centered outcomes without independent forces driving patient-centered care, communication between patients and all providers, and data repositories feeding analytics to identify actionable approaches to improving care.Managed care evolved with a focus on shifting care to the ambulatory sector. As a result, medication therapy became the primary cost-effective choice for care. Cost was a major consideration within the pharmacy benefit, because benefit models did not reduce physician and acute care hospital reimbursement to pay for ambulatory treatment. However, with the introduction of biotechnology methods to produce new and improved diagnostics, as well as treatments for previously untreatable or poorly treated illness, the boundary between site of care and expert providers blurred. The cost of production of these biotechnology “specialty” medications now requires that the entire expense of care is considered, and the division of benefits into medical and pharmacy is not an acceptable method for judging payment.This paper will attempt to discuss the future of health care, from general principles to how the changes will impact all providers. This is not forecasting using crystal ball gazing but rather predictions that are based on forces that already exist in the marketplace today.