Health plan and provider technology’s biggest disruptors for the year ahead

In our previous post, we described COVID-19’s medium- and long-term impact on health plans, suggesting that virtual care, or telehealth, which has accelerated the digital transformation of healthcare over the past 10 months, will become a universal standard.

As we look ahead to the rest of 2021, healthcare resources will largely be centered around vaccine delivery and planning for the extended cost impact of COVID-19. The adoption of telehealth for primary care visits and behavioral healthcare is certain to continue, along with a continued push for value-based care adoption. In 2020, providers, especially primary care providers, who participated in outcome-based pricing models fared better than those who remained under fee-for-service models. It’s increasingly accepted that value-based care creates value and stability for both providers and health plans and helps align incentives around focusing on patient care.

We believe the following trends will continue to disrupt health plan and provider technology in 2021:

1. Whole-person health will be more common. The COVID-19 mortality rate has made health plan members and patients more engaged in managing their own health and preventing health issues by adopting wearables and health apps. Members are more comfortable sharing and owning their health data as consumer data. Regulations are paving the way to establish an end-to-end interoperability in the ecosystem, enabling a greater adoption of telehealth. Therefore, leading national and regional health plans have created comprehensive whole-person health plans that include medical, pharmacy and mental health coverages. Integrated, whole-person health plans, enabled by advanced analytics, will help health plans tailor coverage to specific population segments.
2. Digital transformation will be fueled by automation. The pandemic dramatically accelerated the rollout and adoption of virtual care. To provide whole-person health coverage, many health plans are implementing seamless virtual or in-person member/clinician experiences. As members’ expectations and usage of digital and cognitive technologies increase, the virtual care experience will continue to improve. Robotic process automation and AI now allow caregivers to spend more time providing care and less time completing documents. Clinician fatigue and mental health issues have been major challenges during COVID-19. The digitally-enabled hospital of the coming years will be poised to enhance productivity and performance under value-based contracts by integrating analytics into a seamless patient experience.
3. Data interoperability will pave the way for seamless virtual/in-person care. In the past, loosely integrated technologies and siloed data sources across departments made it difficult to scale virtual care. However, renewed focus on data interoperability across the entire ecosystem, with members owning their health data, is helping establish a seamless virtual/in-person care experience. New regulations created a strong foundation for data and analytics capabilities in 2020. With data becoming a new care currency, clinicians will largely have access to health data, real-world data and social data to provide better treatments and improve health outcomes. Members’ engagement with their own data will lead to better medication adherence, management of chronic diseases, and identification of risks, helping close the last mile for population health management initiatives with clear ROI for both health plans and providers. This will help achieve the “quadruple aim” of healthcare: clinician and provider well-being, cost, quality and patient experience.
4. There will be deeper collaboration and disruptive new entrants. Historical boundaries are gradually diminishing in the healthcare ecosystem, with greater collaboration among pharma, biotech, health plans and providers. The invention and development of a COVID-19 vaccine in record time is a testament to that. In 2021, this enhanced collaboration will continue in vaccine delivery and planning for the next generation of vaccines. In partnership with new entrants like startups, the industry will continue to deliver affordable and convenient treatment options for patients. Fast forward to the next few years, and healthcare products and services will be akin to consumer experiences in other sectors like banking and retail.
5. Blockchain and advanced analytics will control healthcare costs. In the past few years, plans and providers have used advanced analytics and machine learning to make diagnostics better and personalize treatment options. In 2021, we’re likely to see more cloud-based AI systems improve the speed, accuracy and costs of diagnostics, hardening decision support systems by applying diverse, evidence-based data sets, eventually resulting in the best therapy for an individual patient. Blockchain technologies will help democratize patient data across the entire ecosystem to control healthcare costs through advanced analytics. Several blockchain consortiums are already underway to tackle systemwide health data access problems that are common pain points for health organizations, such as standardizing and managing patient consent. A leading national health plan has several pilots that will enable encryption of medical data to ensure patient data privacy.

Over the next few years, stabilizing costs and revenue will be important for health plans and providers as member/patient utilization and volumes continue to adjust to the new normal. We believe health organizations will continue to achieve progress as these trends disrupt the industry in 2021 and beyond.