With startling serendipity, a month to the day after the ACHA passed out of the House, Anthem joined Aetna, Cigna, and Humana in quitting the ACA health plan marketplaces in Ohio. The very next day, Premera Blue opted to end participation in two counties in Washington state, adding another region of the country poised to be without coverage through the ACA. Blue Cross and Blue Shield of Kansas City is also planning exits impacting some 25 counties in western Missouri.

And now that we’ve seen what’s in the Republican’s Senate healthcare bill, it’s unlikely those health insurers will reverse their business-driven decisions. In the process, the problems for individuals and families with coverage through an ACA marketplace will get worse in all probability. What’s more, those who have employer-provided health plans are contending with their own set of healthcare-related troubles.

According to the Kaiser Family Foundation, 83% of workers who are getting some form of coverage through their employers have plans with deductibles. That dollar amount has gone up nearly 50% in the last five years. Data from the Centers for Disease Control and Prevention show one-quarter of those covered have high-deductible health plans (HDHPs), and most anticipate this form of policy will soon become the standard. Kalorama Information, a medical market research firm, noted recently that Americans will be shelling out a stunning $608 billion from their own pockets by 2019.

Healthcare organizations have been slow to react to the fact that an increasing percentage of their revenue is coming from patients. It’s been occurring over the last ten years.

In 2006, just 5 percent of employer health plans had members enrolled in high-deductible health plans (HDHP). Last year, nearly one out of three covered employees was in an HDHP, according to Kaiser Permanente. Along with that enrollment growth is the rise of deductibles, which, notes Kaiser Permanente, is outpacing earnings and savings rates by a factor of six.

Four years ago, the management consultancy McKinsey & Company took a look at revenue cycle operations in hospitals and made the following observations:

"Today's realities are that managing a practice is more complicated than ever…"

That's how an assessment begins on what it takes to successfully run a medical group in 2017 by Triple Tree, a merchant bank focused on healthcare. In a recent report, the bank also looked at the forces driving mergers of specialty groups. Chief among them is the realization by administrators and their physicians that the healthcare business isn't what they hoped it would be.

The mounting pressures are affecting medical groups' top and bottom lines. The bank's report suggests that while opting to be part of a larger group might sound attractive to an independent practice, the non-clinical demands are the same, just more complex.

And that is why all medical group administrators must realize the way to manage their group should sync with the business environments in which they operate. According to TripleTree, a critical success factor is administrative and operational efficiency, due to the significant burden created by government regulation. It also noted that groups need to support and keep pace with changing consumer preference.

The changes that have occurred thus far are likely to pick up speed, in part because of who will be working for the White House. Trump’s choice for Secretary of Health & Human Services, Tom Price, MD, is a supporter of consumer-centric health plans. Further, Vice President Mike Pence brings with him experience as governor of Indiana where he oversaw the implementation of consumer-centric healthcare policies. Adding to that, Pence’s health plan architect was Seema Verma, who’s been tapped to head the Centers for Medicare & Medicaid Services (CMS).

The essentials of consumer-centric healthcare include empowering the patient to make choices, be involved in the decision-making process for her/his care and, it should be emphasized, understand what the costs are upfront by way of transparent pricing and candid conversation.

The driver behind this consumerism is the emergence of high-deductible health plans (HDHP). Back in the day, a patient’s financial responsibility for their healthcare was often a single digit percentage of the cost, if that. Now, with HDHPs, a patient is confronted with 30% to 50% of the financial responsibility for their care.

Immediately after the 115th Congress of the United States was sworn in, Republican leadership of both houses began their move to dismantle much, if not all, of the Affordable Care Act, also known as Obamacare, which sought to bring health insurance coverage to more Americans.

I am not qualified, nor interested in exploring what we might see in the ACA’s place, but with that said, as the CEO of a company offering solutions that bring greater operational efficiency to healthcare providers, particularly in regards to patient payments, my interest ought to be apparent.

If we blow away the cloud of confusion surrounding the effort to do away with the ACA, one thing is clear: uncertainty. Despite all that’s unknown, it appears clear that consumerism will be a major part of healthcare’s future, according to Rep. Tom Price, who is the nominee to head the Department of Health and Human Services; Rep. Paul Ryan (R-Wis.) the majority leader in the House; and President-elect Donald Trump.

Mobile devices will be the chief mode of access for the Internet, accounting for three out of every four minutes of connectivity in 2017. That forecast was made recently by Zenith Media, a unit of Publicis, a global marketing group. That represents a seven percentage point rise from this year’s 68 percent. It also projects mobile Internet usage will reach 79 percent by 2018, nearly doubling since 2012.

Gartner, the technology industry and advisory company, estimates that 50 percent of all digital commerce in the United States will be transacted on mobile devices in the new year.

None of this should be surprising. Marketers have always shown a savviness to engage customers in ways that reflect their preferences. Evidence of that, as well as a further indication of the importance of mobile, is another data point in Zenith’s forecast. It reports mobile advertising will overtake desktop ad spending next year and will account for 60 percent of all Internet advertising, making it bigger than newspapers, magazines, cinema and outdoor advertising combined.

President Barack Obama called upon America to apply all its innovation to create a moonshot-like initiative to rid the scourge of cancer during his final State of the Union Address, Jan. 12, 2016.

The term "moonshot" comes from a speech given on May 25, 1961 by President John F. Kennedy. He asked America to undertake a space exploration program; landing men on the moon by the end of the decade. Interestingly, President Richard M. Nixon first used the imagery of a moonshot for healthcare in a 1971 speech where he too talked about finding a cure for cancer

Clearly, we're better able to meet the challenge than when Nixon put it before us. However, the point I wish to make with this blend of history and optimism is as fast and far as healthcare goes in research, discovery, procedures, treatments, and cures, that's how slow it moves with to make its operational side more efficient, easy and equitable. Take a stroll through the business office of group practice and you’ll see what I mean. The level of inefficiency, in terms of process and cost-effectiveness, is disturbing.

I have a friend who lives in New York City. For the sake of protecting the innocent, let’s call him Sam. What follows is his experience during a recent appointment with his urologist for a post-surgery check-up as well as some pertinent observations.

Sam uses a big group practice affiliated with a large teaching hospital in Manhattan. He’s more technically savvy than most, so the idea of working through a portal to make an appointment or check on test results doesn’t faze him. He even uses the HIPAA-compliant messaging system to ask questions of the doctors in the practice. He finds it amusing that an emailed notice of a bill sitting somewhere on the portal shows up a day or two after the same bill in paper form shows up in the snail mail.

You’re sitting in an exam room with a patient who’s been with you for years. There have been a wide assortment of maladies addressed over that time. And, to the delight of both you and your patient, the outcome has always been successful. From all outward appearances this looks to be a superb relationship. You understand him. He trusts you; even recommends you to folks he knows.

But now this patient asks you how much something will cost as he recently switched to a high deductible plan and the initial dollars are now coming out of his own pocket. Your conversations have evolved from discussing just clinical issues to costs. I strongly suspect most providers can’t answer cost questions as well as they can clinical issues and, more importantly, don’t want to answer since they see it as the job of administrative staff.

The Kaiser Family Foundation reports in its 2016 Employer Health Benefits Survey that the average insurance premium for a family covered by health plans offered by employers rose just 3% this year. This is actually a slowing of the rise of premiums for such insurance coverage, which is the biggest source of health coverage in the United States.