When we shared our 2020 Provider Forecast last year, we didn’t have a clue what was in store for us with the COVID-19 pandemic.  That said, it did force the issue on some of the key trends that we did share, including telehealth and focus on social determinants of health.  One year into the pandemic, we are looking at what’s changed, what’s stayed the same, and pulling out our crystal ball to predict the trends that will impact health care providers in 2021 and beyond.

Care Outside Our Four Walls

Telehealth is nothing new – in fact it emerged more than 60 years ago! However, it has been waiting for its moment – waiting for regulatory and licensing requirements to change, for reimbursement parity, and for consumers to get on board. It took a pandemic, but telehealth is here to stay. In his recent Senate confirmation hearings, HHS Secretary nominee and current California Attorney General Xavier Becerra shared, “If we don’t learn from COVID how telehealth can help save lives, then we’re in trouble.”

  1. Permanent payment changes will also require a shift to alternative payment models: We expect that Medicare telehealth flexibilities that were stood up in response to the COVID-19 pandemic will become permanent, but that providers will need to move to a value-based payment system to address overutilization concerns.
  2. Hospital-at-home: As we look at the promise of telehealth, there is a move to the “hospital-at-home” concept to help manage health care costs by reducing readmissions and supporting the desire of patients to age in place. In November, CMS launched its Acute Hospital Care at Home program in response to COVID-19 surges, which provided further regulatory flexibility for eligible hospitals to treat eligible patients in their homes, through telehealth and remote monitoring. A new advocacy group called Moving Health Home launched just last week, bringing together health systems such as Ascension and Intermountain Healthcare, care delivery services like Dispatch Health and Home Instead, and technology vendors like Amazon Care and Signify Health to help change how policymakers think about the home as a site of clinical service.
  3. Hybrid care models: Systems are looking at hybrid models that fuse virtual and in-person care. There will always be a need – and a desire – for in-person care, but telehealth has become an expectation for many consumers. In the future, smart devices are expected to further enable a hybrid model of care by integrating in-home testing devices as part of virtual visits. From a blood pressure cuff that connects patients directly with their doctor to a portable EEG brain mapping device designed for early detection and supportive care of neuropsychiatric disorders such as dementia, Parkinson’s disease, and PTSD, the possibilities are stunning.

Digital Divide – the New Social Determinant of Health

Telehealth has great promise – but it is leaving behind some of the patients who could most benefit from it.  In many communities, inability to access broadband or Wifi (either because of location or cost barriers) is limiting access to health care.  We’ve talked about the issue in rural communities, but a Journal of the American Medical Informatics Association report found that disparities also fall along racial lines, with Black and Hispanic patients being less likely to utilize telehealth than their White and Asian peers. In addition to access issues, language concerns may impact use – the report found that only about a quarter of Spanish-speaking patients chose to use telehealth over the ED.

Health Equity as a Strategic Priority

Many organizations have had health equity as a focus area – but the COVID-19 pandemic made it clear that health equity needs to be a strategic priority for every health system. People of color have been disproportionately impacted with higher hospitalization and death rates. Health inequality existed long before COVID-19, but the pandemic has magnified vulnerabilities in our health care system that cannot be ignored. Health outcomes are inextricably linked to social determinants of health, especially poverty, structural racism and discrimination – and as pillars of communities, health systems must take on these issues as priorities if we want to move the needle on population health.

Private Equity and Payers as Industry Disruptors

What does private equity have to do with COVID-19?  Turns out, a lot. Most health systems have struggled financially as a result of the pandemic, creating a need for investment and generating interest from private equity. According to the Thomson One database, the fourth quarter of 2020 saw a total of 86 deals, more than any other fourth quarter in the last 20 years. Not surprisingly, equity firms are most interested in telehealth and home health, and continue to be interested in physician practices, especially high-cost specialties targeting distinct populations.

With an influx of capital and a focus on profitability, private equity will bring innovation in care models and technology (and some say higher costs).  However, private equity isn’t the only type of investor we are seeing. Large health insurers like Humana are investing in expanding capabilities. For Humana, this included the acquisition of Kindred Healthcare in 2018 and investments in primary care and physician groups, and digital platforms like Buoy Health and Heal’s house call and telehealth technology.

Challenging Regulatory Environment

Less of an emerging trend and more of an evolving situation is the challenging regulatory environment for health care providers.  Buckle your seat belts folks, because price transparency, high prices, and consolidation will continue to be scrutinized by Congress. Hospitals are already having to comply with the new price transparency regulations, and expectations for reporting will likely only increase. It’s about quantifying community benefit, value, and affordability – and communicating to the right stakeholders on an ongoing basis.

In Summary

2020 challenged hospitals in unprecedented (did you really think we’d write a COVID blog post without using that word somewhere?!?) ways. It pushed our health care system to the brink and forced us to think differently to address ongoing challenges.  Looking back – one year after the pandemic was declared in 2020 – we are more poised for innovation now than ever before. From new care models to new investments to a new lens on important issues, we’re convinced that health care is changed forever – and in many ways, that will be for the better.  

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