Some issues—like access and affordability—just won’t go away. Others, like the convergence of healthcare and technology, are reaching a critical inflection point.

1. Access and Affordability

We are less than two weeks into the New Year and already the US has seen three major stories about healthcare access and affordability. First, a Texas judge’s ruling threatens to take away health coverage from millions of Americans. Second, drug companies increased prices dramatically in the first few days of the year, sparking outrage. And third, it was reported that San Francisco’s Zuckerberg hospital general hospital was engaging in some aggressive pricing practices that left even patients who thought they had insurance coverage facing hefty medical bills.

“2019 will be the year the debate around how we further expand US healthcare coverage, and take steps to make it more affordable, take center stage again,” says Marc Longpre, senior partner and Americas healthcare co-lead for FleishmanHillard. “After two years of failed Affordable Care Act repeal efforts, and just a month after a federal court put the law back in the spotlight, it’s likely 2019 will shift to the question of how best to move forward.

“With nearly 30 million still lacking coverage in this country and recent polling showing cost and affordability to be a top priority for voters, we are likely to get our first glimpse of different versions of “Medicare for All” in the upcoming Democratic presidential debates and in Congressional hearings."

Susan Isenberg, global chair of the health sector at Edelman, believes access has the potential to be a bipartisan issue in the US, given that President Donald Trump continues to express concern about drug prices in particular. “I think you’re going to hear from both sides around pricing and access, and calls for greater transparency.”

In Europe too “the concept of price, affordability and access is a key issue,” says Nicky Walsby, managing director at Syneos Health. “In 2019, with increased scrutiny on drug prices, and a number of novel medicines such as CAR-T treatments and gene therapy that bring with them a price challenge, we will see an increased need for the creation of meaningful, impactful value narratives shaped by experts in the strategic communications and pricing and market access fields.

“Such narratives will encompass emotional and economic levers, and require strong, consistent communications roll-out to key stakeholders.”

The UK, of course, has its own issues. “As the UK focuses on prevention and wellness as part of a £20.5 billion shake-up of healthcare delivery, the nation is actually more concerned about the supply of medicines under Brexit than the NHS 10 Year Plan,” adds John Gisborne, managing director and EMEA co-lead at FH. “What matters most right now – prevention, innovation or just having enough product in the country? The big trends in 2019 will be supply, value, affordability and the industry’s role in the prevention agenda.”

And internationally, according to David Bowen, global head of healthcare, Hill+Knowlton Strategies, the “democratization of healthcare” will bring renewed focus on pricing. “In developing markets, this trend will manifest through increasingly urgent demands by rising middle classes for affordable, high quality care—and political responses to those demands.”

In short, this is truly a global issue.

“In emerging markets public spend on healthcare is still significantly falling short and in many developed markets, particularly in Europe, the inability to afford increasingly impressive therapeutic advances is an ever present issue,” says Wendy Lund, CEO of GCI Health. “Combined with many Asian markets further considering the role that value-based reimbursement can play, national healthcare resource constraints will be a continually growing consideration for communicators.

“The role for us in these constrained environments is larger than ever—our programs must be simple yet sophisticated—focused on changing health behaviour within the reality of varied and pressurized systems.”

2. Patient Power

Ordinary people have access to more healthcare information than ever before, and expanding that access—while also providing people with the tools to make sense of it—will be critical in 2019 and beyond.

“With the speed of healthcare advancements and innovations transforming the treatment of chronic and life-threatening diseases, the biopharmaceutical industry has done well in embracing patient-centricity in unprecedented ways,” says Lund. “However, this is evolving and we’re going to see more and more where people living with a condition simply do not want it to define them. As such, we need to continue to rethink how we’re communicating, going beyond how they are playing an active role in their care and well-being—or care for others—and recognize that they’re living beyond their disease in so many ways and wanted to be seen and treated as people first.”

Adds Tim Goddard, who heads the GlobalHealthPR network from Spectum in the US, “Over the past year, we’ve seen the increased use of the buzzword patient-centricity, driven by recent regulatory mandates from the FDA in the US and EMA in Europe. As a result, we expect to see an emphasis on not just measuring clinical definitions of safety and efficacy, but reporting on what matters most to patients—and determining that criteria based on partnerships with patients more than basic market research—as well as communications being tailored to the patient experience, from clinical trial through market access.”

The Health Unlimited consultancy partners with trends research firm Foresight Factory and sees targeted, personalized communication with patients as an important issue. According to global chief executive Tim Bird, “Scientific advances, including big data, are now combining to allow better and more targeted collection of information. This is paving the way for more precise and individualized treatments.”

But it also brings challenges, Bird says: “The stigma attached to many health issues and diseases such as opioid dependence, HIV, liver disease and others make it challenging to get people with to share personal data, which limits the chances of all people benefiting from advances in medically assisted treatments and health intervention strategies.”

According to H+K’s Bowen: “In developed markets, democratization of healthcare will mean increasing consumer control of data, decisions, and information about care as the gap between consumer informatics and health data continues to erode.

“With all these changes, the power of the public will increase, making it even more important than ever for companies in the healthcare sector to engage that public—and for communications agencies to have the flexibility and diversity to respond to these changes effectively.”

But healthcare communicators would do well to remember the old George Bernard Shaw quote: “The single biggest problem in communication is the illusion that it has taken place.”

“Engaged and health-conscious audiences benefit from greater access to healthcare information and technology but many vulnerable groups are being left behind,” says Bird. “For example, there is a worrying current trend in new HIV infections increasing among some at-risk populations, suggesting that current health promotion and prevention strategies are not working, or more are needed.”

3. The Intersection of Health and Technology

A few year ago when we talked about technology in the context of healthcare, it usually meant medical devices. Then it was wearables, like Fitbit. But heading into 2019, an understanding of technology is essential to understanding the healthcare sector and the changes it is going through.

“It’s much broader than just wearables,” says Isenberg. “We believe that tech companies will continue to move into the health space and offer more innovations and transformations in 2019.”

In some cases, technology leads healthcare, she says, pointing to Uber’s medical transportation arm, Uber Health, or Amazon’s plans to sell software that reads medical records; in other cases, healthcare is leading tech, such as Pfizer’s collaboration with 23 and Me, or biotech companies using AI algorithms to expedite drug discovery and development.

Not surprisingly, a great deal of the focus more recently has been around the role of data and analytics in managing health.

“With the rising use of data in healthcare decision making, the biggest trend for 2019 will be figuring out how we derive insights from data and leverage them to strategically shape communications activities, most effectively reaching the right audiences with the right messages at the right time,” says Tim Goddard, who leads the GlobalHealthPR network.

Isenberg points out that while there has been a lot of focus on increased consumer access to health data, one of the factors driving the patient power discussed above, “a lot of the discussion this year is going to be about how medical professionals and companies are using data and analytics to make better decisions.”

And Brandon Edwards, CEO of ReviveHealth, which is owned by Weber Shandwick, believes the US healthcare system is approaching a critical inflection point when it comes to data.

“For the first time in history, healthcare data is actually becoming much more fluid,” he says. “Consider the inflection point that set off companies like Google, Amazon, and Facebook: it wasn’t about technology—it was about data. Before data was produced and freed in aggregate, pure-play tech companies advanced at a slow, gradual pace. It was the preponderance of data that caused their explosion and ultimate domination. Health tech is beginning to mimic the progress of pure-play tech.

“To date, tech advancements in healthcare have facilitated incremental advancements (like the original, server-oriented electronic medical record). But now that data is flowing more freely, and being produced at parabolic rates from both institutional and personal data sets, we are seeing a similar acceleration in the growth of health tech companies and the scale of their impact. This doesn’t simply mean that the digital health industry will grow; it means that we’re being set up to see the same consolidation and ascendancy of a few key players.”

Other technologies, including virtual reality and artificial intelligence, are also likely to have an impact in 2019.

“AI will continue to be big news, and 2019 looks like it will be a year where we start to be able to sort out what is really just hype from what is real and poised to make a big impact in the industry across the spectrum from drug discovery to diagnosis to treatment and intervention,” says Anne de Schweinitz, global managing director of the healthcare practice for FleishmanHillard.

The availability of new preventive medicine technology is one area where Health Unlimited’s trend-watchers see more activity. “New technologies that connect people to healthcare professionals, services and resources such as health screenings, health-tracking apps and virtual house calls (also known as telemedicine) are becoming more common as more and more people become receptive to them,” says Bird.

That’s particularly true in the developing world. Home to some 1.25 billion people—almost one-fifth of the world’s population—Africa has immense untapped potential, and Mandi Fine, CEO of Johannesburg based F/NE Group, a member of the GlobalHealthPR network, says, “Africa has seen greater urban development and increased wealth, coupled with greater access to mobile phones and the internet.

“Technology will most likely be the key to increasing healthcare delivery on the continent and, more than that, alter and improve the healthcare landscape in future. Technology is currently leapfrogging traditional healthcare delivery methods and systems here in Africa.”

4. Something Corporate

Healthcare public relations has traditionally focused more on public affairs and regulatory issues, on public education around disease categories, and on the marketing of specific therapies, than on good old fashioned corporate reputation issues, but there are indications that healthcare communicators are paying more attention to corporate stakeholders.

Much of that, according to Edelman’s Isenberg, is being driven by the wave of mergers and acquisitions that continues to roil the industry: this year has already seen the announcement of a merger agreement between Bristol-Myers Squibb Company and Celgene Corporation, following December’s news that GlaxoSmithKline and Pfizer would combine their consumer health businesses.

“This creates an opportunity in financial communications, but it also means that companies have to be more sophisticated in terms of employee engagement,” says Isenberg, “because obviously these partnerships have major implications for a wide range of stakeholders, and employees are not only an important audience, they are also a company’s ambassadors to the world.”

In terms of M&A, ReviveHealth’s Edwards predicts that “2019 will be the year we see the first real operationalization of a big, new disruptive initiative from a non-incumbent. This could manifest in a mega-merger or partnership between big brands across payer, provider, consumer and technology companies—all striving to drive actual health care for everyday people. We’ve seen so many partnerships in the past year, but few have included all of the necessary players, nor have they been able to achieve national scale and footprint to drive impact.”

Another potential challenge is litigation. “Litigation and concerns about harassment and social justice have flooded our national discourse over the last year and these high-sensitivity matters continue to be debated in courts, the press—and even in Presidential tweets,” says Jeanine O'Kane of Syneos Health, who says litigation and compliance experts need to work with experts in healthcare communications “to help C-Suite leaders sensitively address their internal and external stakeholders in a polarized climate will dramatically increase in both need and demand.”

That’s another reason that internal stakeholders in general are becoming a higher priority. Says O’Kane, “Employee engagement is the top issue on the minds of business leaders. As we know, there is a direct correlation between engagement and performance. Companies are going to need to increase the dialogue and the transparency of those dialogues. In addition, we will see more employee communication that focuses on helping and helping employees personalize the purpose of their work—I think this will be a new genesis of moving from the purpose-led brand to the purpose-led employee.”

5. Critical Conditions

Finally, there are several disease categories where healthcare communicators expect to see growth in the year ahead.

Michelle Gross, president of Spectrum Science is predicting “an increased focus on niche and specialty programs, because that’s where the science is leading us. We know so much more about these disease areas now that discovering and developing treatments is tangible and very possible, so everyone is trying to own a piece of these newly unlocked areas, which didn’t receive a lot of communications attention before.”

There has been considerable focus recently on the ageing population, in the US and Europe, and in Asian markets such as Japan and Korea, and that is likely to continue.

“The large and aging baby boomer population brings with it increasing rates of age-related chronic conditions, including heart and kidney disease, diabetes and obesity, among others,” says Bird. “Increasing societal emphasis on health, as well as availability of better health screenings, is helping more people take proactive steps to prevent chronic conditions.”

Bird also sees more focus on infectious diseases, which he says are “a global burden and ongoing threat to public and individual health.”

Says Bird, “Greater movement of populations and increasingly diverse societies present new challenges for controlling infectious diseases The growing risk of antibiotic resistance may be especially dangerous for people with compromised immune systems due to cancer, HIV, hepatitis or other conditions. Yet we can prevent the spread of infectious diseases and many can be largely eliminated through vaccination and other types of prevention such as connecting those who test positive with an infectious disease with early and ongoing treatment and self-management education. The need to discover cures/vaccines remains urgent.”