- Increased Utilization and Oversight of Advanced
Technology (Including AI): As Texas health care
organizations, providers, payors, and vendors increasingly adopt
and rely on advanced technology to perform various tasks, certain
technologies will likely be subject to increased regulatory
oversight. The federal government (through various agencies) has
indicated its interest in monitoring and controlling the use of
these technologies in ways that may impact patients and their
data.
- Increased Corporatization and Consolidation: A
trend towards consolidation among health care providers continues,
including an increase in acquisitions by private equity funds.
However, media and research attention have focused on allegations
of higher costs and lower quality in some organizations that are
part of this trend. Recent federal actions by the Department of
Justice and Federal Trade Commission signal increased scrutiny of
these acquisitions and any potentially anti-competitive effects
based on certain facts particular to an arrangement or
organization. Loss of autonomy resulting from practice acquisitions
has some physicians looking to alternative practice arrangements,
including unionizing.
- Changes to Value-Based Arrangements:
Arrangements among providers, health plans, and companies that
manage them are coming under scrutiny by the state of Texas.
Contracts that restrict physician mobility and retention of
patients will soon be subject to Texas legislation banning certain
anti-competitive contracting provisions, particularly by payers and
nonphysician administrators. In addition, a verdict in a recent
Texas corporate practice of medicine case may affect future
structuring and compliance policies when private equity is
involved.
- Telemedicine Expansion: Telemedicine had a
high-water mark during the COVID-19 pandemic. Many of the
telehealth waivers that were put in place during the COVID-19
public health emergency have been extended until Dec. 31, 2024. New
legislation and proposed rules are in place that will expand the
use of remote patient monitoring (RPM) technology as well as boost
Medicare coverage and payment for RPM and digital
therapeutics.
- Continued Emphasis on Containing Costs: Payers are expected to focus on cost containment initiatives in 2024. Managed care organizations and health plans are expected to implement increasingly sophisticated reimbursement models and innovative technology for utilization management.
Originally published February 02, 2024
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