5 Predictions for the Payer-Provider Healthcare Sector in 2021

The impact of the COVID-19 pandemic can be seen in practically every facet or our personal and professional lives. And on a macro level, the pandemic’s impact can be both seen and felt across our economy. Nowhere is that more significant than in the healthcare sector.

Countless experts have written on the big picture shifts, the cause and effect of COVID-19 on the industry as a whole. Many others have put forth predictions of the lasting changes that will occur industry-wide as a result of the pandemic. 

Rather than add to the chorus of a 30,000-foot perspective, I think it’s important to approach 2021 with more of a self-assessment, or sub-sector gut check, if you will. What can we anticipate for integrated care programs, like Sutter Health | Aetna, in 2021? And what does this mean for our plan sponsors and beneficiaries? 

After a year like no other in recent history, here are five predictions for our sector:

Prediction #1: There will be Greater Virtualization & Expansion of Behavioral Health Services

In August of last year, the CDC reported more than 2 in 5 U.S. residents surveyed were struggling with behavioral health issues associated with pandemic. And an assessment of New York City medical claims during the pandemic shows utilization of telehealth for behavioral services increasing nearly 2000% in 2020 compared to the year before.  

The demand for virtual behavioral health services has been remarkable, and shows no sign of diminishing. The de-stigmatization of mental health will also play a role in continued increase in utilization throughout 2021. As such, behavioral health access will be the theme of 2021, with an omnichannel approach demonstrating the greatest efficiency and effectiveness in patient care.

Integrated delivery and financing systems like Sutter Health | Aetna (SHA) make it easier for beneficiaries to utilize the health care system. The coordination between payer and provider streamlines the process, aligns provider incentives to those of the patient, and facilitates access to care while simultaneously improving the patient experience. 

This is true for those patients who are proactive in seeking out behavioral health services. Challenges will remain in identifying and engaging individuals who are undiagnosed, or who do not know where to start when it comes to entry into behavioral health for the very first time. This latter point should be incorporated in how plan sponsors present their benefit structures moving into 2021 and beyond. No longer a menu of services, but rather an if-then framework – “if you’ve felt lonely in the last 6-months then you should check out this benefit.”

By tying the core clinical team, including primary care, into the omnichannel model, SHA are better positioned to identify those overlooked patients, and to move swiftly to engage them and build a care plan. The virtualization of behavioral health eliminates crucial obstacles in time and accessibility—we can get to more patients, sooner, and conveniently.

Prediction #2: Clinical Point Solutions Will Become Less Point Specific

2020 underscored the glaring need for connected experiences in health care. Rather than siloed stakeholders all operating independently, we need a coordinated care model to drive better outcomes and build systemic efficiencies.

Currently, we see point solutions (which in lay terms is when a vendor or provider service line offers a single clinical service independent of other related comorbidities or confounding factors)  in clinical care, with various one-off elements serving as the answer to a need or demand. This has led to a loose constellation of point solutions rather than a cohesive universe. One has to wonder if there is a risk of point solutions bleeding into the digital space—providing the proverbial band-aid on the gunshot wound of markedly increased demand I mentioned above.

There is also a concern that a multi-vendor approach, without any centralized clinical backbone and platform will leave the onus of a connected experience on the shoulders of the vendors and not the health plan or core provider. This can inevitably lead to a disjointed experience that drives more avoidable utilization, only now it will be through a digital front door and not the physical one at the provider’s office.

I see a major shift in the tides, where point solutions are readily adopted and integrated into the central care model. Rather than have each piece operating on its own, point solutions will fold into the coordinated care model. Vendors that offer point specific approaches will be asked to consolidate or rethink their care model altogether. Plan sponsors will need to scrutinize this space as the shiny objects distract from the necessary ingredients required for coordinated care.

We have already seen success with this approach, as programs like Sutter Health’s Tera Practice(a virtual-first primary care offering) have intentionally built a webbing of interconnectivity to all in-person and digital service lines to ensure the patient has a unified experience independent of the need they initially present with.  

Prediction #3: Telehealth Will Become a Fundamental Offering, But Not All Encompassing

Telehealth use saw small, incremental gains over the last decade. Enter COVID-19, and those gains moved at warp speed overnight. Patients were compelled to use, and in many cases most comfortable using, telehealth services. Original skepticism was replaced with a hearty embrace—in those instances where it is possible to continue with telehealth, the majority of patients will be inclined to do so as the pandemic continues this year. 

Investments in telehealth by stakeholders proved themselves many times over. I expect to see a number of changes, all of which will support greater telehealth use by Americans well after the pandemic is over, including:

·        The development of virtual-first health plans and clinical services. The pandemic will yield evolution in plans, namely creating a new facet where telehealth will be the primary mode of interaction. We have seen the start of this concept with our very own virtual-first PCP practice, Tera Practice. Many other plans are in fast pursuit of this newfound demand in the market, but the question is how much of that demand will withstand a post-COVID world.

2021 will certainly bring more of these virtual-first offerings. Stakeholders will need to keep a close eye on the implementation, with real-time assessments of what can and cannot be done virtually. The amount of information gathered from an in-person visit cannot simply be virtualized overnight, nor is it efficacious for certain clinical interventions. It is imperative that we have the right measurement tools in place to ensure virtual care does not lead to lower quality of care or duplication of services.

The convenience factor is certainly valued by our members, but that doesn’t trump the limitations of this service line. It will take some time to find the right balance of virtual utilization that replaces in-person care, rather than creating a vicious cycle of telehealth visits simply serving as the preamble to a follow-up in-person visit or worse yet, greater emergency department utilization.

·        The expansion of chat bots. As telehealth care provision has increased exponentially, so too has the demand for support services and information from care plans. People are utilizing their online health resources in conjunction with their uptick in use of virtual care. Automated chat bots had already become a regular feature on health care websites, satiating the real-time support patients want. Time and user feedback has helped to improve these bots to anticipate many of the questions/answers and resources that people are seeking. I believe 2021 will see greater use of chat bots to automate as much information sharing and problem solving as possible. 

We must acknowledge, however, that health care information comes with certain sensitivities that can most effectively be handled in speaking with another person. The empathy expressed in a live phone call, or live chat with a real person, cannot be replicated by a bot. We can, and should, expand chat bots for perfunctory tasks and Q&A, with the understanding that there will always be a need for real-time customer service.

Overall, the health care sector will continue to leverage telehealth access points but I wouldn’t be surprised to see over 50% of the current pandemic telehealth utilization transition back to in-person visits within 6 months of the federal government announcing the end of the pandemic. Health plans will need to support both preferences via virtual-first products as well as hybrid models that allow patients who need or want to return to traditional in-person access.

Prediction 4: The Mandate to Improve Member Engagement and Education Will Intensify and Outlast the Pandemic

The adage “the doctor knows best” has come under scrutiny, as misinformation and disinformation have created enormous skepticism among the public. There is no better example of this than the pandemic itself, which continues to this day in relation to the efficacy of vaccines. Data shows higher amounts of distrust from patients. The ready and endless supply of misinformation online is only deepening the divide on health care literacy. 

Health care stakeholders have gone into overdrive, providing regular communications to plan sponsors and to beneficiaries. Transparency and consistent communication has proven vital in dispelling myths and assuaging concerns as it relates to the pandemic. We must continue to educate and provide clear and simple resources that people can digest without adding more to their already overflowing plates. In 2021, we must continue an aggressive campaign of member engagement and education, and use the pandemic to build permanent, trusted lines of communication and engagement. 

A key part of that will be having employers and benefit consultants support evidence-based information. Amplifying the information that is provided by health care plans will validate the information because it is being reinforced by a trusted source: their employer.

Employers have a unique opportunity to bolster their relationships with their employees and dependents, creating a differentiated value that helps to recruit and retain top talent. Plan sponsors and their brokers should seize this opportunity to gain the trust of their employees, a bond that can be utilized in years to come to create and sustain a healthy workforce through future initiatives. It’s also important to note that these communications may need to come from day-to-day people managers and executives that sit outside of the Human Resources function, creating a chorus and not a one-time HR-specific communication. We also will need to leverage a “rolling thunder” approach to ensure the information is delivered in consumable pieces and not a single engagement strategy that is easily missed or disregarded.

Plan sponsors should also hold their benefits consultants and health plans accountable; this is truly their time to shine – all eyes are on providers, healthcare benefits, and health plans to deliver value now more than ever.

Prediction 5: Open Enrollment will Transition to a Hybrid-Digital Model

Open enrollment for 2021 was compelled to an online-only format for many in 2020. Employees used the online portals and virtual communication channels to compare plans, price out their options, and ultimately make their benefits selections. And while we should be able to resume the traditional in-person health fairs for open enrollment 2022, I do not think that we will ever return to a pre-COVID level.

Overall, there were some “growing pains” but the industry did not experience major problems with open enrollment last year—there were not legions of employees left without coverage because they did not have a health fair. Employees adapted to this change as one of myriad adjustments they needed to make during the pandemic.

And to our own credit, the health care plans made great improvements to the digital enrollment platforms. We were able to build in the necessary tools and upgrades to create an easy, navigable user experience. This also allowed important information to be successfully communicated in an on-demand style, allowing many employees to make decisions on their own time and not be distracted by the energy, noise, and commotion of an open-enrollment event.

With many employers now shifting to permanent telework models, there won’t be as great a need for at work health fairs moving forward. Even as we hope and plan to be back at the office before open enrollment 2022 begins, we can all expect to see that process move to a hybrid-digital model moving into the future.