Our Take On 6 Key Healthcare Trends For Payers

COVID-19 has accelerated the pace of changes happening in healthcare. As these trends take shape, they create a picture of what post-COVID-19 healthcare may look like. They also reveal opportunities for payers to stay ahead of change by investing in a value-based primary care solution.

 A recent McKinsey article describes the current state of healthcare in terms of six overarching trends: 

1. Reform
2. Health for all
3. Era of exponential improvement unleashed
4. The big squeeze
5. Fragmented, integrated, consolidated care delivery
6. Next generation managed care accelerated

We’ll examine these trends and discuss how value-based primary care relates to each one. 

Trend 1: Reform

Mckinsey summarizes how the COVID-19 crisis revealed weaknesses in the healthcare system and how economic pressure may amplify the need to contain rising healthcare costs. The article names three dimensions of reform: making COVID-19-era waivers permanent, taking action to strengthen the pandemic response, and addressing the crisis created by the pandemic. 

Our perspective on reform

To strengthen the pandemic response and improve every person’s everyday experience with the healthcare system, we need a total shift towards value-based care that prioritizes people’s health above the quantity of services delivered. Making COVID-19 waivers that support value-based care permanent is a good initial step, but healthcare reform can and should go beyond that. Payers who invest in an advanced primary care model will be on the leading edge of the shift to value-based care. 

Trend 2: Health for all

This trend sums up the need for true health equity by detailing five intersecting health and social conditions that correlate with poorer health outcomes: physical health status (chronic conditions, etc.), behavioral health challenges, unmet social needs (food and housing insecurity), racial inequity, and access to care. These factors shouldn’t be barriers to health but they are. All stakeholders in healthcare need to take proactive action to support health for all. 

Our perspective on health for all 

One major reason why these determinants of health create harsh disparities is that our healthcare system is built on a fee-for-service model that passes costs on to individuals.  This makes it difficult for people to get access to care and increases the chance that they’ll put off seeing a doctor until they’re in dire need — even if they have insurance. As CMS Administrator Seema Verma puts it: 

Now more than ever, it is clear that our fee-for-service system is insufficient for the most vulnerable Americans because it limits payment to what goes on inside a doctor’s office. The transition to a value-based system has never been so urgent. When implemented effectively, it encourages clinicians to care for the whole person and address the social risk factors that are so critical for our beneficiaries’ quality of life.”

Unlike the fee-for-service model, value-based care is designed to improve access to care for everyone.

• People with chronic conditions don’t have to pay extra for a primary care provider to guide them through the healthcare system. This leads to better outcomes. 
• Behavioral health services are integrated into primary care and are therefore easier to access.
• Health providers are focused on health outcomes, incentivizing them to track and respond to population health data about food and housing insecurity 
• Payers can respond to racial inequity by placing care centers within communities who have been underserved by the healthcare system

The traditional fee-for-service model falls short on another measurement of health equity: it only deals with health symptoms, not the surrounding factors that create disparities. Advanced primary care is designed to understand all the factors that impact a person’s health and devise a personalized plan to help them live a healthier life. 

Trend 3: Era of exponential improvement unleashed

The McKinsey article highlights how COVID-19 has pushed adoption of virtual care, which could signal a new wave of technology-driven innovation. There is a wide horizon of possibilities for more personalized, intuitive healthcare ecosystems. 

Our perspective on exponential improvement 

When payers invest in advanced primary care, they can design care to meet their members’ needs. This agility makes it easier to adapt and implement healthcare innovations like telehealth (check out this blog post to learn how virtual care is shifting care delivery online). Because the APC model is value-based, it allows payers and providers to share the same incentive: focus on member outcomes. 

Trend 4: The big squeeze

McKinsey estimates that COVID-19 could depress healthcare industry earnings by between $35 billion and $75 billion compared with baseline expectations, with select high-growth segments like virtual care, software, and platforms disproportionally driving growth. As a counterpoint to the expected depression in earnings, the article adds that businesses in lower-growth segments can achieve higher-growth returns by improving productivity. 

Our perspective on the big squeeze

COVID-19 was devastating to health providers who operate in a fee-for-service model that is dependent on a high volume of patients visiting a clinic. A value-based model would have prevented such a deep depression in earnings by allowing providers to continue to be compensated for the care that was needed in the moment, like COVID-19 tests and telehealth.

Productivity gains shouldn’t be the goal of healthcare. Productivity gains mean more procedures and more appointments per day. But that’s not what creates better outcomes for patients. The key to building resilience against a future crisis like a pandemic is to adopt a value-based model that allows providers to spend more time with patients, understand their underlying conditions, and manage their care.   

Trend 5: Fragmented, integrated, consolidated care

The shift of care out of hospitals and towards outpatient options has also been accelerated by COVID-19. More payers than ever now own non-hospital delivery assets like primary care.

Our perspective on fragmented, integrated, consolidated care

Control of care delivery allows for greater agility, innovation, better patient experiences, and higher Medicare star ratings.

As the above graph demonstrates, outpatient options show the most potential for revenue growth through 2022. When payers invest in an advanced primary care model, they can implement high-growth segments like virtual care, care centers, and outpatient behavioral health all in one place. 

Trend 6: Next generation managed care accelerated

Payers who pursue managed care models by deeply integrating with care delivery are showing better financial performance than other multi-segment payers, commercial-focused payers, government-focused payers, or multi-segment Blues. 

Our perspective on next generation managed care

Care coordination is essential to improving patient outcomes and lowering the total cost of care.  But next generation managed care, despite its name, can only have a limited positive impact when care is still taking place within a fee-for-service model. 

In a value-based advanced primary care model, care coordination allows a primary care provider to direct care for patients with complex comorbid conditions, reduce cost while improving outcomes of referrals, and reduce waste that occurs when specialty care is overused. This Q&A with Vera's Chief Medical Officer Dr. Kevin Wang gives an in-depth perspective on the benefits of care coordination.

The COVID-19 era has quickened the pace of change, but payers have the opportunity to respond to these trends by investing in a value-based, advanced primary care solution. 

Do you want to be at the forefront of change in healthcare? To learn more about advanced primary care, download this free eBook.