01/24/23
As the new year gets underway and trends pieces abound (grunge 2.0! viva magenta! wooden satellites!), it’s time to pull out the crystal ball and add our own predictions to the conversation.
What we see in healthcare for the year ahead:
New care delivery models: It’s not just the doctor’s office anymore
Health IT: Technology to address physician burnout
Artificial Intelligence: AI/ML to play a role in clerical, clinical, and consumer-facing advancements
Social determinants of health: Crucial “non-health” factors move to the forefront
Biosimilars: A pivotal year ahead
Value-based contracts: A spectrum of solutions
Let’s take a closer look.
This year will see a proliferation of convenient care treatment sites that go well beyond the doctor’s office. Retail health clinics have seen significant growth over the past couple of years, initially popping up as convenient COVID testing sites and then gaining traction as patients whet their appetite for accessible, convenient, no-appointment-needed, low-cost care.
Retail health clinics are expected to double their share of the primary care market in 2023, according to consumer research firm Forrester. More retail companies will join the ranks of the well-established CVS, Walgreens, and Walmart sites. The big players are doubling down as well, as evidenced by CVS’s new partnership with Carbon Health and Walgreens-backed VillageMD’s impending acquisition of Summit Health. We are also seeing broadening participation of on-demand virtual primary care, such as Amazon Clinic.
As retail settings have raised the bar on patient experience, this shift toward convenient, consumer-centric care has become a broader trend. Health plans that can deliver consumer-centric experiences to their members will have a competitive advantage over plans without the same approach, notes an article in Managed Healthcare Executive.
This movement towards healthcare consumerism (a term we have a hard time applying to patients) will also fuel demand for greater transparency. As patients bear a greater burden of the total cost equation, their demand for more control, transparency, and trust over their own healthcare will be crucial to the patient experience.
Our take: We’re happy to see patients demanding access to convenient, high quality, low-cost, transparent care. Our approach at WithMe Health has always been to put the members at the center and meet them where they are with the support they need.
This movement towards consumer-centric healthcare will also drive a desire for payers to collaborate with providers to manage patient care. This may add to the strain already felt by providers who are overwhelmed by administrative burdens. According to a recent survey from the AMA, Mayo Clinic, and Stanford Medicine, 63% of physicians experienced symptoms of burnout.
As we see advances in interoperability and the secure exchange of healthcare data, technology solutions, such as ePAs (electronic prior authorizations) and e-Prescribing can help alleviate provider administrative burden by speeding time to resolution and replacing time-consuming manual processes such as fax and phone calls.
Telehealth will also continue to grow in 2023, expanding care access for underserved communities, as well as alleviating the pressure on understaffed, overburdened hospitals, according to MedCityNews.
Our take: Any advancements that build towards a more seamless care experience, connecting provider, payer, and PBM, are a win in our book – improving outcomes, lowering costs, and enhancing the member experience.
AI/ML is also poised to help ease the administrative burden according to Forbes. For example, ML can interpret written and faxed documents and structure that information into smart workflows, increasing speed and efficiency for a clinical team.
AI/ML algorithms are also being developed to process the massive amounts of healthcare data available. The insights derived from these analytics can impact chronic disease prevention and long-term treatment plans, as well as assist in drug discovery and diagnostics, according to Tateeda Global.
Artificial Intelligence is also impacting the way patients interact with the healthcare system. Chatbots (AI-backed computer applications) are becoming widespread across industries and are capable of providing feedback on basic patient symptom inputs. However, according to Tateeda Global, there is a high rate of misinformation and incorrect self-diagnosis, so these tools should be used with caution.
…and we wait in anticipation of the impact of OpenAI and the power of ChatGPT. It's downright frightening to think what may occur (good and bad) when those models are trained towards the healthcare sector.
Our Take: At WithMe Health, we leverage predictive analytics in our Analytics Engine to identify members at risk of non-adherence and future complications. While we are excited about the role AI/ML will play in healthcare, we also believe the human touch is a crucial element in patient guidance and care.
A person’s overall health status is determined by much more than just clinical factors. Providers this year are expected to focus more attention on their patients’ social determinants of health (SDOH), a term that includes demographic, environmental, and socioeconomic factors. These non-medical factors predetermine health outcomes by 80%-90%, according to Tateeda Global.
Providers will take a more complete view of patients’ medical histories, allowing them to focus more on prediction and prevention through prescribing prophylactic procedures to stop the advancement of adverse conditions versus reacting to and managing symptoms after conditions have already progressed.
Our take: We take a holistic look at members, integrating SDOH data into our Analytics Engine that drives our Medication Guides’ member outreach and interventions. Our Medication Guides are trained to work with members to understand their needs, remove barriers to care, and help them live their healthiest lives.
2023 is expected to be a pivotal year for biosimilars. Seven biosimilars referencing AbbVie’s autoimmune drug Humira are set for launch this year. Amgen already has four biosimilars in the US market and another eleven in its portfolio. According to an analysis by Amgen, the healthcare system has seen an estimated $21 billion in savings due to biosimilars over the past six years.
President Biden’s Inflation Reduction Act now includes a provision to incentivize biosimilar competition, increasing the amount Medicare will pay providers to use biosimilars instead of the branded biologic.
Unlike generics, biosimilars are not identical to the reference biological product. Biologics require living organisms to develop active compounds so they cannot be exact replicas. They do, however, need to demonstrate that the differences are not clinically meaningful. This can make things more complicated for PBMs and pharmacists. While the insurance formulary will dictate which biosimilar or reference drug will be covered, unless the FDA has given the biosimilar the designation “interchangeable”, the prescriber must sign off before it can be substituted for the reference biologic. Some states actually require prescriber sign-off even with an “interchangeable” designation. While only three biosimilars currently on the market have this designation, several launching in 2023 are expected to be designated “interchangeable”.
Our take: Biosimilars represent a significant opportunity to reduce costs while improving adherence and health outcomes. As with all advances that impact our members’ medication experience, WIthMe Health will work closely with our members to minimize disruption and ensure they understand their options.
Value-based-care (VBC) arose in the 1990s and early 2000s as an alternative to fee-for-service structures. Under VBC models, provider compensation is tied to health outcomes. According to Bessemer Venture Partners, VBC has been slow to adoption. Thirty years in, only 15% of physicians participate in value-based-care models, and of those only a third have seen a marked improvement in quality. However, Bessemer argues that all is not lost. Payers and partners are expected to continue to invest in VBC solutions in disease categories that have seen success with the model, such as cardiology and orthopedics.
Additionally, government programs, such as CMS Specialty Care Models and ACO Reach, continue to promote value-based-care. We have also seen interest in regional partially risk-bearing provider groups, where providers collectively assume financial risk for a portion of healthcare delivery costs. Instead of abandoning value-based-care, Bessemer posits that we’re likely to see a broader range of models falling along the spectrum between VBC and fee-for-service. Despite the model, transparency and data technology are key to the success of any full or partial value-based care model.
Our take: At WithMe Health we are committed to aligning incentives in the healthcare system. We are so confident in the ability of our Medication Guidance model to drive savings through utilization and clinical guidance that we share in the risk by guaranteeing a specific level of savings for our clients.
Bring on 2023. We’re ready!
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