There is consensus among C-Suite from health plans, providers and life sciences that the health care industry has made progress in care delivery innovation in 2020. Yet results also show progress is lagging in the associated mechanisms to sustain it, mainly care payment and funding evolution. According to new research findings by Optum, COVID-19 has mandated dramatic changes in care delivery and cross-industry partnerships. It has exposed the human and financial costs of the nation’s health inequity. And it has accelerated change — forcing us to shift to virtual health, flexible staffing models and in-home care.
Insights from more than 161 health care leaders- 60% of respondents, came from the C-suite, with 25% from the vice president level and 16% from the senior vice president level observed that changes in consumer coverage, policies,
macroeconomics, untended disease states and new market entrants continue to disrupt the landscape.
Where we are making progress, what challenges still exist, how partnerships, have changed 2021 investment priorities-
Five things to know
- Care delivery innovation: Progress
A full 89.1%, including all executive segments, believe the industry had made progress in care delivery innovation — which includes virtual health, in-home care and avoiding unnecessary care. Much of the technology associated with care delivery innovation has been here for some time. But COVID-19 forced adoption and showed how well it could be embraced by both patients and physicians. The crisis has also shown us ways to refine regulatory rules, adjust the prior authorization processes, activate a remote workforce, and invest in artificial intelligence and machine learning. Additionally, it has forced reexamination of payment and perceptions of value for virtual care delivery.
- Patient and consumer engagement: Good progress
As many as 73.2% believe the industry had made progress in patient and consumer engagement and experience. This is second highest after care innovation. Part of this improvement relates to the fast adoption of telehealth and investment in patient portals, as well as, broadly, mobile connectivity and connection. The channels were launched, and the providers are working to integrate the associated data into their EMRs. But to achieve the greatest return, health organizations will need to invest in consumer segmentation and continued adoption of these modalities, as well as new ones. Then they can develop the personalized care plans and associated engagement strategies that improve outcomes and reduce costs.
- Infrastructure development: Some progress
Report said 64.6% believe the industry had made progress in infrastructure development and modernization. Organizations have been modernizing their infrastructure for several years. But they are still learning what kind of bandwidth is necessary to support widespread use of this new technology. We need to learn what will be the required capacity for virtual care and how infrastructure, care pathways and payment mechanisms should align.
- Data and analytics: Some progress
It said 63% believe the industry had progressed in data and analytics maturity. Like many of these areas, change has been occurring for several years. Today health organizations are still learning how to derive insight from incoming data and use it to drive meaningful actions. Leaders will need to reorganize their systems to accommodate the hybrid physical/virtual world we now live in. There is now even more data to capture and new ways to use it. The challenge is to appropriately share and reconcile data so that it can inform clinician action at the point of care and change member or consumer behavior at key inflection points.
- Care payment and funding: Some progress
According to the report 61% believe the transition to value-based care is accelerating —but not evenly across the industry. Respondents gave care payment and funding the lowest marks. The pandemic unlocked some payment restrictions allowing for more virtual health, telehealth and in-home care. But from a business standpoint, it’s not enough to innovate. The financial incentives for preventive programs that keep patients out of the doctor’s office need to be consistent for widespread use of digital health tools by providers. Payment innovation must keep pace with care innovation. And as we see in these results, leaders recognize that care payment and funding evolution is not keeping pace.