Getting our population healthier, more equitable, and more access is and has been a vision for years now. Care delivery and payments are on the line in 2024. Will the industry step up and create the tools providers need? Can providers stay relevant without embracing technology solutions? Here is what the experts are seeing in the coming year.
And join us for all of our prediction posts as we look at what we might see in 2024.
Payers and risk-bearing providers have a massive opportunity to modernize logistics and coordination workflows to drive care into the home and ensure timely access to home-based benefits and services. By being in the home, care teams can delight members with better delivery of services and unlock volumes of new data that highlights the ongoing needs of the person (and their family). Often those needs are non-medical in nature and can address challenges with health equity and other SDOH factors. Payers and providers have an opportunity to be invited into the homes of those they serve, and they should not take that lightly. It’s a win-win for all involved.
As organizations strive to compete in a challenging economy, they face strong headwinds that demand immediate solutions. We anticipate that 2024 will be a critical pivot point for employers and care providers to join forces and revolutionize the conventional approaches to care delivery and payment. Anticipating this shift, the market is preparing for a substantial surge in population health-focused solutions. These solutions will be tailored to meet the specific health needs of employee populations rather than adhere to a blanket, one-size-fits-all approach.
In 2024, healthcare organizations’ (HCOs) will make dedicated progress towards bridging health equity gaps. Our extensive engagement with Medicaid, D-SNP, Medicare, and other vulnerable patient populations brings to light the pervasive disparities in healthcare delivery and community wellness.
To fully address health equity we’ll see heightened collaboration among HCOs, advocating for every community member. It is imperative the industry discards the notion of vulnerable populations as an added expense. Instead, we must implement programs that address immediate needs while also yielding improved organizational, financial, and individual health outcomes in the long term.
At the core of the issue lies inaccurate patient or member data and outdated engagement tactics. In 2024, HCOs will adopt a more individualized and empathetic approach to vulnerable populations. Look for HCOs to establish trusted relationships on an individual level, encouraging individuals to keep their health plans up to date and adhere to health equity interventions. This refined approach is expected to usher in a multitude of new partnerships and programs addressing SDOH such as food insecurity, housing status, senior isolation, behavioral issues, and other factors.
Private Equity & Mental Health… A Risk in Care Outcomes?
In 2024 we can expect to see an increase in mental health clinics absorbed by private equity investors. While the concept of a comprehensive, one-stop-shop healthcare ecosystem holds potential advantages, the field of mental health necessitates a nuanced and individualized approach. The prominence of profit motives in these transactions underscores the importance of maintaining a vigilant stance on the patient, the quality of treatment, and the potential escalation of care costs. As we navigate this evolving landscape, careful consideration must be given to safeguarding the integrity of mental health services amidst the dynamics of private equity and clinic consolidation.
In 2024, it will be crucial to prioritize population health by addressing the multifaceted challenges of improving health literacy, enhancing access, and promoting equity, especially considering that 25% of the US population resides in rural areas with access issues, 33% face healthcare literacy challenge, another 29% struggle to afford care, and the unsettling trend of declining lifespans is observed in both the US and Mexico.
The promise of value-based care (VBC) in 2024 is based on the ability of healthcare stakeholders – including providers, payers, patients, and community-based organizations – to share data across systems and collaborate on care plans. By digitizing patient data – including social determinants of health (SDoH) data – and making it available through a scalable, cloud-based data engineering framework, healthcare organizations can build a ‘network of networks’ that enables a holistic view of patients. This will allow healthcare organizations to identify and proactively address health equity issues and to empower patients by providing them with greater access to their own health data. Patient data can be analyzed at scale to identify trends impacting underserved and vulnerable populations, allowing providers and payers to proactively intervene with education and support.
Holistic care: The shift towards holistic care departs from the traditional disease-centered model. Healthcare providers recognize the interconnected nature of health, addressing not only the symptoms but also considering the broader context of patients’ lives. This approach encompasses social, physical, behavioral, and nutritional aspects, fostering a more comprehensive and patient-centric approach to well-being, population health inclusive.
Over 50% of Americans depend on their employers for health care coverage, underscoring the pivotal role employers play in shaping not only the well-being of their workforce, but the health care industry as a whole. Escalating health care costs compel leaders to explore inventive benefit structures and models. As the industry pivots towards innovative care models in 2024, we anticipate a heightened interest from employers in value-based care benefits and solutions.
2024 is shaping up to see the possibility of expanded adoption of pharmacogenetics as standard-of-care. In October of this year, California Gov. Gavin Newsom signed a bill into law specifying that pharmacogenetic testing is a covered benefit under the Medi-Cal program. This represents a significant step towards more wide-spread adoption. In addition, more and more new drugs are being released with pharmacogenetic warnings and recommendations, increasing the scope of pharmacogenomics as a tool to be used by providers.
Breaking Down Barriers in Specialty Pharmacy Care
In specialty pharmacy – we see some incredibly costly medications and there are so many challenges around patients accessing and finding a way to pay for these life-changing medicines. In 2024, it is time for stakeholders to break down some of the walls that exist – let’s make them fences—and have a conversation about a better, simpler path forward, enhancing intelligence sharing to improve the specialty prescribing process for everyone involved – but especially the patients in our care.
Expanding Precision Medicine Solutions and Access
When I first started as a practicing pharmacist, colleagues were still hand-writing labels for prescription bottles. More than two decades later, specialty medications are treating diseases that we never thought possible. We will continue to see incredible advancements in precision medicine that focuses on who the patient is at the core – using their genetic information – to go beyond palliative treatment and actually cure diseases. Predictive technology that is based on a patient’s biology will also play an important role in how we treat disease. Having up-front conversations about the side effects that a patient is likely to encounter– and that they might feel worse before they get better—will help patients have faith in medicine and stick with a treatment. My hope is that these precision medicines and treatments will not cost patients astronomical amounts of money but instead, will be more easily accessed by patients who we know will benefit from them.
In 2024, I predict that a value-based model focused on the three Ps: provider performance, patient participation, pathology prevention, will be further implemented by the healthcare community. Applying this approach to treat CVD will bridge the gap of health inequities.
Cardiovascular diseases (CVDs) are the leading cause of death globally and while the etiology is multifactorial, there is increasing evidence suggesting that inflammation plays a critical role. For African American adults, the burden of cardiovascular risk factors like high blood pressure and obesity is much higher, making them twice as likely to die of CVD. The health status of any person and their response to diseases are impacted by innate (gender, family history, genetics, etc.) and external factors (diet, employment status, environment, etc.) but the latter, also known as social determinants of health, impact inequity in healthcare and disparities in disease outcomes.
Hackler et. al investigated the racial differences in the general population using biomarkers for cardiovascular inflammation and found that different ones like high-sensitivity c-reactive protein (hs-CRP) may contribute to or mediate racial differences in CVD. Offering LODOCO (0.5 mg daily), an anti-inflammatory, to all demographics represents a novel precision medicine approach to the mitigation against this ubiquitous disease. This strategy, at least with respect to CVD, could easily serve as a first step and best practice to help bridge the gap of health inequities between African American and Caucasian adults by simply offering anti-inflammatory treatment to both cohorts.
Sabrina Poon, MD, MPH, Assistant Professor of Emergency Medicine, Medical Director, Office of Episodes of Care, Population Health, Vanderbilt University Medical Center
LinkedIn: Sabrina Poon, MD, MPH
Amid the health care industry’s shift toward novel care and reimbursement models, it is imperative for providers to be at the forefront of broad, transformative change taking place in 2024. Physicians are already actively involved in enhancing the care experience not just for their patients but for themselves, as well. Their aspiration is for a health care system to operate rationally, which we’re beginning to see reflected in value-based care models that successfully align financial incentives with provider performance.
Given the CMS (Centers of Medicare and Medicaid) increased focus on health equity via the new Medicare Advantage Star Ratings Health Equity Index (HEI), health plans will be forced to develop new data-driven approaches to engage at risk patients. As such, these high-risk, unengaged populations will become an increasingly higher focal point for MA Star Ratings outcomes in 2024. High-risk patients represent the ‘last mile’ in healthcare because they are not only medically complex but often have significant socioeconomic barriers (SDOH) to overcome to improve outcomes. These populations require specialized support that go beyond the limitations of routine clinical care. Further, navigating complex HEI issues requires advanced analytics and clinical workflow software that is patient-centric and focused on overcoming respective SDOH barriers of care.
2024 – understanding the implications for weight loss drugs: This year, the cultural phenomenon around weight loss drugs, or semaglutides, exploded. From celebrity stories in the media, to problematic prescribing at medspas, and the impact on pharma and the supply chain, the hype hit from all angles. In 2024, the industry will gain additional understanding of the impact of these weight loss drugs on other medical conditions, from heart failure to mental health, for patients. In 2023, we saw semaglutides have varying beneficial impacts on existing comorbidities – like heart disease, while in the same vein, rare and severe problems for others – such as stomach problems and complications with anesthesia. Novo just announced at the AHA meeting that Wegovy reduced risk of MI and cardiac-related death. They had previously reported that it also reduced symptoms in patients with HF. Real-world patient data over this last year will provide insights into determining why certain drugs worked better in specific patient populations and not others, while critically examining health equity and disparities of who had access to medications, and why. Investigating datasets across populations, will provide pathways for the industry to explore semaglutides for diseases outside of obesity, driving improved, and tailored care plans. In 2024, the industry will move from hype to understanding critical insights on the magnitude of weight loss, impact on comorbidities, and how the industry can better personalize care for specific patient populations when it comes to weight loss medications moving forward.
As we look to 2024, improving equity in healthcare—regardless of race, gender, age, socioeconomic status, or any other demographic or clinical characteristics—is paramount. The development of advanced AI systems for healthcare can have a dramatic impact on this effort. Systems must be designed to work effectively across diverse patient populations and mitigate the systematic biases present in the data used for training; otherwise, these biases could propagate into the model’s predictions. To ensure that AI systems contribute positively to healthcare outcomes and do not perpetuate disparities, healthcare providers and developers must commit to rigorous testing, validation, and continuous monitoring for fairness in AI models, just as we monitor safety.
In 2024, homecare services – already invaluable to many – will assume even greater importance. With heightened demand fueled by an aging population, the year will likely bring concentrated efforts to stretch homecare resources and identify solutions to industry challenges. In particular, the aftermath of Medicaid unwinding – which resulted in substantial accidental coverage loss – will bring significant changes to the Medicaid and self-pay member populations. Enrollment will shrink while the self-pay segment expands, and providers will face challenges in sorting out the logistics and ensuring care is provided to everyone in need. One thing that may help alleviate some of the fallout and help meet demand is the prevalence of self-directed care, which is an efficient way to stretch resources while allowing members to take a more active role in their own care. As more benefits of expediting the adoption of self-directed care become evident, we’ll see more states ease restrictions and take measures to incentivize the approach.
Social Determinants of Health (SDOH) play an oversized role in health outcomes, which is why initiatives are underway to empower social services organizations and others in the healthcare ecosystem to use HL7 FHIR as their data interoperability standard. The shift to FHIR not only facilitates interoperability within healthcare, but more importantly, allows social services providers to capture SDOH data by leveraging existing social services networks in local communities, and then share this data with healthcare providers.
Data interoperability is critical to achieving health equity. And while today’s healthcare providers continue to be incentivized to be interoperable, it is imperative to expand these incentives to include community-based organizations. This expansion allows them to track patients to and from care settings and social services, ultimately leading to improved outcomes, reduced provider frustration, time and documentation savings, lower healthcare costs, and, most importantly, whole-person care for every individual.
Recognizing the essential role that accurate data plays in population health and value-based care initiatives, health systems will continue to adopt solutions that improve interoperability. For example, with higher-quality, more accurate data, hospitals can more precisely target patients for care programs that are the most appropriate for their needs. Solving patients’ social determinants of health challenges starts with having the right data about those challenges.
In 2024 we will see a major shift in how heart failure and other chronic diseases are diagnosed, especially in underserved populations. Rather than the current norm of late-stage ER discovery, advanced noninvasive technologies will empower earlier identification in outpatient clinics or even home settings for these patients. By leveraging advanced digital health technologies, we can reduce expensive ‘crisis care’ ER visits by focusing care further upstream and earlier in the disease progression. The technologies exist – we must focus investment on increasing access and expanding proactive chronic disease management to improve outcomes and mitigate inequities.
Virtual care will become an increasingly appealing option for health systems that endeavor to improve population health, care access, and health equity for their patients and communities. Virtual care delivery options are particularly relevant to patients experiencing social determinants of health issues, such as lack of access to transportation or economic opportunities. By helping to close care gaps via wider access, virtual options will play a key role in health systems’ population health and health equity improvement efforts.
In 2024, all roads lead to patient engagement, and technology is the next generation of competitive differentiation. We’ll see more health systems touting technology solutions that advance goals such as improved care, especially as it relates to access and health equity. Increasingly, we’ll see a trend of technology providers working closely with health systems to communicate the value of the solutions throughout their care network, with a focus on interoperability, automation, and AI related to improved care coordination and financial outcomes.
We’re living through an important time in history: every player in the healthcare arena–regulators, health systems, solutions partners, telemedicine companies, healthcare stakeholders, and society as a whole–agree that our healthcare system must no longer serve only a select few. In 2024, expect to see AI playing a bigger role in achieving this vision towards global equitable healthcare. Through predictive analytics, machine learning algorithms, and natural language processing, AI will create proper channels of care that not only bridge the gap in health disparities and promote access but also create a better patient experience and better health outcomes.
Population health will evolve from a mostly surveillance approach to a strategic one that delivers clinically actionable insights and improves medication adherence for high-risk patients at scale. Digital tools and value-based care incentives are driving outcomes for these populations on a level previously only possible for individual patients. Providers will embrace this approach, giving rise to the era of care navigators, who work with primary care practices to ensure patients with chronic illnesses have the resources they need to achieve better outcomes.
As we embark on 2024, I am optimistic about the profound positive changes on the horizon for the business of healthcare. The current state is marked by error-prone and labor-intensive processes between care providers and payers, contributes to a staggering $1 trillion waste in the healthcare system, and I envision the start of a transformative shift, specifically with the use of generative AI – by simplifying and expediting transactions between care providers and payers. My vision is that providers will be armed with the tools to estimate and settle payments at the point of care, promoting real-time financial resolution with payers, aiming to streamline routine transactions, settling them promptly, and proactively addressing anomalies, much like identifying unusual patterns in financial transactions.