A look ahead at health news in 2017

Dec. 27--The past year saw skyrocketing health insurance premiums, an election that threatened the Affordable Care Act, fading concerns about Ebola and increasing worries about Zika.

What will the new year bring in health news?

We asked Northland experts to look into their crystal balls, and here are their thoughts on some of the big topics:

Affordable Care Act

"There will be some significant changes to the Affordable Care Act (ACA). I don't know what that'll look like, however, with the new administration and Congress. If they decide on a full repeal, they'd need to have some other strategy and efficient timeline for replacement vetted as not to cause massive budget costs and increases in the uninsured. I'm hopeful that smart, thoughtful revisions to the ACA would be implemented to improve the current system, rather than throwing out the good parts with the bad."

Cassandra Beardsley is executive director of Two Harbors-based Wilderness Health.

"Repealing the ACA won't even be the biggest part of the story. What we will all have to follow closely is what replaces it, and how any new legislation affects health care delivery and financing at the federal and state level. I know our efforts to reshape health care delivery will continue with patients, other providers and private insurance companies regardless of what happens; however, the opportunity to reshape health care working with our public payers such as Medicare, Medicaid and others will be influenced by the actions of our elected officials at all levels of government."

Rick Breuer is CEO and administrator of Community Memorial Hospital and Sunnyside Health Care Center in Cloquet.

"Our center is particularly interested in how any changes to the ACA might impact health service delivery and access to care in our rural communities. Medicaid expansion is important to rural hospitals and clinics that operate on a low margin. Furthermore, the health insurance marketplace has brought coverage health to more rural citizens although there is room for improvement in developing networks and lowering deductibles. The impact of changes in the ACA for rural communities will be important to watch."

Sally Buck is CEO and Terry Hill senior adviser of the National Rural Health Resource Center, which is based in Duluth.

"Already in Minnesota, we are seeing more high-deductible insurance plans. These high-deductible plans have changed the way people access and utilize health care. It will stress the importance of shared decision-making between the physician and patient as to what tests are performed. Also, patients also are demanding alternative options to care outside of the traditional office visit. Serving patients in rural areas has meant we are using care points like telehealth visits, messaging options with care team members and remote monitoring for heart disease now and more in the future. Physicians and advanced practitioners need to be flexible, responsive and creative in how we respond to their needs within a framework of increasing health care provider shortages."

Dr. Peter Henry is chief medical officer for Essentia Health. He is based in Brainerd.

"The most important health care industry news story of 2017 will be about how and when the Trump administration and the Republicans in Congress bring about the demise of health insurance for economically disadvantaged Americans. There will undoubtedly be lots of talk about more 'choice' and more 'freedom,' but the changes they devise will boil down to proportionately more access and financial advantage for wealthier people, and less for others. The linguistic contortions Republicans will need to undertake in order to mischaracterize this policy larceny would be more entertaining if the likely consequences weren't so tragic. I'm not confident the news media is able to report about health care finance and reform intelligently so it will be interesting to see if the public actually understands the ramifications of the changes that will be made. If the urge to privatize reaches into Medicare benefits, we could see a significant reaction by voters in the midterm elections."

Phil Norrgard is director of human services for the Fond du Lac Band of Lake Superior Chippewa.

"Changes to the ACA could impact major employers in the Duluth-Superior area like St. Luke's and Essentia, and the reduction of the Medicaid funding could have a major impact on the state of Minnesota. Currently, the federal government is paying a majority of the Medicaid expansion. If this money is reduced, it would mean the state of Minnesota would have to fund the shortfall, which could be extremely difficult for the state."

John Strange is president and CEO of St. Luke's hospital.

Emerging diseases

"First, we are likely to continue to battle with emerging diseases. The relative ease of travel allows for disease spread in ways that we have not previously imagined. Thus, diseases spread from human to human on one continent can quickly impact us in the United States by virtue of someone getting on a plane. An example of this is the Ebola virus, which we experienced a couple of years ago.

"We will also continue to see spread of diseases such as the Zika virus and Lyme disease as insects respond to the environment. A couple of diseases to watch out for on the horizon are another tick-human disease found in Africa and Asia known as Crimean-Congo fever and the MERS virus. Active development of vaccines is underway for several of these emerging diseases.

"Second, we have seen the ravages of narcotic drug abuse in our region and across the nation. However, the heightened awareness has spurred physicians to be more cognizant of our prescribing habits. The Minnesota Prescription Monitoring program will help us share information across health systems and locales so that we can catch individuals who are misusing narcotic medications. We are also becoming inspired to create more thoughtful approaches to pain management and to develop nonpunitive programs to help those affected by addiction.

"Lastly, at the University of Minnesota Medical School, Duluth campus, we will continue to fight against health disparity by producing physicians who serve our rural and Native American communities. In addition, we are supportive of a diversified health workforce that can provide an array of health services and preventive care. We support and have contributed to the growth of telemedicine, particularly for mental health services. Appropriate mental health care across the spectrum is one of the most needed types of care in our state. Innovative methods of care delivery such as telemedicine will help to bring care to all areas of Minnesota and, in particular, our rural and underserved areas."

Paula Termuhlen is regional campus dean for the University of Minnesota Medical School, Duluth campus.

Healthy Duluth

"During 2017, Duluth will take great strides in becoming a healthier community. There are several initiatives already underway, such as adding health as a principle in the city's comprehensive plan; greater emphasis on active living and outdoor recreation; local hospitals, public health and community organizations working together on our community's greatest health issues; efforts to improve mental health; and more focus on fresh and local food. These initiatives and many others recognize that most of what contributes to health happens where we live, work, learn, pray and play -- not within the walls of our health care organizations. Next year, Duluth will build on these efforts and continue to improve the health and well-being of our entire community."

Jenny Peterson is executive director of Generations Health Care Initiatives.

Lung cancer

"I think one of the most important health news stories in 2017 will be strides we make in lung cancer survival rates (by the way, lung cancer is the No. 1 cancer killer for women and men), with more high-risk people getting early screening and targeted cancer treatments."

Pat McKone is director of mission programs for the American Lung Association of the Upper Midwest.

Medicare, Medicaid

"Under the Trump administration and with a Republican-controlled Congress, I believe we will see major changes to Medicaid and Medicare, many following the proposals of Speaker Paul Ryan and of incoming Secretary of Health and Human Services Tom Price. I suspect Republicans will roll back the Obamacare Medicaid expansion and change Medicaid by giving more control to states with block grants for financing. Under that model, I expect many states will reduce eligibility for coverage and benefits due to reduced federal funding. The Ryan and Price Republican models also propose more privatization of Medicare by having private health insurance carriers offer Medicare policies, many with less coverage and narrow networks of providers. Ironically, Republicans will likely adopt Medicare exchanges similar to the insurance exchanges under Obamacare as part of this effort to have Medicare operate through private insurance."

Rep. Jennifer Schultz represents District 7A (eastern Duluth) in the Minnesota House of Representatives. She serves on the House's Health and Human Services Reform Committee.

Mental health

"I think mental health will be a top priority in the Northland in 2017. Key stakeholders in both the private and public sectors have been meeting this past year to address one of the top areas of need as completed by the Community Needs Assessment. In 2015 alone, the cost of care for the top 200 utilizers of mental care in both Duluth hospitals was a staggering $37.1 million. The collaborative is currently gathering information of perceived needs of both community members and mental health providers. The challenge will be to look outside the box of how we improve treatment for patients with mental illness with the possibility of a triage center, crisis beds and acute management as ways of improvement. We can do better both morally and financially for our citizens."

Commissioner Patrick Boyle represents St. Louis County's 2nd District. He also sits on the Public Health & Human Service Advisory Committee.

Opioids

"The current crisis of opioid prescribing and addiction will continue to be a major issue for 2017. St. Louis County continues to have the highest rate of accidental narcotic overdose deaths in the state, according to the Minnesota Department of Human Services. Physicians and health systems are currently working hard to implement best practices for prescribing and monitoring patients. Innovation regarding addiction treatment and access to treatment will also be a focus. Further, new prescribing guidelines for naloxone (Narcan), and its greater accessibility for the acute treatment of overdose will become more widespread."

Dr. Joe Bianco is Essentia Health director of primary care, family medicine provider and research collaborator for the Essentia Institute of Rural Health.

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(c)2016 the Duluth News Tribune (Duluth, Minn.)

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