Health care stayed at the top of the news in 2015, as it has for the past several years.  The Affordable Care Act continued to dominate much of it, although passions surrounding the law seem to have cooled somewhat.

But there is a lot more to health care in America than the ACA. Other important developments that received less media attention are also changing our care and the way we pay for it.

Here is my list in reverse order of importance of the five most underrated health care developments of 2015. Of course, a list that pares down dozens of possibilities to a handful must be somewhat arbitrary. But each of these developments reflects an important trend that bears watching.

5.            Drop in young adult smoking

Most public health officials see smoking as the greatest single health scourge in the world today. Decades of public health efforts to reduce it have seen slow success, but a recent trend is especially encouraging.

According to a recent Gallup survey, cigarette use among young adults aged 18 to 29 has dropped markedly - from 34% in the period between 2001 and 2005 to 22% in the period between 2011 and 2015.

Some of the decline may be due to greater use of tobacco alternatives, such cigars, pipes and smokeless tobacco. However, the decline in cigarette use has still outpaced growing use of these other products. If that trend continues, the effect on the burden of chronic disease and on health care costs could be significant in the decades ahead.

4.            Physician-prescribed apps for chronic care

It is no surprise that technology is transforming health care, but the pace has begun to accelerate. Apps are moving beyond general health advice and tools for health monitoring. A new generation of apps is prescribed by physicians for use under medical supervision to treat specific conditions in a similar manner to pharmaceuticals. They include tools for recovering from surgery, managing cancer pain, and adhering to HIV medications.

This is the leading edge of a trend that is reshaping the care we receive. Your next doctor visit may end with advice to take an app and call in the morning.

3.            Triumph of public health over Ebola

A year ago, health news was dominated by the worsening Ebola epidemic in West Africa. The death toll was mounting rapidly, eventually exceeding 11,000, and fear was spreading as quickly as the disease itself. Fierce political battles were waged over quarantining travelers from affected countries and banning travel to those countries altogether.

This week brought news that Guinea, the last country with active cases, is now Ebola-free. The public health response to the disease was slow to start, but once it finally got going, a campaign that combined treatment, isolation, and health education prevailed.

Lessons were learned for responses to future outbreaks, but the ultimate message is clear. A strong public health infrastructure is essential to keeping us healthy and safe in a world of constantly emerging disease threats. Political leaders may finally be taking notice.

2.            Continuing drop in the rate of uninsurance

The percent of Americans with no health insurance continued in free fall for the second straight year. According to the Centers for Disease Control and Prevention, it stood at 14.4% in 2013, at 11.5% in 2014 and at 9% today, an all-time low.

The ACA deserves much of the credit, although opponents point out that many of the policies offered on the insurance exchanges are quite skimpy. Nevertheless, more Americans with health insurance means more people receiving needed care. It also means fewer unpaid hospital bills and more patients purchasing pharmaceuticals.

This is a tremendous boost for access to care and for health care business that will grow over time.

1.            Bipartisanship to reform Medicare

A bipartisan effort in Congress (that right, bipartisan!!) eliminated a serious glitch in the Medicare payment formula for physicians. In 1997, the program had added an automatic adjustment to physician pay of about 1% each year, known at the Sustainable Growth Rate, to limit overall spending. But every year since then, Congress delayed the adjustment before it could take effect, adding it to the following year's amount.

The cumulative effect of these delays produced a total adjustment of 23% for 2015 - enough to put many physicians out of business.

Rather than simply delaying the adjustment for another year, both parties agreed on legislation to eliminate it altogether. Physicians no longer face the annual prospect of a large pay cut, and, perhaps more importantly, Congress showed that bipartisanship on health care is possible. If bipartisanship can succeed on this issue, it may spread to other health care concerns.

These developments may not have received the most media attention. But their effects on our health care will be with us for years to come.


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