The Top Hospital, Payer, and Healthcare Trends to Watch in 2023
The COVID-19 pandemic upended healthcare. The public health emergency is scheduled to end on May 11, 2023. The upcoming year is going to be one of change and upheaval in healthcare.
The public health emergency finally ends, triggering some major changes the healthcare system will have to deal with
The end of the public health emergency on May 11 will cause major changes to healthcare, including the sudden termination of multiple waivers providing flexibility in healthcare. Mandatory coverage of COVID-19 tests, treatments, and vaccines will end. Major changes to Medicaid and CHIP implemented during the pandemic will abruptly end. An estimated 18 million people will be cut off from Medicaid coverage.
Telehealth will either turn out to be a fad or the future of medicine
The higher reimbursements for telehealth instituted under the public health emergency will continue until the end of 2023, which will allow healthcare systems to either ease away from telehealth or promote it and establish it as a permanent part of medicine.
The fact that telehealth can cut operating costs by at least 10% suggests that payers and healthcare systems are in favor of it staying even after the higher reimbursement level goes away. Whether patients will continue to use telehealth is unclear; many patients seem to be more inclined to return to in-patient visits these days.
Technology and automation will increasingly be used to reach patients and streamline healthcare
Current telehealth systems that involve simple video chatting are likely to be augmented with remote diagnostics, allowing the healthcare provider to measure blood pressure, listen to the heart and lungs, view the ears, nose, throat, and eyes, and collect the patient’s vitals. Augmented systems that support remote diagnostics could significantly cut healthcare operating costs and prevent the need for many in-person visits.
Hospitals will cut expenses
Hospitals are facing severe financial stresses, and at the same time, patients are not returning to hospitals for care at pre-pandemic levels. The idea of the huge, centralized hospital that provides everything may need to be modified or abandoned as patients seek care outside hospitals at specialized centers and remotely from home.
As part of the cutting expenses trend, there will be mergers, partnerships, and acquisitions
Fee-for-service programs are out and value-based care programs are in. At-home care, specialized senior primary care clinics, and hospice care are becoming major players in the healthcare system.
Are hospitals at home a fad or a cost-saving future?
The implementation of acute hospital care at home during the COVID pandemic will be supported through the end of 2024, but the program that supports at-home digital monitoring will abruptly end on May 11, 2023, which may doom hospitals at home. CMS or Congress needs to act soon to extend the program.
Amazon, CVS, Walgreens and UnitedHealth will compete as they all try to move into primary care
These companies are all trying to re-imagine primary healthcare by making it more convenient, applying new technology, and shifting it into a home-based setting.
Payers will have to deal with the Transparency in Coverage rule after it went into effect on January 1, 2023
Payers were required to provide transparent prices for in-network and out-network costs as of January 1. Tools to provide this information have been available since July 1, 2022, but they weren’t mandatory until 2023. Tools to provide transparency information for prescription drugs have been delayed.
What is in and out for Medicare Advantage?
As increasing numbers of patients choose to enroll in Medicare Advantage, the number of companies offering plans is increasing. HMOs are decreasing and PPOs are becoming increasingly popular. Special needs plans have doubled in number.
Interoperability for providers and payers will expand
The current lack of true interoperability is contributing to staff burnout and difficulties in recruiting and retaining skilled staff. Digital solutions for predicting healthcare demand several weeks in advance will improve staffing and eliminate two major sources of stress on staff, understaffing and sudden changes in worker schedules. Some hospitals have suggested allowing nurses to perform charting, a major part of their job, from home, which will also help reduce stress on staff. Integrating all of the various types of software a hospital uses will improve interoperability as well.
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