Early signals point to another year of transformation in healthcare, as the effects of COVID-19 will leave their long-term mark. Now it’s time to think about how 2020 trends will evolve in the coming year. What does it all mean for patients? And how will payers, providers, and employers respond?
The COVID-19 pandemic increased the pressure on fee-for-service providers and accelerated the movement towards a value-based model. Fee-for-service primary care practices suffered from the sharp drop in volume of services and have not been able to bounce back. Many either shut their doors or were bought by hospitals.
This quote from Tom Banning, CEO of the Texas Academy of Family Physicians, sums up the pinch that fee-for-service primary care providers will continue to feel:
“As it goes along, there will be more pressure on unaligned primary care practices to partner up with insurance, hospitals or like-minded colleagues. It’s really going to be difficult for those practices to survive long term.”
As the fee-for-service system breaks down, the need for a dramatic shift towards value-based care becomes even clearer. Payers and providers are seeing the pitfalls of a model that relies on the quantity of services delivered. The pivot to value-based advanced primary care that delivers better patient outcomes is already under way; 2021 could be the year in which it becomes a large-scale movement.
COVID-19 increased awareness about social and mental health — and the role that both play in overall health and well-being. Sustained stress, rapid change, and repeated lockdowns increased people’s interest in self-care practices, management of stress and anxiety, and more.
According to a Kaiser Family Foundation poll, the number of adults reporting that the pandemic has negatively impacted their mental health grew from 32% in March of 2020 to 53% in July of 2020. As that trend continues, payers and providers will continue to see the extent to which social, emotional, and physical health are connected.
For Vera Whole Health providers, primary care is the ideal setting for this biopsychosocial approach to care. Dr. Paula Dygert describes it well:
The only truly effective care is care that treats the whole person. Longer appointments, full care coordination, health coaching, mental health services, and an emphasis on healthy behavior change are all essential.
Telehealth adoption grew by leaps and bounds in 2020, leading forecasters to predict it will increase seven-fold by 2025. The growth of telehealth is an opportunity to improve care delivery — providing people with the care they need when they need it. In 2021, payers will see the benefits of a lighter physical footprint and a strong virtual wrapper. They will also discover the importance of a telehealth solution that is shaped by clinical know-how — not just pure tech brilliance.
But telehealth adoption is only part of the story. Fundamentally, telemedicine is not a new or better form of care; it is only a new form of care delivery. Payers and providers will also need to choose what kind of care they will deliver using this new means of distribution.
In a worst case scenario, telehealth could become just another way to distribute transactional, acute sick care. Even the most sophisticated technology or the most user-friendly UI can’t redeem the fee-for-service model. Fragmentation, overutilization, and waste will live on.
In the best case scenario, telehealth will be used to more effectively deliver advanced primary care. Care teams will provide continuity and coordination. Virtual access, when leveraged with data and monitoring, will allow payers and providers to manage bigger and broader populations more efficiently.
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COVID-19 showed that access to primary care in the fee-for-service model can be cut off. Many providers in PPOs were furloughed for extended periods in 2020. Behavioral and mental health support were largely absent altogether or provided through an EAP — not integrated into a whole person approach to care.
Lack of access to care, coupled with intentional care avoidance during the pandemic, will resurface in the form of pent-up demand for care. Care avoidance (whether intentional or not) leads to worse health and the need for more care down the road. Payers and employers who will be footing the bill for this oncoming tidal wave should start to think about how to avoid such significant care gaps in the future.
For example, Vera Whole Health leveraged the decline in physical-site care as an opportunity for care teams to reach out to members and guide them through virtual care. This led to effective management of chronic conditions and improvements in quality scores during COVID-19. Payers and employers may want to achieve similar benefits by investing in advanced primary care that gives them increased control and gives members better access to care.
The COVID-19 era has quickened the pace of change, but 2021 brings an opportunity for payers and employers to respond by investing in a value-based, advanced primary care solution.