We have made major steps in moving to a value-based care payment model. What will it take to really have value-based care? Moving mindsets of patients to consumers when you are transforming how healthcare is paid for will continue to be a great debate. But how people will get, pay for, and engage in their healthcare will truly be transformed and we can’t get there without health technology. That’s what our experts are saying.
The pandemic has accelerated infrastructure and workflow innovations that Value-Based Care programs were previously advancing only slowly. Earnest efforts to connect the dots across disparate data to better assess and manage clinical risk have enabled new care models that are more proactive, better aligned with patient needs (including social support), and more robust in terms of cost and clinical quality performance. As the crushing burden of acute Covid-19 cases recedes in 2021, I predict that thoughtful organizations will revisit their long-term plans to address several essential questions: Which new capabilities should be permanently folded into care design to address the growing complexities of chronic illness in the community?; What degree of flexibility is necessary to scale care models up and down to address future hotspots?; and, finally, How can we organize and simplify requisite care coordination, management, and administrative activities to support a health care workforce that is on the verge of exhaustion?
I predict 2021 will mark the beginning of more dramatic digital transformation in the healthcare industry. The response to COVID-19 demonstrated our ability to accelerate progress on critical projects such as telehealth. Transforming other areas of patient care is next. Healthcare CIOs must catch up to the expectations set by retail giants like Walmart and Amazon entering the healthcare market. They’re cutting the cost of care provisioning—finding ways to reduce costs while improving the online patient experience. CIOs who have the foresight to make radical changes and shed legacy operating environments that hamstring progress will be more than value creators. They will lead their organizations through any new storm.
Once the COVID crisis is under control, expect to see attention turn to innovation in the management of patient health status. Current HIT systems were designed for transaction-based billing and reimbursement, but the industry must make the shift to systems designed to support clinical-decision making. This will require systems to provide better tools for clinicians to manage patient conditions at the point of care. I expect to see advances in this area start to make their way into the marketplace by the end of 2021.
The digital transformation of U.S. healthcare systems will continue, and data scientists will play a role in improving treatment outcomes. Predictive analytics combined with biomedical technology will become core not only to treatment protocols and clinical research, but also will improve operations and business performance, speed the implementation of value-based care, and help healthcare organizations continue to pivot quickly as the pandemic progresses toward its later stages.
The impact of the COVID-19 pandemic on patients, payers and providers has been significant. One key to driving recovery in 2021 will be the adoption of innovation to provide value from existing data assets. Healthcare data remains siloed and extracting vital information – especially from unstructured data – is a challenge. However, by leveraging technologies such as natural language processing (NLP), organizations can normalize data to quickly deliver insights and build detailed pictures of patients and populations. This will enable them to develop more targeted, and preventative strategies to improve patient health, and reduce the burden of care.
This use of technology to better harness data can also have broader application. Consider, for example, the growing use of real world data (RWD) to enhance the discovery and development of new therapies. Conventional trial recruitment and data collection has changed during the pandemic, increasing the need for high quality RWD to somewhat fill the gap. By using technology to unlock their unstructured data, providers can also help advance the work of drug discovery and development while mitigating some of the harsh impacts of COVID-19.
Value-based care has been a buzzword in the industry for years, yet the road to effective risk-based contracting has had many speed bumps. As we enter into 2021, providers – particularly those in fee-for-service models who experienced significant financial impacts from COVID-19 – and payers will turn to technology to accelerate, enable, and ease the transition to more risk-based contracting. Value-based care, which has prevailed as a more cost-efficient and sustainable model in light of the pandemic, will seem far more attractive to providers that were once hesitant to enter into risk-bearing contracts. They will no longer be wondering if they should transition to value-based care, but how best to do it.
Our national focus on defeating and recovering from COVID-19 has understandably delayed various policy changes that address payment reforms, interoperability, and patient access. Hopefully, we’re moving through the final phases of this tragic pandemic. And when everything equalizes, new alternative payment models will help accelerate further adoption of value-based care, interoperability requirements will vastly improve data sharing, and advances in patient access to data will improve engagement and health outcomes.