Due to new developments in digital health technology, in addition to a changing regulatory landscape and evolving consumer expectations, several trends have become crucial indicators of what is to come next in the provider market. Leaders must consider these trends and take advantage of recent market changes to stay ahead of the innovation curve and provide patients with the most impactful, low-cost care possible.
Changing economic models. In recent years, regulatory changes have offered new payment models as share of revenue in at-risk models increases for provider organizations. This has offered the market new opportunities to leverage value-based payments, bundled payments, and quality incentives such as MIPS and MACRA.
- Payors no longer want to reimburse providers for services that do not improve the individual’s health status, pushing less of a focus on fee-for-service reimbursement for specific episodic services and increasing the interest in bundled payments.
- Care models and health IT solutions are misaligned for new economic models, as they are still shaped around episodic, fee-for-service care.
- Current EHR systems make it difficult for physicians to understand the full continuum of care as it applies to a patient, focusing on individual encounters instead. Providers must look to new solutions which support a pay-for-performance model and continuous care in order to reap the benefits of new regulations.
The impact of chronic conditions. The prevalence of chronic conditions across the U.S. has resulted in increased care utilization. 80% of adults over the age of 65 have at least one chronic condition, and many have comorbidities. This, in turn, is decreasing reimbursement for these services or pushing the reimbursement toward a more outcome-based model.
- In response, care teams are being created that are responsible for chronic disease patients, and often invest in systems for early detection via the capture and analysis of patient-generated health data (PGHD).
- More continuous, personalized care is being offered to patients with chronic conditions, in order to offer real-time feedback to keep patients engaged in their own care and in turn reduce care costs.
Access and coverage issues. The demand for healthcare provider services is outpacing the supply. Because of this, both patients and providers have adjusted their thinking to achieve the best care.
- Patients are utilizing venues that can give them the most appropriate, most immediate care, meaning they may take advantage of retail clinics or virtual care.
- Providers are working to optimize their resources, ensuring that clinicians operate at the top of their license and that technology is used strategically to take any unnecessary workload off of clinicians and care teams.