Choosing the right health plan model can be confusing (at best). When there are so many options out there and little information to help you understand the benefits available to you, it can be easy to just settle for the familiar fully insured option. But let’s face...
A Look Ahead: 2021 Healthcare Predictions
By Steve Kaltrider, Senior Director of Product
2020 and the COVID-19 pandemic shed a lot of light on gaps in the healthcare industry, from how people access care to understanding their options. While we saw some immediate changes made in response to the pandemic and economic crisis last year, there is still tremendous room for disruption and growth in the year ahead.
Here’s a look at some of the biggest changes we saw in 2020.
Health and tech providers formed major partnerships.
Tech innovation proved to be a critical part of ensuring better access to healthcare last year, with a focus on digital access and patient-focused support. Teladoc acquired Livongo as a strategic move to broaden their telehealth services and offer virtual chronic condition management.
Telehealth and remote monitoring coverage were expanded (several times).
CMS expanded Medicare coverage of telehealth visits, adding 85 additional services to support healthcare providers’ ability to offer telehealth options, allowing patients to stay at home and still receive care. Other payers followed suit.
Institutional control around access to medical data was loosened.
A fragmented data landscape made it practically impossible to use data on COVID-19 patients to help fight the pandemic and develop a national strategy.
Stricter regulations around fair pricing were passed into law.
Congress passed the No Surprises Act in a year where unexpected costs became astronomical due to COVID-19, leaving many patients on the hook. The bill sets up an arbitration system to help resolve balance bill disputes and reduce surprise bills, however, Medicare can’t be considered as a benchmark during the arbitration process.
So what can we expect to see in 2021?
Virtual care will continue to become more mainstream.
Providers, payers, and TPAs are building solutions or partnering to offer telehealth and remote monitoring services. COVID has spurred acceptance of this mode of delivery and it’s an access model that can have a lasting positive impact for many populations.
We’ll see more transparency around pricing.
2020 shined a light on a number of the complexities related to the healthcare system, costs and billing practices chief among them: CMS and HHS enacted new price transparency rules and mandated the immediate publishing of COVID-19 testing cash prices.
We’ll also see alternative access strategies, like direct contracts and narrow networks, gain a stronger foothold in the market as more employers seek out ways to control costs while still providing a strong health and benefits offering to their members.
Pharmacy will play a larger role in price transparency and provider access.
As we start to learn more about the long-term cost impact of COVID-19, specialty pharmacy strategies will play a critical role in helping keep health plan costs stable. By providing more transparency around prescription drug pricing, including specialty medications, employers and brokers will have more choice and insight into what’s driving plan costs and how to tailor pharmacy benefits around members’ needs.
We’ll also see retail pharmacies blend more care options, such as clinics, into their consumer-facing offerings, providing additional access points between providers and members. Retail clinic offerings like these, paired with member education strategies, can help reduce unnecessary ER visits and provide more access to primary provider care.
Transparency and access strategies will be key to lowering healthcare costs.
Costs will continue to rise in an effort to compensate for revenue loss due to COVID-19. However, government-mandated transparency efforts and the continued shift away from fee-for-service care will be key strategies for employers.
These shifts, along with the increased focus on wellbeing in the workplace and member education will also have direct impacts on employers’ bottom lines, hopefully resulting in more pro-active care and support models.
Members will (finally) have more of the spotlight and support they need.
The focus on employee engagement and support in 2020 will continue on as a mainstay strategy for employers.
Engagement tactics, like better communication, accessible resources and a focus on physical and mental wellbeing, are shown to have a direct impact on costs. Making healthcare easier to understand and access can result in better health outcomes and lower high-cost plan utilization.
As tough as last year was, we can expect to see some lasting positive changes as a result. Many employers are shifting their focus to cost management strategies that are focused on providing their employees with the support and resources they need. We’re going to see the industry continue to take a similar people-focused view through new offerings, better access and more transparency.
Get in touch with us to learn how we’re helping brokers and employers navigate the healthcare landscape with better options and cost management strategies.