The Trends That Disrupted Medicine in 2016: Our Take

Healthcare is ever-changing, it seems now more than ever. What trends are resonating with our colleagues and our patients?

Whether it's emerging technologies, clinical changes, or the fast-paced transformation of the business of medicine, we hope to help you stay on top of it. Here are our picks for what most disrupted the health landscape as we knew it in 2016.

Trend 1: We Are Truly in the Tech Age

Rapidly changing technologies affect us now—and certainly with promises of even more change in the future. One of those is telehealth. In 2015, a total of 200 state-level bills were introduced revolving around telehealth. The government is clearly interested in this area, with its potential to address workforce shortages and reduce health disparities. The reimbursement issue is key—49 states and Washington, DC, are now providing some coverage under Medicaid, and many private payers are mandated by state laws to reimburse "virtual visits" at the same rate as in-person visits.

But what happens when tests are needed? Technology seems to have the answer to that, too, with lab tests that can be conducted at home. Of interest, doctors are coming on board with virtual visits too: A recent [issue of] Becker's Hospital Review reported that 57% of doctors and 64% of patients were interested in telemedicine.^[1]

Telemedicine is not the only technology changing practice; a dizzying array of devices are now available to help our daily practice and are slowly gaining US Food and Drug Administration (FDA) approval as well. One such groundbreaking device is Ahead 300, a technology that could help clinicians on the frontlines in emergency departments or urgent care centers assess the degree of traumatic brain injury in patients with a head injury.

Other examples? Handheld ultrasound that transmits images to smartphones, a virtual otoscope that allows parents to transmit an image to their pediatrician, and continuous glucose monitors. The list goes on. And we can expect more in 2017—devices that will help us to deliver better and more efficient care in all settings.

Trend 2: Old Medicine, or New Age Medicine?

Even though many of us may believe that alternative types of healthcare are not what patients need, the complementary and alternative (CAM) medicine field is quickly growing. Patients are voting for this new model with their healthcare dollars. In 2012, patients invested an overwhelming $30 billion in complementary medicine and the supplement industry.^[2] This year, I had the opportunity to interview Dr Mark Hyman about functional medicine, an area that he has spearheaded. This blend of alternative with traditional medicine could be an interesting—and effective—fit for patients with chronic diseases.

But are other CAM modalities, from acupuncture to supplements, research-based? Some of them do indeed have good evidence of benefit. Unfortunately, some supplements don't have much research at all; being aware of those products that do and do not have valid evidence can help us to deliver better-informed care.

Trend 3: The Evolving Doctor/Patient Relationship

The old-fashioned healthcare model, in which patients visited their family doctor, took his or her advice, and paid for the visit with medical insurance, is changing dramatically. Instead of fee-for-service, a growing number of practices are moving to direct primary care or concierge models, where patients pay providers directly in the form of a membership fee. Doctors who take part in these care models can afford to spend more time with each patient because they have smaller caseloads, and they are less bogged down by the burden of managing insurance claims. But what about those patients and practices where this is not an option? There will be many ethical questions to answer as this trend matures.

Medicine today is also shifting from a process-based to an outcome-based reward system, in which more of the responsibility and burden falls on patients. Will patients' growing desire to have input into their own treatment result in poorer outcomes—and could that reflect badly on physicians? In this new world of patient-centered care, one large healthcare system is now giving refunds for care that doesn't meet their standards. To improve patient adherence while maintaining patient satisfaction rates, doctors will need to gently steer patients to the treatments they need, while still letting them take part in the decision-making process—not necessarily an easy task. Patient portals, utilized by a large percentage of practices, do provide patients with access to the information they want; our job will be to help them understand that information so that they can take a more educated role in their own care.

The location in which patients receive their care is also evolving. As retail health clinics rapidly expand across the country, they add a new level of convenience for busy patients who impatiently want the gratification of an instant diagnosis. Since 2014, retail clinics have increased by 47% and are expected to handle 25 million patient visits annually. Located in pharmacies, supermarkets, and other retail chains, these clinics often provide service at a lower cost than traditional primary care providers. Whether they reduce healthcare costs overall is still questionable. Some research indicates that retail clinics might cost more, on average, than primary care providers.

These are only some of the ever-changing trends in healthcare today. Medicine is evolving, and as physicians, we need to keep an eye on the pulse.

For Medscape, I'm Hansa Bhargava.

Follow Dr Bhargava on Twitter: @dr_hansa

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