5 Defining Payer Trends to watch in 2021
After a year of pushing the healthcare system to its limits, industry leaders name 5 trends for payers in 2021.
The health payer industry makes predictions about what’s to come in the following year. They did not predict, along with everyone else, that Coronavirus was going to rage across the world and the United States in March of 2019. The Coronavirus tested our healthcare system to its limits and continues to do so as we face new surges across the country.
Reports continually come out that tell us where and how the healthcare system is failing in specific areas, with certain demographics, and how the pandemic has highlighted a range of necessary improvements. These have all impacted the predictions for what’s to come in 2021.
A shift toward value-based care and alternative payment models.
Value-based care models and flexible payments allowed healthcare providers to stay afloat while their elective procedures were reduced if not eliminated entirely. The flexible payments and value-based care models allowed both payers and providers to exchange data, share responsibilities and improve coordination centered around the patient. Health insurance companies are looking at these models and urging clients to take on value-based care models.
In addition, CMO of Blue Cross stated: “It's really about how we partner to strengthen that partnership so that we really make care more affordable as well as improving the quality of care for our members.” - healthpayerintelligence.com This sentiment is felt across the healthcare industry with many payers and providers agreeing that trust and relationship building will be essential to the success of the new partnerships. The industry segments need to learn to trust each other and develop cooperative thinking to accomplish a reduction in cost and increase in quality of care for all patients.
2. Integrating behavioral health into physical healthcare.
Many health insurance companies saw mental health expenditure skyrocket in the first couple of months of the pandemic. Blue Cross stated that almost half of its claims in 2020 are for mental health. (healthpayerintelligence.com) Integrating mental health with physical healthcare has been a long-standing recommendation but the pandemic made a perfect example of why. Telehealth is a major contender for pushing the needle on the integration and accessibility of mental health.
3. Integrating Telehealth into the healthcare system
The pandemic forced us to come up with alternative solutions to care. Telehealth, a tool that has been slowly moving along throughout the last decade was suddenly the only solution to “see” patients during the pandemic. Telehealth was used most frequently for primary care in diagnostic and follow-up appointments.
Many doctors saw how telehealth can be used as preventative care to avoid the costly hospital-based solutions and catching things before they become an issue. There is still a great deal to figure out with telehealth, as well as improvements to be made. One of the largest growth opportunities is integration with the provider side. “Leading payers will see this as just greater flexibility because ultimately it's going to be a cheaper and less invasive way to deliver care. So we have to make sure that it doesn't get too restrictive and that we're looking at it just in a pure transaction as opposed to the total cost of care.” - Healthpayerintelligence.com.
4. Medicare Advantage flexible benefits and dual eligible managed care
Through the recent Annual Enrollment Period we saw Medicare Advantage plans take the lead over Supplemental plans. Why? Well one of the reasons is due to greater flexibility of benefit coverage. We saw an expansion of chronic disease management and benefits in 2020.
One huge change for 2021 is the inclusion of Coronavirus coverage. This is for all covid-related illnesses. We see that social determinants of health are starting to be integrated into the insurance industry because benefits like covid-coverge will help people in the daily course of their lives, something that insurance has typically remained binary and abstained from.
Additionally, we can expect to see an increased integration of Medicare and Medicaid services for people who are dually eligible. The conjoining of Medicare and Medicaid will greatly benefit Medicare Advantage beneficiaries because many of them have comorbidities or multiple chronic conditions. There is a great deal of room for improvement in the integration of Medicare and Medicaid as patients often find themselves scattered between the two, reducing their overall quality of care. Integrating State and Federal programs will be tough, but if we do it successfully it will reduce the cost of care and improve the quality of care received.
5. Accelerating Cell Gene Therapy usage
Those with rare and unique diseases might see new options in 2021 as the pandemic has pushed the progress of cell gene therapy. In 2020 companies were actively trying to reduce the cost of Gene Therapies, but with value-based care we could see the cost of a whole genome sequence with a price tag of $700.00.
Gene therapy was used specifically for Covid-19 and bring to light that we can leverage this technology for consumers all over the United States. The creation of accessible gene therapy solutions could reduce the cost of care to patients who will have preventative measures for chronic conditions and rare diseases, while costing the healthcare system less money in the process. We can expect to see prices dropping and gene therapy becoming an option for some patients.
2020 pushed us to our limits but it also lead to breakthroughs in healthcare that might have take years to progress naturally. This is the healthcare system taking the Obama approach of when Covid goes low, we go high. Continually looking for improvements through technology and focusing on the best outcomes for patients will be the focus of 2021.