Commentary

Meet the Field of 64: Holdover Trends from 2021

Mar 16, 2022

The 2022 March Healthcare Classic features a number of trends that found themselves in 2021’s bracket. Many of these trends are pitted against each other in repeat matchups in Round 1. As these trends lace ‘em up again in 2022, how will they fare? Which trend will be the reigning champion this year? To join the conversation and submit your selections, please click here. Stay tuned as we reveal Round 1 results this Friday, March 17! 

General Trends Region

(in order of Seed)

1) Platform

(2021 Classic: eliminated in the Top Four)

Platforms support telehealth along with other virtual services by managing traffic and security. In this lineup, Platform was triumphant and landed a spot in the Top Four. With the pandemic being a key accelerant, many digital platforms advanced and digital health companies saw nearly $60B in deals. One major deal was Walmart Health’s acquisition of MeMD. The deal allowed Walmart to provide seamless care delivery and coordination experiences, while offering virtual access.

2) Affordability

(2021 Classic: eliminated in the Sweet 16)

As millions remain uninsured or underinsured, affordability continues to be a top concern for many Americans. A 2021 survey from the Commonwealth Fund revealed that 1 in 3 insured adults and half of uninsured adults said they had a medical bill problem or were paying off medical debt. 

National health expenditures grew 9.7% to $4.1 trillion in 2020, or $12,530 per person, and accounted for 19.7% of Gross Domestic Product. Despite massive legislation, disruption from the private sector and attempts at reform from consumer groups and nonprofits, affordability remains elusive prey in the tangled jungle of healthcare. 

4) Innovative TPAs

(2021 Classic: eliminated in Round 1)

Third-party administrators (TPAs) help streamline the administration of self-insured health plans, which now cover about 64 percent of U.S. workers. There is a growing expectation for TPAs to deliver more technology-driven solutions, as the user base becomes more technologically demanding. 

In an environment beleaguered by rising costs, ever-changing regulations, technology evolution, workforce challenges and cybersecurity demands, TPAs are having to adapt to remain relevant and useful to their customers. They are turning to automation, cloud-based Software-as-a-Service solutions, predictive modeling and other innovations.

5) Health Equity

(2021 Classic: eliminated in Round 1)

Health equity is defined as equal access to healthcare for all people, regardless of race, socio-economic status or other social determinant. In March 2022, the National Committee for Quality Assurance (NCQA) launched the Health Equity Resource Center, a website designed to give insight into health equity. By providing research and white papers, the site will share protocols for improving health disparities. 

12) Health Literacy

(2021 Classic: eliminated in Round 2)

The U.S. Department of Health and Human Services, in their Healthy People 2030 10-year national plan, defines health literacy as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” In a media landscape fraught with misinformation, health literacy is an even tougher objective to reach.

As individuals increasingly use information to make their own healthcare decisions, and with a growing emphasis on health equity, health literacy is key to the success of public health missions. As we have seen during the pandemic, weak health literacy can have negative consequences on individuals and overall public health.

16) Point Solution

(2021 Classic: eliminated in Round 1)

A point solution addresses a single specific need and is typically used when a quick, inexpensive fix is required. It usually functions in isolation and does not address the larger context to which it belongs. It can be a perfect fit, a temporary solution while a more comprehensive approach is developed, or it can be problematic.

As opposed to a platform, a point solution fulfills only one part of the process. The upside is that the solution can be deployed fast. The downside is that the solution may not integrate well, causing friction among patients and other stakeholders. While a comprehensive platform is the gold standard, many companies have to occasionally use point solutions to keep moving forward.

Business Model Innovation Region

3) Payviders

(2021 Classic: Runner-Up)

Payviders – a model that combines the highest value of payers with the highest value of providers – had an outstanding performance, ranking in the Top Two. According to a survey from November 2021, nearly 60% of health systems plan to get into risk-based Medicare Advantage payment models in 2022, making Payviders a fierce contender in this year’s bracket.

5) Shared Savings

(2021 Classic: eliminated in Elite 8)

Shared savings agreements have gained a lot of traction, in large part due to being a risk-free transition step for providers between fee-for-service and value-based contracts. In shared savings arrangements, if providers meet quality standards, they become eligible to share with the payer any savings they generate. However, if they spend above the target, they are not penalized. 

8) Direct to Employer

(2021 Classic: eliminated in Sweet 16)

In a Direct to Employer model, healthcare providers contract directly with a self-funded employer. According to a 2020 Willis Towers Watson study, only 6 percent of employers report purchasing services directly from providers. Even so, in the cases where they work, they can work well, providing value to employers, employees and their families, and providers, with high reported rates of quality, patient experience and cost of care. 

9) Direct to Consumer

(2021 Classic: eliminated in Round 1)

In a Direct to Consumer model, companies provide products and services directly to consumers. Along with the demand for convenience, some healthcare consumers are taking up direct-to-consumer (DTC) healthcare products – and some services – with great confidence. Many have seen insurance companies as “the problem” in healthcare and have longed for an option that worked more like a trusted retail store – high quality products at upfront, transparent prices, no insurance needed. Providers, too, find the possibility of a world without claim management attractive. While this seemed promising, the effects of the pandemic and the influx of consumers using telehealth heavily impacted the performance of such models.

Care Delivery Region

4) Service Expansion

(2021 Classic: eliminated in Round 1)

Healthcare spending is predicted to grow by 5.5 percent annually through 2027, and health systems are angling to position themselves through service expansion to receive some of that spend. 

Hospitals and health systems will have to choose, based on the needs of their patient populations as well as opportunity to attract new patients and revenue, which services to expand and add. These decisions may lead them to avoid spending resources on specialization (like becoming a center of excellence) so that they can add services. If their populations require service expansion due to a lack of other healthcare options in the area, they may be incentivized by the Affordable Care Act to provide new services. Or they may be incentivized by the financial opportunity represented by the service line expansion.

5) Brick and Mortar

(2021 Classic: eliminated in Round 2)

Even with the recent surge in telehealth, hospital at home, virtual care and digital care, brick and mortar facilities will remain the nexus of care for the foreseeable future. In most disciplines, technology still has a long way to go to replace the benefits derived from eye-to-eye and physical examinations. Large-scale diagnostic and imaging equipment and therapies and procedures that must be conducted in person have a heavy anchor on physical facilities.

However, some brick and mortar may see a decrease in square footage when it comes to the degree of medicine that is conversation-based offered by a certain practice. Some may give up a portion of leased real estate or tailor it to the needs of telehealth. 

7) Physician Employment

(2021 Classic: eliminated in Round 2)

In recent years, physicians have been embracing employment. More physicians have become less interested in the stress and burdens of owning and managing a private practice, electing instead for the stability and freedom to focus on patient care offered by employment. According to the American Medical Association, 2019 was the first year that recorded more physicians as employees rather than practice owners. 

8) Behavioral Health

(2021 Classic: eliminated in Round 1)

Mental and behavioral health take into account biological factors as well as life experiences and their effects on an individual’s emotional, psychological, and social well-being. Access to mental health resources and attitudes about mental health are improving. Social stigmas are lifting, particularly in younger age brackets, and more healthcare professionals are embracing whole person care. While there remains a critical shortage of behavioral health providers, insurance coverage has expanded significantly in the last 10 years.

10) Physician Independence

(2021 Classic: eliminated in Round 1)

Buying into a private practice is considered a way to maintain physician independence. The choice gives physicians great freedom to decide on culture, policies and care style; however, the freedom comes with the burden of running a business and keeping a steady eye on profitability. The shine of physician independence has started wearing off for a number of doctors, who are opting in larger numbers for employment, where they find another kind of freedom in not having to care for patients while also managing a practice.

12) Hospital at Home

(2021 Classic: eliminated in Round 1)

Hospital at Home has been in practice for about 20 years at Johns Hopkins Medicine, who holds the trademark on the name. Other health systems have implemented various versions of hospital at home services in the years since, toward the goals of reducing costs and increasing patient satisfaction. As of March 2022, the Acute Hospital Care at Home program has been used by 92 health systems since its introduction in November 2020. A new bill introduced to the Senate would extend the waiver by another two years. Will this impact Hospital at Home’s performance this year?

13) Centers of Excellence

(2021 Classic: eliminated in Sweet 16)

A center of excellence (COE) is a specialized program within a healthcare institution with exceptionally high concentrations of expertise and related resources centered on particular medical areas and delivered in a comprehensive, interdisciplinary fashion. For example, Walmart’s COEs focus on heart surgeries, spine surgeries, organ transplants, hip and knee replacements, and more. 

15) Chronic Disease Management

(2021 Classic: eliminated in Sweet 16)

Chronic Disease Management aims to reduce hospital admissions through whole person care and a greater degree of self-care. This year, major players within the industry have shifted their focus to chronic disease management. VillageMD recently acquired Healthy Interactions, a platform that aims to strengthen patient-provider relationships in chronic care management. According to a recent study by the CDC, 90% of annual healthcare expenses within the US are related to chronic or mental health conditions. 

Data and Technology Region

3) Price Transparency

(2021 Classic: eliminated in Round 1)

In January 2021, federal laws requiring hospital price transparency went into effect. The laws dictate that hospitals must openly publish their actual prices, which in theory promotes a more competitive healthcare landscape, where consumers can compare prices while shopping for healthcare providers. As of last summer, only 5.6 percent of hospitals were in compliance, and it’s unclear if access to this information will have the intended effect of lowering healthcare prices and costs to consumers. 

4) Artificial Intelligence

(2021 Classic: eliminated in Round 1)

Artificial Intelligence (AI) mimics human cognitive function and is “trained” on large amounts of data. Adoption of AI has been slow within the industry, with only .05% of healthcare job descriptions requiring AI skills. However, in February 2022, Duke, Mayo, and DLA Piper announced a collaboration to ensure security, privacy, and safety for AI in healthcare. Will this help to advance the rate of adoption?

5) Predictive Analytics

(2021 Classic: eliminated in Round 1)

Predictive Analytics (PA) uses past and real-time data to forecast future events and detect patient care trends, using artificial intelligence, machine learning and other techniques. PA can help providers predict what diseases a patient is likely to develop and how they might respond to a particular treatment. PA can identify patients at risk for readmission, and it can alert public health administrators to looming population health dangers.

8) SDOH

(2021 Classic: eliminated in Elite 8)

SDOH are conditions in the environments where people live, learn, work and play that affect a wide range of health risks and outcomes. This past year, North Carolina’s Medicaid transformation was approved. Starting in March 2022, North Carolina’s Medicaid system will reimburse Human Service Organizations in an effort to address SDOH. 

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