The changes brought to the industry in 2020 amid the pandemic continued to weigh on the minds of healthcare executives throughout 2021.
And, as they look ahead to the coming year, they’re expecting similar themes to carry forward: interest in virtual care, the ongoing pandemic response and a greater focus on patients’ social needs.
Hear from 12 industry leaders on what they’re watching in 2022:
Milan Shah, chief technology officer at Biofourmis
Regardless of what happens with the pandemic next year, the shift to virtual care and care-at-home will continue to accelerate. Beyond telehealth visits, 2022 will see increased adoption of hospital-at-home and remote patient management because healthcare providers have seen how feasible it is, and payers are recognizing the inherent cost savings. Most importantly, patients much prefer to be at home instead of a hospital and all stakeholders are realizing that optimal outcomes can be achieved outside of a medical facility. That shift means healthcare organizations will need to work closely with virtual care providers to ensure their networks—and patients’ personal health information (PHI)—is protected from any vulnerabilities.
John Schwartz, chief revenue officer at HSBlox
COVID-19 has focused a sharp lens on the state of health inequity within our current health system and uncovered the value of incorporating social health requirements. With care growing outside the four walls of a hospital and the need for incorporating SDOH, the administration of value-based care contracts will emerge as an important industry issue to address in 2022. This value-based administration cuts across all care settings—traditional site-based, virtual, in-home and in-the-community—and enables whole-person care through the concurrent orchestration of medical and nonmedical care delivery and service assets into high-performance networks. To be successful, however, stakeholders will need to capture and share data on a permissioned basis as well as compensate partners in these contracts who previously have not been part of the traditional medical network.
Michael Dulin, M.D., chief medical officer at Gray Matter Analytics
Everyone in a health system who engages with a patient or participates in the patient experience has a responsibility under value-based care contracts. In 2022, best-practice health systems will incentivize their staff and clinicians as well as patients to discuss and document social determinants of health (SDOH)—from the front door to inpatient discharge planning—as critical to patient health and outcomes. Further, value chain thinking will accelerate the proliferation of social programs to address SDOH, from food security to housing to childcare, employment and transportation. The most successful initiatives will enlist patients in program design and evaluation and incorporate their feedback on whether and how they will use resources from community organizations.
Richard Brooks, president of healthcare at Connect America
The future of digital healthcare at home is the convergence of personal emergency response services, remote patient monitoring and medication management. Payers will deploy platforms that seamlessly deliver reliable analytics that predict adverse outcomes in order to reduce the number of emergency room visits and readmissions as well as hospital lengths of stay. While the savings will be substantial, integrated connected care solutions will equally increase patient engagement and improve communication with the care management team while helping members live longer and more independently in the comfort of their own homes.
Calum Yacoubian, M.D., associate director of healthcare strategy at Linguamatics
Given new federal regulations requiring interoperability of the full medical record, payers will invest in new ways to support management of mountains of data at scale, including artificial-intelligence-powered tools such as natural language processing (NLP). NLP automates text mining to minimize the need for time-consuming manual searches of patient charts, enabling payers to unlock important unstructured data trapped in the notes sections of electronic health records, such as details about patients’ symptoms, disease progression, lifestyle factors and lab tests. By leveraging AI-based solutions, payers will gain access to the accurate, holistic member data that they require to properly assess patients’ health status, rigorously assign risk adjustment and proactively identify gaps in care.
Neeraj K. Sharma, chief operating officer and co-founder of Santech
Payers should be looking at 2022 as an opportunity to transform their provider network management infrastructure and thereby reset their relationships with providers and patients. It’s critically important to bring agility in the network build and launch processes to build an edge in the market and cater to newer models of engagement with providers. The payer business model is shifting fast due to data-centric care models with advanced analytics, automation and decision making. Data friction, such as incorrect data or manual updates, and data nuances are becoming costlier for business decisions. Payers are getting vigilant about such friction and nuances by constantly updating provider data and its impact on network strategy, pricing, claims automation and other downstream areas. Looking ahead, payers joining forces with providers by servicing them with self-service capabilities can ensure the provider data points are accurate.
Dan Greenleaf, CEO of Modivcare
Although the healthcare industry has made great strides in recent years toward a new evolution in healthcare delivery, we can’t rest on the progress we have made. There are still massive gaps in access to healthy food, care and reliable transportation for vulnerable populations across the nation. As we look to 2022, a critical goal every major player in the industry should share is to expand healthcare access. The most meaningful way to help underserved populations close health equity gaps is by delivering solutions that connect members to the community organizations and resources that will enable them to directly address social determinants of health.
Russ Thomas, CEO of Availity
If 2021 is a bellwether for the coming years in healthcare technology, the demands on providers, health plans and all other stakeholders will only continue to accelerate. Healthcare consumers have had a taste of what this industry can achieve during the pandemic—and they want more, and they want it faster. Patient empowerment will be the theme of 2022. The No Surprises Act is a prime example of where the industry is going in insisting that patients have all the information they need to make crucial decisions about their care, including cost. It sounds so simple, but for health plans and providers, unraveling the complexities of determining the cost of care is an impossible task to achieve on their own. So much so that enforcement of the Act has yet to be determined. When you combine the pace of innovation with the complexity of the healthcare system, health plans and providers will be looking to partner with established solutions that truly understand their businesses and can address the challenges that lie ahead, like the No Surprises Act. Healthcare is so unique in that newer, faster, and shinier isn’t always better like it is in other industries. Real solutions in healthcare require knowledge that comes from experience—and it’s on that foundation where real innovation happens.
Oron Afek, CEO and co-founder of Vim
2022 will see a continued rise in creative partnerships between payers and providers to make the transition to value-based arrangements easier for physicians while in turn reducing administrative burden. Traditional barriers to entry into higher performing risk-based partnerships, such as heavy IT lift and workflow connection limitations, will continue to fall as new technologies take hold. The new partnerships and digital infrastructure solutions that emerge will be good for patients, good for providers, good for health plans, and good for the nation’s health system overall.
Damon Auer, chief executive and general manager of North America for Dedalus
“Interoperability with a purpose” will become an increasingly important mission in 2022 and beyond. Members and providers will either view payers as a helpful partner in regards to improving interoperability and price transparency for members or they’ll be perceived as another data dinosaur. For the payer community, it’s important to focus not only on regulatory requirements surrounding data but also on personalized member experience. Payers need to determine the information most important for each member along with how to serve up that information to that member, in the right medium and at the right place and time to be most useful.
Rob Cohen, president and general manager of Bamboo Health
Quality healthcare relies on the ability of providers to share patient data and coordinate care. Care coordination requires interoperability between the EHRs of primary care practices, specialists, hospitals, labs and payers. As we continue moving toward value-based care, it will become increasingly important that other relevant stakeholders such as community-based organizations (CBOs) also are able to share data with providers.
Kyle Silvestro, CEO and founder of SyTrue
Payment Integrity programs will become more crucial to health plans as they aim to save money and cut costs. Organizations will look to bring this function in-house using innovative technologies and automation that can be deployed around DRG audits and other clinical reviews.
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