The pandemic’s impact on the financial health of healthcare has, to say the least, been monumental. What will turn this around in 2021? Technology, investment, consolidations, strategic partnering, and implementing AI say these experts.
An accelerated shift from fee for service to pay for value payment models – driven by healthcare organizations
The COVID pandemic has exposed the risk of FFS payment models to ambulatory and acute business models in a way we have never seen before. The primary driver of the shift away from fee for service to pay for value has been driven by payers and patient advocacy groups, not from the healthcare organizations. The massive drops in revenue, furloughs, layoffs, and in some cases independent provider organizations going out of business has created a new urgency for healthcare organizations to diversify their revenue streams. Now, instead of viewing capitation or partial capitation payment models primarily as a revenue risk, healthcare organizations will view them as an opportunity to have more control over their own destiny.
As healthcare emerges from the Coronavirus pandemic next year, we will see further consolidation, where hospitals will be acquired by larger health systems nationwide due to the financial and operational impact of the crisis. Along with it will come convergence of IT systems and vendors that healthcare providers rely upon to provide the best quality patient care. By focusing on fewer strategic partners to deliver more solutions, CIOs and other leaders will look to do more with less. IT vendors will need to demonstrate how they can provide multiple capabilities and use cases that go beyond being a “one trick pony” and provide a platform for both current and future initiatives.
COVID-19 continues to disrupt the business of healthcare and its effects may reach far into 2021. In early 2020, it was critical that hospitals and health systems changed priorities, resulting in a dramatic slow-down in investments in new technology. As revenue in the form of delayed and elective surgeries continues to return, we predict a renewed focus on administrative, operational and IT enhancements within provider organizations. Our mantra of “Paper is Contagious” took on a new meaning in 2020, and we see those same hospitals and health systems leveraging paperless technologies in 2021 with renewed vigor.
Work From Home (WFH) : Even Post-COVID, remote work will continue to gain momentum and traction as providers further secure WFH environments. They will also use advanced gamification and other incentives to keep workers productive, happy and fulfilled. Large wins will be enjoyed in provider business offices, call centers, and other back office functions where tasks to be done can benefit most from robust virtualization and workforce productivity enhancements.
RCM and other Back Office automation will also experience both incremental and leapfrog moments as the pressure to reduce and remove billions of dollars of administrative waste continues to mount. Continued pilots and innovation projects centered around business problem focused Robotic Process Automation (RPA), AI & ML, Process Intelligence and Anomaly Detection technologies will continue to showcase the potential for dramatic automation advancements and an inherent and demonstrable ROI.
As the pandemic continues and hospitals work to recover from lost revenue, strategies to engage patients at pre-service will be integral as we’ve seen patient apprehension in seeking care since the onset of COVID-19. Knowing how patients want to engage is crucial. Organizations will look to fine-tune RCM to normalize and tailor recurring patient touchpoints to best fit the patient’s needs using technologies that are dynamic enough to adjust to changing regulations as well as environmental factors such as COVID-19. Price transparency will be a major touchpoint for which many hospitals are choosing to delay. However, the financial side effects of government penalties coupled with the gap in the patient experience may not be worth the “we’ll address it later” approach.
RCM automation tools that include artificial intelligence (AI), robotic process automation (RPA), and machine learning will continue to be implemented to increase operational efficiencies, accuracy, staff productivity, and hospital margins. Automation serves an important part in the patient-provider relationship and compliments the human interaction that already takes place with every provider.
Perhaps the biggest – and least spoken of – issue with the pandemic has been its impact on the population’s mental health. The pandemic and public health measures instituted throughout the last several months have led many to experience high stress and anxiety. Mental health will be a significant part of the 2021 healthcare conversation. The economic recession, job loss, general stress, and feelings of isolation from the coronavirus will continue to shed light on the U.S. mental health crisis. Digital technologies, such as telemedicine, text message therapy, online support groups, meditation apps, and E-books, will be leveraged by healthcare organizations in the coming year to expand patient access to mental health treatments that don’t require in-person contact.
There is no question that the pandemic has ignited a massive transformation in healthcare. In 2021, health systems will shift their focus from facilitating basic two-way video visits to implementing strategic enterprise-wide virtual care delivery solutions. That means virtualized end-to-end processes that integrate every step in patient care from scheduling, intake, waiting rooms and patient queuing to interpretation services, e-prescribe, billing and analytics, referral management and more. By the end of the year, the virtual care paths will be fairly ubiquitous across the continuum of care from urgent care and EDs to specialty care all to serve patients where they are – at home and on mobile devices.
COVID-19 has had a tremendous impact on the trajectory of the healthcare industry and as we head into 2021, the pandemic’s ramifications that will continue to shape the industry. COVID-19 is driving the pace of change and disruption in healthcare faster than any force has in recent times. In 2021, I expect to see a renewed focus on how artificial intelligence (AI) can be harnessed to further transform the healthcare industry. These advances in AI are being driven by increased utilization of real-world data linked to a broad ranging set of databases and enhanced by text mining and semantic analytics.
Investments in AI are paying off, and we have seen how the technology has aided in the diagnosis and tracking of COVID-19 cases, predicting future outbreaks and assisting in selecting treatment plans. However, I foresee a deeper focus on healthcare systems channeling AI to promote better efficiencies in operations as we face a backlog of patient cases across other diseases and conditions that were sidetracked due to the pandemic. As our healthcare system deals with financial strain due to the virus, this technology will be paramount in helping many healthcare systems return to regular operations as they were pre-pandemic.
Real-time operating room (OR) capacity management tools will become an operating standard as organizations realize they must manage their ORs differently after the financial impacts felt in 2020. COVID-19 left perioperative executives scrambling to use manual methods to rationalize their OR capacity and how they would use it. After feeling the pain, organizations will look for a better way to optimize one of their most critical financial resources. We can expect OR capacity management technology will become the industry norm. All organizations will need real-time, analytical methods that are both visible and transparent for surgeons, administrators, and executives. This will allow organizations to optimize their most critical resources and return to a sustainable and healthy performance level.