From the launch of new initiatives aimed at increasing patient access to health data to the rising potential of artificial intelligence (AI) to meaningfully impact the outlook of healthcare delivery, 2018 was a year flush with change and new opportunities, with data and its role in transforming the industry at the forefront. In 2019, the healthcare industry can expect continued emphasis on delivering care that focuses on patients more holistically, as the evolving data exchange landscape and innovative technologies continue to alter the face of clinical decision making.


Evolving Healthcare Legislation to Shape Policy for 2019 and Beyond

The healthcare industry’s slow march toward adoption of value-based arrangements will continue in 2019, as state and federal policy leaves many health plans no choice but to get on board and government experimentation with outcomes-based contracts increases. New federal rules will enable Medicare Advantage plans to exercise more flexibility in how they impact health outcomes, with the ability to offer new supplemental benefits beyond what has traditionally been covered by Medicare. A great deal of innovative approaches to care delivery will also stem from shifts in health policy focus following the 2018 election season, which culminated in Democrats gaining control of the U.S. House of Representatives.

With new legislators now in control of the House, expect any number of proposals to introduce a public option, allow individuals to buy into Medicare, or move to a Medicare-for-All system. According to Avalere, we can also expect debate over expanded access to new or existing public health programs to heat up, as Democrats position for 2020. A new legal challenge to the Affordable Care Act from a federal judge in Texas that ruled the law unconstitutional will also be something to watch early this year, as the decision awaits appeal.


Healthcare Organizations will Eye Social Determinants of Health Data for Key Insights

As all aspects of healthcare delivery – from preventive care to point-of-care services to chronic disease management – continue to shift to a more patient-centered system, 2019 should see social determinants of health (SDOH) play an increasingly significant role in improving everything from risk stratification to overall quality outcomes. The ability to better understand the associations between social determinants and poor health status will play an integral role in the successful management of member populations and their needs.

According to a recent survey, 80% of payers believe that addressing SDOH will be key to improving outcomes, with 34% of those surveyed indicating they are deriving new insights by integrating SDOH data with clinical data. In 2019, expect to see an increase in new strategies for leveraging SDOH data to collaborate with public health and community organizations to connect individual patients with the services and resources they need.

The ability to collect, analyze and leverage SDOH data allows healthcare organizations to treat patients more holistically – a trend that will continue in 2019 as the few states yet to adopt Medicaid expansion make their decisions. Advanced analytics can facilitate deeper patient-level insights and inform effective, targeted outreach to the right patient, through the right venue and at the right time, driving meaningful improvements in care quality and patient retention.


Expect Artificial Intelligence to Make Strides in Data Management

If one trend stood above the rest in 2018, it was the emerging potential of AI and machine learning (ML), with these technologies “revolutionizing the way we interact with our analytics and data management,” according to a recent survey. Harnessing data-driven insights to drive greater organizational efficiencies and patient-centered care will remain a priority in 2019, and AI tools are already proving their mettle in areas such as clinical decision support, risk scoring and diagnostics – even if steps toward adoption are incremental.

AI, including natural language processing (NLP) and ML, can be leveraged for automated medical record retrieval and review – a valuable tool considering there are approximately 100 million medical record reviews performed each year. With more than 75% of that patient data appearing in unstructured form, the ability to manage and streamline it in an automated, cost-effective way is essential to enabling informed clinical decision making, enhanced care coordination and a more valuable patient experience. As the healthcare industry further understands the applications and implications of AI, we will undoubtedly see greater adoption in this area. 

There is no question that healthcare organizations will face new opportunities and challenges in 2019. As value-based models evolve and the industry continues to sharpen its focus on how data and advanced technologies can be leveraged to better understand and more appropriately serve patient populations, we will see measurable impact for patients and increased speed-to-value across the spectrum.

Watch Avalere’s Industry Outlook 2019 webinar today, Healthcare Industry Outlook 2019: View All Angles, to learn more about trends and changes that will shape the industry in 2019. Avalere, an Inovalon company, leverages Inovalon’s large-scale real-world datasets, predictive analytics and data-driven platform, to develop custom solutions for clients, helping to guide strategy and accelerate financial performance.


Sean Creighton –Managing Director, Avalere Health, an Inovalon company

Sean Creighton, Managing Director, is responsible for leading advisory services work tied to Medicare Advantage (MA), risk adjustment, and related issues. His extensive experience with claims data and application of Avalere’s modeling and analytics functions enable him to advise clients on their strategic goals. Prior to Avalere, Sean was a Senior Vice President at Verscend Technologies, where he led the development and management of risk adjustment products. Prior to that, he spent 15 years at the Centers for Medicare & Medicaid Services (CMS), leading the policy development and implementation of major public programs. Sean holds graduate degrees in Sociology and Statistics from the London School of Economics and Trinity College, Dublin, Ireland and a BA from University of Limerick, Ireland.