Some of the trends on the horizon this year may be familiar as they’ve been emerging over the years. The healthcare industry is nothing short of a behemoth and although not resistant to change, it can be rather slow to adapt, even when health crises demand it. However, the eruption of COVID-19 in 2020 and the continuation of the pandemic into another year has put pressure on the healthcare industry to make rapid advancements and sharply change direction, in many cases.
In 2021, it’s expected that payers and providers alike will adapt to several new ways of doing business. A new political climate, economic challenges brought upon by the pandemic and a stronger focus on the patient-provider-plan billing cycle are some of the strongest catalysts driving disruption in the healthcare industry in 2021. Adopting real-time and near-real time payments and transactions is a way to transform the payer and provider universe for better member experiences. Accepting not only this factor but many others is an acknowledgement that this disruption is not just beneficial, but rather, necessary for industry players to continue to stay afloat in this new pandemic-era (and eventually post-pandemic era) we’re living in.
Here’s a look at some of the specific healthcare industry trends that are emerging, or being emphasized, in 2021:
Technology Adoption in Healthcare
Telehealth was necessary for doctors to manage to treat their patients without contracting the virus, whether they knew they were treating a COVID patient or not. Providers had no choice but to quickly learn how to navigate telehealth software to treat patients. Now that they’re more familiar with it, and now that payers have had time to incorporate telehealth into their coverage options, the question is whether telehealth should be a permanent addition to insurance coverage.
Some payers are still trying to decide whether telehealth is here to stay, or if telehealth coverage and benefits should phase out along with COVID-19. Regardless, telehealth will undoubtedly continue to be part of the conversation and is deserving of its role as a major player in emerging healthcare trends in 2021.
Telehealth isn’t the only way doctors will be able to better treat their patients virtually, though. Connected devices such as wearable health sensors can measure skin temperature, heart rate, respiratory rate, body position, activity levels, and cough frequency. These devices and others that treat conditions such as wellness and self care were presented at the 2021 Consumer Electronics Show.
Additionally, technology will be essential in automating the processes that make healthcare difficult to navigate for payers, providers, and patients alike. Adopting technology that can automate everything from prior authorizations to medical chart reviews will help enable better communication. Additionally, as payment integrity programs continue to evolve, we will see a greater emphasis on moving payments far left towards the fastest speed to pay, such as ClaimLogiq’s TrueCost software, that will help payers discover errors in itemized bills and DRG bills at a fraction of the time in order to uncover savings for the Plan, the provider and ultimately, the patient.
Healthcare Claims Payment Transformation
Pricing transparency and value-based payments are driving payers to focus on moving payment timelines left. Payers want to get billing corrected as soon as possible and from post-payment reviews to pre-payment reviews through adopting technology and software.
TrueCost is the payment integrity solution that is completely customizable, transparent, and user-friendly. Payers can trust TrueCost's Operating Rules and Routing Engine, or CORRE, to perform pay-pend decisions in under 250 Milliseconds so that you can start your review process with the most accurate billing possible.
Correct billing the first time and adopt technology and software that doesn’t interrupt payment timelines.
Data Exchange in the Healthcare Industry
Data exchange will continue to be a vital aspect of the ever-evolving healthcare landscape. Between the Price Transparency Ruling that took effect on January 1, and the limited data we have on the long-term effects of COVID-19, data will be more precious than ever and cooperation between government and private entities will be essential in order to benefit the industry and exchange data.
There will be a greater emphasis on quality of data, too. Clinical data needs to be readable to be useful, so cleaning and parsing through data will be yet another challenge. This is a daunting task to do manually, and softwares that can automate this process will be essential in helping payers optimize their data.
Health Equity Awareness
The healthcare industry is finally catching up to speed with the social issues facing minority populations that ultimately impact their health. Racism and bias impact care, both in the development of technology and in the hospital room, and more equity-conscious payers and providers are acknowledging that they need to invest in health equity training to help improve outcomes in a measurable way.
It’s important to note that while equitable healthcare itself should not be considered a “trend” and should be a constant pursuit, hopefully, a rise in awareness and continued learning will lead to quality healthcare for everyone who needs it.
Behavioral Healthcare Trends
The pandemic has unfortunately led to health crises other than COVID-19.
According to data from the CDC (via the Carroll County Times), before March 2020, over 45 million Americans, or 20% of Americans, were diagnosed with a mental illness. That percent had doubled by June of 2020, where 40% of adults were struggling with mental illnesses or substance abuse.
Those with mental health and substance use disorders have been impacted at heightened levels since early last year, and the number of people suffering from them has also increased – so much so that mental health care workers often can’t see everyone seeking treatment.
Finding ways to treat behavioral health issues will be a large focus of the industry in 2021. Solutions may need to be inexpensive, and be available virtually, in order to treat more patients. Finding a way to care for patients and help them find balance in the midst of a pandemic will be essential to avoiding rising healthcare costs and, more importantly, helping save lives.
Providers / New Payment Models
2020 presented countless financial problems to everyone. Patients, avoiding catching COVID-19, deferred care until 2021. Providers, as a result, may be struggling even while payers profited.
This situation may lead to many considering moving away from the fee-for-service payment model. With help from wearable technology and remote patient monitoring, providers may be able to optimize treatment and provide higher-value care as a way of improving patient outcomes while also increasing ROI.
How to Tap Into Healthcare Trends in 2021 and Implement Best Practices
2021 and healthcare transformation may just be an understatement. With a continued focused on price transparency, value-based payments and the importance on tackling critical issues plaguing our population such as health inequality, it’s critical that payers are in a position to be agile enough to tap into trends and adopt new best practices.
Is digital transformation one of your healthcare plan’s resolutions this year?
ClaimLogiq can help. With a rules engine that makes pay/pend decisions in less than milliseconds, and a platform that performs an itemized bill review in less than 2 hours, TrueCost is the key to reinventing your payment integrity program in 2021.