Thought-Leaders newsletter

Perspectives on a selected key topic November / December 2021

hat healthcare trend(s) for 2022 have captured your attention the most and why?"

Lindsay R. Resnick
Executive VP
Wunderman Thompson Health

These 10 trend-defining factoids set the stage healthcare market moves going in
to 2022.

1. One out of every 500 U.S. residents have died of coronavirus From contagion to pandemic to infodemic…ongoing hospitalizations & deaths are now preventable but 25% of Americans choose not to vaccinate…uncertainty and anxiety will persist.

2. Over 50% of Americans are covered by a government health program From ACA to Medicaid to Medicare…whether healthcare is a right, responsibility or privilege, 28 million people across the nation remain uninsured.

3. There’s a 10-year difference in life expectancy between black & white Chicagoans From neighborhood disenfranchisement to voter suppression to health inequity…political determinants of health are just as deadly as social determinants.

4. There are 76 digital health unicorns valued over $1 billion From breakthrough to disruptive to faster & better…innovation across the healthcare’s ecosystem can be transformational, only complacency will slow things down.

5. A 1/3 of all money raised on GoFundMe is for medical expenses From high deductibles to surprise billing to bankruptcy…with $140 billion of medical debt in collections it’s time to rethink consumer out-of-pocket exposure.

6. Drug overdose deaths exceeded 94,000 in 2020 From illicit fentanyl to prescription opioids to heroin…a pandemic worsened an epidemic underscoring need for new laws, new treatments, and new substance abuse solutions.

7. There were 90,000 new health apps introduced last year From COPD monitoring to diabetes wearables to metaverse augmented reality…totaling over 350,000 health apps beware of tech for tech’s sake, technology’s a tool not a solution.

8. More than 50 million people in U.S. experience mental illness From warning signs to access-to-care to social stigma…heightened by COVID fatigue, mental health is in crisis, particularly among America’s youth.

9. The 3,705 health data breaches over last 10-years exposed 268,189,693 health records From privacy to cybersecurity to ransomware…the ‘Internet of Threats’ is a health brand’s reputation buster waiting to happen.

10. A newly retired 65-year-old couple is estimated to need $300,000 for medical expenses From family to finances to wellbeing…security and freedom in retirement begins with preparation knowing there’s a health care cost gap coming..

Natalie Trebes
Director Health Plans, Advisory Board

One of the biggest things we’ve been watching in recent years is the rise of virtual-first products—plans with a benefit structure that encourages members to always start their care with the virtual provider of the plan's choosing. Humana’s On Hand plan with Doctor on Demand was the first of these to launch in 2019 with a handful of others following suit, but it wasn’t until the pandemic brought a clear interest from consumers in virtual care that we started to see many plans offer virtual-first pilot products across 2020 and 2021.

From a payer standpoint, the model is extremely attractive in concept. If all goes as intended, these models could give plans something they’ve always wanted: a stronger lever of influence over the care decisions that members and providers make. By encouraging members to start with a preferred virtual provider, plans are using a lower-cost access point, such as a Primary Care Physician, to give guidance on any next care steps—from following cost-effective treatment pathways to steering to preferred specialists.

But we haven’t seen proof of that yet, and there are many reasons to be wary. As I talk to payer strategy leaders, they’ve pointed out that configuring the right approach is tricky because they have to balance so many tradeoffs. For example, they have to ensure that the out-of-pocket cost impact is meaningful and noticeable to members, so that they respond to the incentives—but not so large that any savings are negated. They also have to design a user experience that members find easier to use (including the integration of data from multiple sources for care coordination and continuity), while also advising them to seek care from preferred providers. And they’ve got to ensure that any steerage or referral decisions don’t conflict with their network contracting priorities with providers in a market.

All of these challenges will heavily depend on which virtual provider payers opt to partner with—as it stands, most virtual-first products are built with third-party virtual care vendors, who often struggle with continued care coordination across the ecosystem. But providers are still struggling to offer robust virtual care options that can offer the capabilities—and rates—that payers need for success.

So in 2022, I’m extremely interested to watch what actually happens across the market with these products—including their popularity, effectiveness, and strategic impact.

Hank Osowski
Managing Partner, Strategic Health Group LLC

As we quickly approach the end of another challenging year there are a number of trends to be excited about as we look optimistically at the coming new year. Among these are the evolution and refinement of telehealth and digital health solutions, the extraordinary efforts to develop and distribute effective vaccines targeting the COVID-19 virus and, importantly, a return to a reasonable sense of normalcy in our daily lives.

There is one trend that is particularly exciting. Though supplemental benefits such as vision, hearing and dental have become key competitive differentiators for Medicare Advantage plans, few ever ventured into the area of supplemental benefits that responded to the other influencers of health, such as the Social Determinants of Health (SDOH). Issues such as social isolation, mobility, housing and food/nutrition have significant impact on an individual’s health.

In 2019, Medicare Advantage health plans were given the authority via the Chronic Cares Act to begin offering a range of special supplemental benefits for those members with chronic conditions. The 2020 CMS Call Letter further expanded on the opportunities for plans to address the complex needs of members with special supplemental benefits that could be delivered in a targeted fashion, rather than applying benefits to an entire membership. This was a major step in the evolution toward keeping members healthy and independent rather than just reacting to an acute care episode.

For the first time plans could deliver special supplemental benefits such as in-home support services, caregiver support, home-based palliative care and home safety devices/home modifications that had a reasonable expectation of improving the chronic disease condition or aiding the member to maintain their health or overall function. This authority was later expanded in 2020 to include meals beyond a limited basis, pest control, indoor air quality equipment, structural home modifications and ADL/IADL supports. This was a major transformation of the Medicare Advantage program. There are many examples of the trade-offs that can be achieved by using this authority to respond to individual member needs. Can a $200 grab bar installation help to avoid a fractured hip and a multi-thousand dollar hospital/rehabilitation stay? Can a nutritious meal program help a diabetic gain some control over their key health metrics and avoid frequent emergency department visits at several thousand dollars each visit?

MA plans were understandably slow in 2019 to adopt processes and procedures to fully embrace this new found authority as they tried to understand the developing rules and regulations and understand the likely return on investment. Many plans experimented with versions of these special supplemental benefits in select target markets while building the capacity to manage and control the roll out. In 2020, slightly more than two hundred fifty of the MA plans offered these special supplemental benefits, while just under five hundred plans began to offer expanded primarily health-related benefits. For 2021 the numbers of plans offering special supplemental benefits grew to over nine hundred and offering expanded primarily health-related benefits grew to more than seven hundred plans. It is estimated that both categories will expand to more than one thousand MA plans for 2022. While this is significant progress, it still only represents about twenty percent of the MA plans in the U.S.

There is an important opportunity awaiting the other MA plans to move into a proactive regimen of benefits for members with complex chronic care needs with a focus on keeping those members healthy and independent. No longer do we have to wait and react to an acute care episode such as an inpatient stay or multiple emergency department visits. This is an opportunity to get to know our members in a deeper and more consequential way. This trend is core to my optimism for a more effective health care system and a healthier beneficiary population.

One concern is that recognition for the tireless and dedicated efforts made by our colleagues on the front lines during the last two years may be forgotten too quickly. These are the real heroes of our industry and the challenges are not over. We hope the trend of our thanks and recognition will continue well into the future.

Pam Nicholson
Director, BDC Advisors

The public’s health and healthcare equity are likely to continue to be high visibility issues for the healthcare market in 2022 as we emerge from the COVID-19 Pandemic. The cost of caring for socially vulnerable populations, many of whom have complicated medical and mental health conditions, can be enormous: an estimated 59% higher cost of care, 79% higher hospital admissions, and 100% higher emergency room utilization than the population as a whole according to recent projections from software analytics leader Carrot Health. As a result, healthcare equity is a growing focus of government programs, with state Medicaid programs leading the way in terms of innovation with a particular focus on targeting the social determinants of health. Health systems can participate, collaborate and invest in the work to improve overall health in the communities they serve by adopting a person-centered approach to population health coupled with the integration of physical and behavioral health to reduce health disparities and control the cost of care. New IT platforms under development in many states will provide a means of digitally connecting healthcare providers and community social service organizations and reshape the continuum of care.

Another major issue for 2022 planning will be the need to develop new forms of provider relationships in an era of value-based contracting and innovative government programs. These efforts will include the integration of digital applications, virtual care, and wearables necessary to provide the connection to patients at any time and any place. Contracting capabilities will continue to be expanded to respond to the challenges and opportunity created by the increasing transparency of prices required in the commercial market. Large health systems have had these capabilities--- in 2022 it will be more important than ever for smaller hospital systems to add this expertise in competitive markets.

Creating durable physician and medical group practice alignment and relationships in time of increasing private equity and competitor physician roll ups will be another contemporaneous issue in 2022. The creative development of innovative partnerships may be a way of offsetting focused competitors trying to disintermediate the relationship between providers and their customer base.

Health Care Systems that serve many communities must be willing to customize solutions allowing for each community hospital to be the pillar of health for those they serve. Health Systems will need to allow for innovative partnerships with payers, provider, and start-ups. They will need to understand digital transformation and the impact it will have on health. As we are coming through the pandemic the need for integrating community resources to address food, housing and financial well-being will be essential to their success. To stay leaders in the transformation of health care, health systems must engage with their communities as never before.

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