Seven Key Practice Trends for 2019

How will medical practice evolve through 2019, and what do those changes mean for physicians? The Massachusetts Medical Society (MMS) has identified seven key trends driven by underlying market forces. These include:
1. Shifting toward population-based care. Population-based care systems use data derived from large patient populations to guide the care of individuals. They aim to help practices provide proactive, evidence-based interventions and coordinated care, ultimately improving clinical outcomes at lower cost. For example, the electronic health record (EHR) may flag patients who would benefit from certain vaccines, or a case manager may identify patients who share certain characteristics and work with them on self-care. 
2. Considering the social determinants of health. The MassHealth ACOs now consider the social determinants of health (SDOH) — non-medical factors influencing disease risk — in their care-management systems. A related federal waiver has secured substantial funding for programming addressing the SDOH, including education, socioeconomic status, neighborhood, food security, racial segregation, housing, public safety, transportation, and more. Addressing these factors is essential to improving outcomes and reducing disparities.
3. Prioritizing physician wellness. Health systems and provider organizations are increasingly surveying their providers for burnout and seeking solutions. These may include, for example, the use of scribes and templates to ease EHR use, social gatherings to help reduce isolation, increased mentoring, improved practice workflow and on-call coverage, and expanded provider-wellness programs.
4. Tackling prescription drug costs. Spending on specialty pharmaceuticals, gene therapies, and orphan disease drugs continues to rise rapidly. The HPC, which monitors cost drivers, is recommending an increase in transparency and accountability in drug pricing and an effort to enhance state negotiations of drug prices — priorities for which the MMS is advocating at the state and federal levels.
5. Incorporating artificial intelligence. Advances in AI, robotics, and machine learning can potentially improve the quality of healthcare services and reduce costs. Emerging applications of AI include voice-enabled digital assistants for physicians, such as Amazon’s Alexa. AI applications have been used to schedule patient visits, refill prescriptions, supply laboratory results, and more. AI offers additional opportunities, from diagnostic algorithms to advanced treatment queries. That said, some aspects of AI raise regulatory questions and challenges.
6. Ongoing mergers and acquisitions. Health systems, hospitals, and payers are continuing their consolidation activities — witness the megadeals between Beth Israel Deaconess Medical Center and Lahey Health, CVS Health and Aetna, and even Cigna and Express Scripts. Merging healthcare organizations aim to expand care services, control costs, and gain market share and negotiating power.
7. Tightening cybersecurity. With the increasing number of ransomware and malware attacks and other security breaches, we expect to see growth in cybersecurity methods in 2019 and beyond. Digital health technology requires medical cybersecurity to manage and protect patients’ healthcare records from viruses, hackers, and other cyberattacks. Physicians are encouraged to invest in cybersecurity training programs and software tools, adopt updated protocols in protecting information, implement analytical and risk-assessment tools to detect potential attacks, and ensure robust compliance and encryption technologies.

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