How has healthcare changed in the past 10 years

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Holmes and former COO Ramesh Balwani each face up to 20 years in prison for multiple counts of wire fraud and conspiracy to commit wire fraud; their trials are set to begin July 28, What made the downfall of Palo Alto, Calif. This is what makes Theranos more than a case study of corruption and deception: Although its collapse occurred in a steady cadence over about three years, Ms.

Holmes founded the company in A dozen years came and went before Theranos received the scrutiny worthy for any company claiming to process more than laboratory tests with only a finger prick's worth of blood. The Theranos board was stacked with U. The Food and Drug Administration cleared Theranos to run tests for herpes on its "proprietary" technology. Walgreens partnered with Theranos in to install kiosks in thousands of stores without ever validating its technology.

Holmes to Bill Gates and Steve Jobs alongside the photo of a vial of blood the size of an Advil gel capsule with the caption, "Theranos can run as many as 70 tests on a sample this size, obtained by pricking a finger.

Holmes flew to Boston for a previously scheduled appearance at the Harvard Medical School Board of Fellows, where she was honored as an inductee, as reported by Vanity Fair. There is a long and impressive list of highly educated experts in their field who missed a chance to dig deeper, ask the right question and press for results.

Many smart people believed lies and exaggerations. The scars they bear? Lost investments, retractions, blemishes on resumes, public humiliation, legal expenses — these and more, none of them good. But in the s, after Ms. Holmes' trial and the movie premiere , healthcare needs to remember the people too often overlooked in the rise and fall of Theranos: the patients.

They were not biotech, healthcare or investment experts. They trusted Theranos for answers about their health, and they believed its promises for convenience, reliability and affordability. What they got were perplexing and flawed results, some signaling serious or even life-threatening problems.

Theranos was a dark chapter of healthcare in the s, but it reminded the industry that the trust put forth by patients in hopes of a less painful healthcare experience deserves fierce protection. That faith moves healthcare forward, and it does not run in endless supply. Through the decade, major companies, including Walmart, Amazon and Berkshire Hathaway, responded to this rising cost with programs to lower their employee healthcare spending.

In , Pacific Business Group on Health , a San Francisco-based group of private employers and public agencies focused on improving the quality and affordability of healthcare, created the Employers Centers of Excellence Network.

Companies can join the network, which designates physicians, hospitals and health systems as "Centers of Excellence" based on their quality statistics. Employer use of some type of Centers of Excellence program rose to 88 percent in , up from 79 percent in , according to the National Business Group on Health. In order to boost quality and cut costs of these programs, employers have become increasingly selective about the physicians, hospitals and health systems they include. In , Walmart launched its Centers of Excellence program , available to the 1.

Through the program, Walmart has partnered with some of the nation's largest health systems, including Cleveland Clinic, Baltimore-based Johns Hopkins and Danville, Pa. Walmart's program flies employees , all expenses paid, when necessary, to top hospitals around the world. Lowe's quickly followed in Walmart's footsteps, joining the Centers of Excellence network in October General Electric began offering a Centers of Excellence program in to provide hip and knee replacement surgeries for its employees.

Boeing, along with Blue Cross Blue Shield of Illinois, launched a Centers of Excellence program in , which benefits more than 15, Boeing employees.

McKesson joined the Centers of Excellence network in to provide hip and knee replacement surgeries for its employees. Perhaps one of the largest examples of employers entering the health insurance market came in , when Amazon, Berkshire Hathaway and JPMorgan Chase launched Haven Healthcare, a company aimed at cutting healthcare costs for the companies' combined 1.

Haven began testing its insurance offerings in November, presenting 30, workers in Ohio and Arizona with two separate plans. Why has employers' role in healthcare changed so much in the last 10 years?

In , employers began prepping for the ACA's employer mandate, which requires larger employers to share responsibility for their employees' health coverage. The mandate went into effect in To avoid fines, large employers began rolling out their own healthcare programs, while those who already had programs had to keep theirs competitive. Harder to prepare for was an unstoppable rise in premiums and deductibles that in the last half of the decade made the coverage employers are mandated to offer unaffordable for employees.

Going into the s, expect large employers who are sick of the healthcare cost status quo — and this includes health systems that are often the largest employer in a state — to find new ways to squeeze out cost.

Employers are arguably more motivated than any other player to keep their healthcare costs down, which are rising two times the rate of wage increases. How else will they ensure competitive salaries and attract top talent in the labor market of the s? The s saw steady improvement in the survival rate for men and women with all types of cancer as well as several prominent discoveries and significant advances in cancer care.

The editors cited an emerging belief among oncologists that "a corner has been turned and we won't be going back. That belief was strengthened in , when two cancer immunotherapy researchers — James P. Tasuku Honjo of Kyoto University in Japan — earned a Nobel Prize for their pioneering work in checkpoint therapy, which unleashes the body's own immune system to attack cancer cells.

Their work represented advancements in research that many had given up on well before the s. The FDA approved the first CAR-T cell therapy in , expanding its use in standard therapy for the treatment of pediatric and young adult patients with B-cell acute lymphoblastic leukemia. The milestone was one of several FDA approvals for leukemia drugs in the s, including more than 10 for acute leukemia in three years.

Progress in leukemia treatment was relatively rare in the 25 years before this decade. For instance, the majority of advances for acute myeloid leukemia — the most common form of leukemia in the U.

Culturally, actress Angelina Jolie Pitt brought wider public awareness of genetic testing in when she wrote a New York Times op-ed detailing her choice to undergo a double mastectomy after testing positive for a high-risk gene mutation, BRCA1. Her test results estimated an 87 percent risk of breast cancer. In the two weeks after her op-ed ran, researchers identified a 64 percent uptick in the rates of genetic testing for breast cancer but no uptick in mastectomy rates, suggesting the tests did not result in more breast cancer diagnoses.

The researchers dubbed it "The Angelina Effect" — while her testimonial raised awareness of genetic testing for breast cancer mutations, it possibly inadvertently influenced overtesting in low-risk groups.

Progress made with cancer drugs or therapies inspired much-needed hope and presented new options, but it also served as a reminder of the steep costs of cancer care that are unsustainable for individual patients and the health system as a whole.

These are but two findings from a decade in which the financial costs of cancer increasingly came to light. Another study published in Health Affairs found cancer patients were 2. The medical community made progress toward cures for cancer in the s, and the next decade begins with a growing need for structural changes throughout the health system to ensure cancer patients can actually access and benefit from the research and breakthroughs.

Investigative reporting shed brighter light on several deep-rooted industry problems in the last decade. Stories on surprise billing and skyrocketing drug prices captured the nation's attention and became the subject of public ire, spurring legislators to demand and promise reform.

To date, little substantive action has been taken. Instead, industry stakeholders and partisan lawmakers have taken to finger-pointing, and gridlock has largely prevailed. Federal lawmakers ramped up efforts this year to end surprise medical bills after President Donald Trump vowed to address the issue and media continued to highlight the breadth of the problem. Insurance companies, hospitals and physicians agree: Patients should not be on the hook for surprise out-of-network charges.

However, they disagree over the best way to resolve payment disputes between insurance companies and physicians once the patient is protected. Progress was made on legislation in December after key lawmakers announced a bipartisan agreement. In a unilateral effort to curb the burden of patients' rising healthcare costs, the Trump administration finalized a rule requiring hospitals to disclose the prices they negotiate with insurers for a range of services, beginning in The rule also mandates that hospitals make the fees they charge patients public.

At the same time, the administration issued a health plan transparency proposal that would require insurers to share price information with members before treatment. The dual moves spurred controversy, drawing both derision and support from industry groups.

In December, hospital organizations moved to block the rule by filing suit against HHS, arguing the federal agency lacks the proper statutory authority necessary to enforce such regulation. Even if the price transparency rule takes effect as planned, it's unclear how effective it will be at helping patients avoid cumbersome healthcare bills.

Rising drug prices were, and are, also at the center of legislative and industry blame games. The origins of America's drug price crisis stretch back into the late s, when prescription drug spending increased at an average rate of 9.

In the subsequent decade, the trend worsened. In one memorable drug price-hike story of the s, the drug manufacturer Mylan increased the price of its EpiPen by percent between and Even those outside of healthcare came to associate "pharma bro" Martin Shkreli with the industry.

Shkreli hiked the price of a lifesaving HIV drug by more than 5, percent in The year-old was lambasted on Saturday Night Live and considered costume inspiration for Halloween Who's to blame for sky-high drug prices? Everyone and no one. Pharmaceutical companies and pharmacy benefit managers have blamed one another, and politicians have attributed fault to both stakeholders but largely failed to take action in a climate of severe partisanship.

However, the bill is not likely to become law, as U. The decade closes with other major issues unresolved. Interoperability remains a challenge for healthcare organizations, and the large EHR companies have not stepped up to fill the gap. Opioid prescriptions, while largely curtailed in the last two to three years, have left thousands of individuals in need of treatment for substance use disorders.

Finally, access to affordable healthcare remains elusive, as insurance plans on the exchange market are often expensive, have high deductibles and leave significant gaps in coverage. This was the decade in which hospitals moved from paper to digital medical records, a monumental transition that came with its fair share of costs and obstacles. The law included provisions about EHRs and the meaningful use of the technology. For showing meaningful use of the technology, hospitals could be eligible for incentives.

Of those hospitals, 94 percent were using EHR data to improve quality, patient safety and organizational performance. Throughout the decade, four major competitors emerged: Allscripts, Cerner, Epic and Meditech. For years, Epic and Cerner have continued to dominate the market. A study conducted by KLAS Research of 5, acute care hospitals in found that Epic controlled 28 percent of the market followed by Cerner with 26 percent.

Cerner and Epic have also battled for government contracts, including contracts with the Department of Veterans Affairs and the Department of Defense. EHRs led to the proliferation of patient portals, which give patients more access and flexibility, particularly in terms of contacting their providers and scheduling and canceling appointments. Patient portal use has also been shown to improve patient engagement and reduce inpatient burden on hospitals. A recent study shows that use of a patient portal through the EHR can improve patients' self management of healthcare services, which results in increased outpatient appointments and reduced emergency room visits and hospitalizations.

Around 70 percent of hospital and health system executives polled in a survey about their organizations' main IT priorities for said that they plan to invest in patient portals.

Patients also have more access to clinician notes via online portals, which enables them to be more engaged in their care. OpenNotes, an international movement focused on increasing patient access to their clinical notes on online portals, announced in July that more than 40 million patients now have access to notes written by their providers. More than half of patients consider access to visit notes through patient portals an important factor when searching for a new healthcare provider, a study published in the Journal of Medical Internet Research shows.

EHRs also helped solve the issue of poor handwriting on the part of providers, which led to inefficiencies, errors and delayed care.

Today, the EHR allows hospital staff members and patients to more easily decipher clinician notes. EHR data has also been mined for research. For example, Boston-based Massachusetts General Hospital researchers developed a machine learning-powered software that can scan EHRs to predict dementia risk, while Penn State Clinical and Translational Science Institute developed a research population discovery tool that can examine and validate the feasibility of clinical studies using EHR data.

While EHRs have made patient information more accessible and have improved the quality of care, they have also been cited as a major source of burnout among clinicians. Researchers from Albuquerque-based University of New Mexico found that increased data entry requirements for medical malpractice, quality assurance initiatives, support for billing processes and government policy oversight have added extra administrative work, causing added stress and burnout.

Additionally, a market for EHR add-ons has proliferated in the healthcare industry, which ultimately increases the cost of EHR adoption and optimization. Add-ons include data analytics tools, clinical documentation software, communication tools and artificial intelligence solutions.

In , EHR vendor Epic launched its "App Orchard," a marketplace for third-party developers to showcase pre-approved reporting, visualization and content apps to its customers. Looking to the next decade, EHR vendors will have to work on making their EHRs more user friendly, allowing clinicians to spend more time with patients and less time in front of a computer screen.

Additionally, Cerner, Epic and other vendors may face questions about the EHR industry's lack of interoperability and competition. In the s, agencies, for-profit companies and analysts attempted to get us closer to answering this question via their proprietary rating and ranking systems, all of which spurred larger discussions about consumer transparency and data accuracy and intensified competition between hospitals for the must-have marketing material of grades and ranks.

The most coveted ranking among hospitals today is that of U. In , the magazine rolled out regional rankings as part of its annual Best Hospitals list to recognize healthcare facilities outside major urban hubs, according to Kaiser Health News.

As a result, the rankings became more useful to Americans with average medical needs seeking information on their local hospitals. Additionally, in , U. News updated its Best Hospitals methodology to place more weight on clinical data than on more subjective reputational scores.

Healthcare rankings hit another major turning point in , when the Leapfrog Group launched its Hospital Safety Grades.

Twice a year, the group assigns letter grades to more than 2, hospitals nationwide based on their patient safety performance. While 36 hospitals have earned straight A's in every safety grade update since , the ratings system is a point of contention for many others.

The Leapfrog Group isn't the only healthcare ratings system to undergo scrutiny for its methodology and data accuracy. CMS has also faced a tangle of challenges since unveiling its overall Hospital Quality Star Ratings program in , citing methodology issues as the reason for a handful of ratings update delays and postponements.

Less than a year after the Star Ratings program launched, the American Hospital Association called it "deeply flawed" and publicly called on CMS to suspend it. In December , the Veterans Health Administration discontinued its internal star ratings system to boost transparency and allow veterans to more easily compare VA hospitals. CMS, U. News and other ratings organizations have spent the latter half of the decade refining their methodologies based on this type of industry feedback.

CMS collected more than comments on its hospital star ratings during a public comment period in and plans to update its methodology in News also updated the methodology for its 12 data-driven Best Hospitals specialties in to incorporate more patient-centered measures, better account for differences in patient populations and address constructive feedback from healthcare professionals.

In spite of these issues, however, hospitals and health systems still rely heavily on third-party rankings as a measure of their performance, a source of competition with their peers, and perhaps most significantly, a launching pad for widespread marketing campaigns. In fact, a New York Times investigation found that, due to major discrepancies between the most prominent ratings systems, results are best used primarily as a marketing tool, rather than an objective and quantitative ranking of healthcare organizations.

Despite some of the major challenges they've faced this decade and an ongoing debate over their usefulness, one thing is clear: Ratings systems aren't going away anytime soon. The healthcare industry is constantly changing as new federal payment rules are adopted, costs for medicines rise, new technologies are implemented and consumers demand a seamless care experience.

As a result of the changing landscape, new C-suite positions emerged throughout the last decade. Chief Diversity Officer. The chief diversity officer is responsible for cultivating diversity and inclusion in the workplace. This individual plays a crucial role in recruiting, retaining and developing diverse healthcare leaders and executing inclusion initiatives, like diversity training. Chief Experience Officer. Take a look at the biggest changes to the patient experience below, and read through our infographic to learn how digital healthcare is changing the way we get well.

More important than you might expect, the revolution of electronic medical records has made it easy for doctors to disseminate patient information to one another and reduce the number of lost records. Instead of individual doctors and specialists holding one piece of a larger puzzle, they may now share information seamlessly, leading to better patient care. Predicted by the great science-fiction writer Arthur C. Doctors may prescribe medications through this technology, and even, in special cases, operate on a patient from across the world with the use of robotics.

One of the biggest changes to patient care, remote monitoring allows patients to head home after a procedure earlier than ever, reducing the cost of care for both the patient and the hospital. Patients are free to heal in a more comfortable space, with the assurance that doctors are monitoring their healing via small digital implants.

This technology allows patients to be treated more efficiently and return to their lives more quickly. These devices can monitor your overall health and vital signs, and record the amount of exercise and the things you eat every day, leading to more efficient exercise routines and a better diet.

Reaching near fad-levels of public consumption, wearable technology like the Fitbit have helped millions of Americans lead a better, healthier lifestyle. Wireless communications allows hospitals to function more effectively, providing better all-around patient care. Take a look at our infographic below to learn more about emerging digital health careers, and for more information, browse our Careers Page to find the right career in the medical and technology fields for your aspirations.

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Connected systems with microsensors will monitor and control the release of medicines into the body. All of this could aid doctors in doing what matters most: improving patient health. Figuring out how to execute this improvement in patient health. One option could be virtual visits, which may improve patient and provider satisfaction, as well as improve relationship, reduce burnout, and enhance patient outcomes.

A recent study conducted by Stanford and the Harris Poll found that physicians spend half of their working days using the electronic health record; their response to this survey was to create a new leadership role — chief wellness officer, who could work on issues like improving documentation that may then lessen burnout. Well, for starters, as technology is improving, they will likely want to have continued and improved access to their medical records online, as well as communication with their providers electronically, perhaps quicker than the current standard.

They will want to have a visit with their provider on their terms — when they want it and where they want it — virtually, if possible. They will also want continued advances in technology that benefit them. They will also want a leadership team that continues to work towards these goals. Healthcare has rapidly changed over the past 10 years. There have been many advancements in technology that will continue to improve our ability to care for our patients. Our plea to our healthcare leaders is that over the next 10 years, we continue to grow and accommodate our patients wishes while also caring for our frontline staff.

Future of Healthcare Leadership. Greengard, S. A look into the future of health care leadership. Henderson, R. Growing pressures facing healthcare leadership.

Landi, H. Healthcare leaders look at the past, present and future of consolidation. Then I became burned out and left the floor. So what is going on in healthcare? Present State of Leadership Healthcare leadership is in an interesting state as we move into the next decade. What can we expect in the future? And what to our patients expect? In addition, the ACA holds private insurance companies accountable for charging fair premiums, whether for individual market policies or for employer-sponsored coverage.

The medical loss ratio MLR rules require insurance companies to return money to policyholders and employers if their health plans spend less than 80 percent to 85 percent of premium funds on medical care. The evidence shows that better affordability translates into better access. Between and , the share of nonelderly adults who skipped a medical test or treatment fell 24 percent.

ACA implementation reduced the probability of not receiving medical care due to cost by about one-quarter, and it dramatically increased the share of people who reported having a usual place of care. Prior to the ACA, women faced unique barriers to adequate care. Insurers in the individual market could charge women up to 1. The ACA outlawed gender rating and prohibited insurers from discriminating against people with preexisting conditions.

The latter is a crucial protection for women: About 1 in 2 girls and nonelderly women have a preexisting condition. The ACA mandates that plans include maternity coverage and makes key preventive services available without cost sharing , including breastfeeding support services and supplies; annual well-woman visits; and screenings for cervical cancer, HIV, and interpersonal and domestic violence.

Thanks to the ACA, about 61 million women nationwide can access contraception without any out-of-pocket cost. The ACA also recognized that supporting maternal and infant health required policy changes beyond health coverage.

The law mandates that employers provide breastfeeding mothers break time and a private space to express milk during the workday. About 2. Later on, additional young adults gained coverage though marketplace financial assistance and Medicaid expansion. As a result, the uninsured rate among people ages 18 to 24 fell by half, dropping to 15 percent in The ACA raised standards to ensure that children in low- and middle-income families can access health coverage.

About one-quarter to one-third of new enrollees under Medicaid expansion are children. The ACA also defined pediatric dental and vision care as part of essential health benefits, ensuring that kids covered through both the marketplace and Medicaid have coverage for those services. Further, expanding coverage to adults—through the ACA marketplaces and Medicaid expansion—helps parents stay healthy and provides financial security to the entire family.

Prior to the ACA, 9 percent of individual market plans did not cover prescription drugs. By expanding Medicaid eligibility as well as broadening the Medicaid Drug Rebate Program, the ACA gave more low-income Americans access to brand-name and generic drugs and lowered the costs for taxpayers.

The ACA also expanded the B drug discount to include more providers, including critical access hospitals and rural referral centers. The ACA also laid out a process for faster Food and Drug Administration approval of biosimilars , biologic drugs that are essentially analogous to generic versions of branded drugs. By encouraging competitors for high-cost biologic drugs, the ACA rules on biosimilars can potentially help bring down the price of these types of prescription drug costs and help make new therapies available to patients who need them.

These are all important steps toward drug affordability, but there is much more work to be done. Medicaid expansion is particularly important for coverage and the sustainability of the health care system in rural areas. Rural residents are more likely to be covered by Medicaid: Medicaid expansion reduced the amount of uncompensated care that hospitals provide, boosting the financial viability of rural hospitals relative to their counterparts in nonexpansion states.

While more than rural hospitals have closed in the past decade, the closures have occurred disproportionately in nonexpansion states. The ACA provides patients and the health care system with resources to combat the opioid crisis , which has hit rural areas particularly hard. Without this requirement, only 1 in 3 people covered through the individual market would have had access to SUD treatment.

Many people in rural and other medically underserved communities rely on community health centers and other Federally Qualified Health Centers FQHCs for comprehensive primary care. Federal grants provide 1 in 5 revenue dollars that community health centers receive, and 70 percent of that funding comes from the Health Center Trust Fund set up by the ACA.

Before the ACA closed the coverage gap, about 5 million Medicare enrollees fell into it. The ACA also invested in other improvements for the Medicare program by establishing the Center for Medicare and Medicaid Innovation , which is responsible for developing ways to improve patient care and lower health care costs.

Prior to the ACA, people would be functionally uninsured after hitting arbitrary annual or lifetime coverage limits. The ACA prohibits insurers from setting coverage limits, as well as from denying coverage or raising prices for preexisting conditions. Medicaid expansion has helped many disabled people and caregivers access care based on their income status. Not all disabled people qualify for the traditional Medicaid disability pathway.

Medicaid expansion allows disabled people to join the workforce without jeopardizing their Medicaid benefits and gives low-income workers a fallback option for coverage if they lose access to employer-sponsored insurance. Essential health benefits help disabled people access necessary services. Prior to the ACA, 45 percent of individual market plans did not cover SUD services and 38 percent did not cover mental health care.

Following ACA implementation, people with mental health conditions became significantly less likely to report unmet need due to cost of mental health care. The ACA has helped millions of Americans gain insurance coverage, saved thousands of lives, and strengthened the health care system.

The law has been life-changing for people who were previously uninsured, have lower incomes, or have preexisting conditions, among other groups. Emily Gee is the health economist of Health Policy at the Center.

Maura Calsyn is the managing director of Health Policy at the Center. The positions of American Progress, and our policy experts, are independent, and the findings and conclusions presented are those of American Progress alone. A full list of supporters is available here. American Progress would like to acknowledge the many generous supporters who make our work possible. The U. Supreme Court heard oral arguments in California v.

The case was brought by a number of Republican state attorneys general and supported by the Trump administration.