Will more provider revenue be directly tied to value more than fees in 2023? Will telehealth continue to expand as a care and payment model? Here is what the experts have to say. And check out all our 2023 prediction posts.
Virtual care is at an interesting crossroads coming into 2023. On the one hand, study after study shows that patient interest and demand to access virtual care for routine matters is very high – especially for items like mild urgent care issues, stable chronic disease follow-ups and mental health. On the other hand, reimbursement for virtual care is trending down and office-based doctors are getting back to their comfortable workflow of seeing patients in their physical settings. On top of that there is a huge workflow shortage affecting both physicians and their staff. What’s a health system to do!? An increasingly viable option we will see expanding in 2023 is for the health system to partner with a virtual care workforce to augment their own teams. And when that partner is using the same EHR as the health system, the results will be a more seamless patient experience, a higher quality visit due to fully integrated data sharing, and lower overall cost due to economies of scale. Furthermore, patients can get more accessible virtual care for their routine needs, but also know that their office-based providers will have more time for them when they have higher complexity needs.
The positive clinical and financial outcomes resulting from the hundreds of Acute Hospital Care at Home programs around the U.S. will reach a critical mass in 2023. It is hoped that this evidence-based information will drive the Centers for Medicare and Medicaid Services (CMS) to make the program permanent—or at the very least, extend it for several additional years. Once the home-hospital program is made permanent or extended, expect major commercial insurers to launch similar programs for working-age adults, who, in many cases, are better suited for hospital-level acute care at home due to their lower health risks and higher degrees of independence. This watershed moment will likewise prompt many health systems and hospitals that have been in ‘wait-and-see’ mode for the past couple of years to implement their own programs.
Personal well-being has a direct impact on organizational performance, but employers have much work to do to support employees’ mental health. As the prevalence and acuity of mental health issues continue to rise among college students, the future of work depends on it. Research finds half of U.S. workers left previous roles due, at least in part, to their mental health, and more than 60% of college students met the criteria for one or more mental health concerns. Companies that don’t invest in Gen Z’s well-being in 2023 will pay a higher cost for lost talent in the future.
Virtual care in behavioral health is here to stay. Unfortunately, we just do not have the psychiatrists in this country, especially in rural America, to meet the growing demand for behavioral health care. The only way to provide the care we want is to take new creative approaches – leveraging innovative shorter-term care models, utilizing lower licensure types where clinically appropriate and leveraging technology wherever possible. Health systems know they need to rely on a virtual workforce to meet the demand and their strategic imperative will be to make their virtual care network feel local to their communities.
2023 will be a breakout year for value-based care in which we will see significant acceleration of payment and delivery system transformation. Now having journeyed through the COVID-19 pandemic, we better understand that this type of ground-up redesign is an imperative, not an option. The fee-for-service grind is burning providers out at unprecedented rates, social and cultural health inequities are in the spotlight, and CMS has put a stake in the ground that virtually all Medicare and Medicaid members need to be aligned to value-based payment models by 2030. Finally, it seems, all healthcare stakeholders will be aligned and incentivized to drive the durable, systems-level change needed to meaningfully accelerate value-based care in 2023.
We will see continued growth in the percentage of provider revenue tied to value-based programs as federal, state and commercial programs continue the push to reduce costs and improve health outcomes. Leading-edge provider organizations also will expand Direct-to-Employer contracting initiatives.
In the new year, we’ll continue to see a focus by payers and providers on whole-person health and exploring new care delivery models, using consumer-centric strategies to expand their reach and consumers’ access to healthcare. Companies such as Walmart Health and UnitedHealth are partnering to bring value-based care to underserved populations in 2023 as a way of reducing disparities in health access, particularly in rural America. Placing extended clinics in stores and teaching employees how to educate customers on making healthier purchasing decisions enable us to bring healthcare to where people are instead of making them travel to a provider’s office or a hospital. This care model will be interesting to watch in the new year.
At its current growth rate, Medicare Advantage is on pace to capture the majority of beneficiaries from traditional Medicare. As enrollment is becoming increasingly concentrated in large plans and streamlining operations more prevalent, the realization among payers and providers will be that working together is the only way forward to better align strategies around members. For providers, that means a renewed focus on clinical care beyond the office setting. For payers, its forcing them to rethink their strategic value and how they deliver on member experience.