Where will you focus?
As part of our healthcare solutions services, we conduct market audits and trend research by looking at the needs of our clients, as well as reliable secondary sources. Since most of our healthcare clients are looking to grow or retain market share, improve care outcomes versus cost, as well as increase operational and care efficiencies, our research tends to lean into those categories.
Here is a quick roundup of some of the healthcare trends that, based on our research, we see as a priority for payers and providers in 2019.
Overarching Healthcare Trends:
Healthcare Trend One: Community Connections and Social Determinants of Health
One year ago, Humana’s CMO called the inclusion of social determinants of health in care as the “democratization of healthcare.”
This healthcare trend is starting to take off as payers and providers realize the value in addressing barriers like food insecurity, transportation challenges, healthcare literacy, and others.
Organizations are creating a community-based health strategy, evolving their chronic care management program and technology to address social gaps, as well as finding ways to integrate social issue screenings and data sources into their existing data analytics.
Healthcare Trend Two: Omnichannel Approach to Healthcare Customer Service & Retention
Organizations are evolving their digital outreach and customer service processes and technology to fit better into the life flow of the growing digitally-literate consumer.
They are creating symbiotic digital channels – mail, email, social media, web portals, in-office experiences, retail, wearables, and more – to deliver enhanced healthcare literacy, cost transparency, health monitoring, and new education and treatment options.
Healthcare Trend Three: Combining Analytics and Artificial Intelligence with Deeper Digital Experiences
Payers and providers are combining various data sources — clinical, utilization, social determinants, demographic, and social media — to manage health and drive individual, provider, and payer decisions.
Additionally, they are investing in ways to automate more valuable data into the systems and programs, as well as customize messaging and experiences for engaging patients and members with their data utilizing artificial intelligence.
Healthcare Trend Four: Healthcare Privacy and Data Security
While privacy and data security have become a standard concern and area to build as a center of excellence in every healthcare organization, focusing on security risks for networked medical devices and patient-initiated data from the Internet of Things is a major healthcare trend for 2019.
The goal of protecting the privacy and security of consumer information to maintain consumer trust in sharing data should be a top area of investment.
In addition to highlighting these four, overall healthcare trends for 2019, there are several trends within the payer and provider space that seem to be gaining traction and focus.
Payment & Operations Transformation & Automation: Applying automation to revenue cycle management, operational systems, and process efficiency is another healthcare trend for 2019 as payers look for more ways to streamline data collection and processing and cut cost.
73% of payer CMOs cited “the road to downside risk” as their #1 priority with payment transformation and cost-containment the focus.
– Gartner 2019 CIO Survey
Member Experience: By now, payers have evolved their programs and processes, but many are looking for how to create a more seamless, customized member experience based on population health criteria.
Advancing Care Management: Whatever care management initiatives a payer has in place, a focus for 2019 is giving coordinators and care managers better tools to mitigate gaps, work more effectively from-office or in-home, as well as provide the most effective and personal experience for members.
High-Performance Networks: Payers are responding to employers by creating high-performance networks after years of selling high deductible plans, which are plateauing.
Employers increasingly are implementing or considering performance-based networks created and maintained by a health plan or are contracting directly with providers or accountable care organizations.
63% of provider executives said that they plan to be included in a narrow network plan in the next five years.
– HRI survey 2017
Reinventing Primary Care and Care Delivery: Consumers have more ways to obtain care than ever – grocery stores, retail clinics, telemedicine, urgent care. Yet, a goodly number of patients across all age groups still do not have primary care. More providers are aligning with payers, retail, and other organizations to deliver new models for primary care, including home care, doctor home visits, and specialty primary care and medical homes.
Partnering with Retail: Also related to the first healthcare trend, providers are partnering with businesses to transform and reinvent care delivery and location. New players like Amazon, Chase, Apple, Walmart, and Google are changing the face of provider care.
High-Performance Networks: Also related to the payer trend, providers must prepare for the direction of high-performance networks by ensuring that their quality and performance records are accurate and easy to share and substantiate.
Where is your payer or provider organization focusing your efforts for 2019? Do these healthcare trends align with your priorities?
We’d like to hear from you and even update this article with your thoughts. Contact us if you’d like to discuss any areas of concern or how you plan to realize these in the new year.