1.  Privacy & Data Security

2014 brought huge and expensive data breaches across all sectors to include many in health information data. The challenging task going forward will be implementing the correct balance of secured privacy and convenience.  There’re estimates that upwards to over 5 million patients had their personal data compromised in 2014.  Complying with HIPAA in 2015 will become more important than ever.

2. Digital, Mobile and Telehealth

The health tech boom and the widespread use of smartphones, patients are transforming into savvy health care consumers.  In the next five years, the telehealth market is expected to reach over $1.5 trillion, driven by the use of 7 billion smartphones. This will open health care providers to deliver health care and wellness in a more ways than we have ever seen before. It will as well bring risk a new security breach issues.

3. Fraud and Abuse Enforcement

The new HHS FY2015 budget reflects the larger focus on fraud prevention and improper payments this year. The Budget includes a $403 million mandatory investment in HCFAC and the Medicaid Integrity Program as part of a multi-year investment to enable HHS and the Department of Justice to detect, prevent, and prosecute health care fraud. Additionally, the Budget proposes $25 million in new discretionary HCFAC funding to support program integrity activities in private insurance, including the Health Insurance Marketplaces. The budget also proposes a series of new authorities to strengthen program integrity oversight.

4.  King v. Burwell (U.S. SUP. CT.)

The Supreme Court has agreed to decide how far the federal government can extend its program of subsidies to buyers of health insurance. Oral arguments are expected to be held in March 2015, and a decision is expected by late June or early July 2015.

5. New and Expanding Payment Models

The current administration wants 30 percent of payments for traditional Medicare benefits to be tied to alternative payment models such as accountable care organizations by the end of 2016. They want even larger portions of hospital payments to be tied to quality or value-based payment models. HHS indicated that it wants 85 percent of Medicare’s hospital payments made through programs such as the Hospital Value-Based Purchasing Program or the Hospital Readmissions Reduction Program by the end of 2016. Transitioning to value-based reimbursement has only just begun.

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