As providers embrace data-driven results and are measured on their performance, patients will receive more appropriate interventions. Condition-specific reimbursements, including MSK, maternity, cancer, and BH will be tied to better outcomes. Data sets are being used to determine outcomes and track patients to ensure they’re achieving the recommended outcomes. These solutions will accelerate in 2023, driven by payers and self-insured companies who are becoming focused on results.
Pharmacy & Drug Spending
New entrants (i.e., Mark Cuban Cost Plus Drugs), plus innovative models from disruptors (i.e., Amazon RxPass) will push continued reform of the drug purchasing and PBM landscape, while outcomes-based arrangements will be a dominant strategy among payers to help control drug spending, specifically on high cost, specialty medications.
Due to increased regulations for hospitals and Rx, there is an unprecedented level of availability of data around healthcare prices. However, the complexity of these data sets has prevented widespread use and actionability. 2023 will see new solutions emerge to analyze and provide actionable insights around this data, driving new purchaser behaviors.
Digitally savvy consumers have higher expectations of their healthcare experience and and will demand higher quality, convenient, personalized care. Consumerism will drive providers to adopt new techniques and innovative solutions.
As new solutions emerge, purchasers and individual healthcare consumers are given new choices in how they access and experience care. Convenience will be the dominant consumer preference as people look to access care in settings best for them rather than be forced to travel to the care.
The emergence of shared risk contracts between employers and providers to achieve short and long-term cost reduction combined with data and analytics tools designed to identify high value providers are examples of new business models and tools to better manage the cost of care. These, plus other similar solutions, will lead to an overall system that is more affordable for the purchaser, whether a self-funded employer or an individual consumer.
As employers fight for industry transformation, coalitions are taking a more progressive role in shaping the future. National groups like Purchaser Business Group on Health (PBGH) and Health Transformation Alliance (HTA) are advocating on a national scale, while coalitions in Houston, Maine, Colorado, Indiana, and others are implementing at the local level. This will shape the industry outlook throughout 2023.
According to the Business Group on Health, the overall trajectory of employer negotiations is driving toward more direct contracting with 17% of large employers reporting that they were considering the approach through 2023. Additionally, new solutions are emerging with a focus on smaller employers, which will continue the direct contracting momentum.