Pondering 2021 in Healthcare

As I move through Q4, I am finalizing plans for primary research topics for 2021. COVID-19, elections, market fluctuations, government aid, the Affordable Care Act’s fate, and employment levels will of course be the headliners, so no need to recycle that content. But there is a set of industry-specific trends that will impact the way healthcare is delivered and paid for in 2021 and beyond. Some–such as telehealth—are newer, but most have their roots in past years and are entering their next chapter.

Boosting customer engagement: Health plans, corporate communications organizations, third-party administrators, financial institutions, and retirement planners are committed to engaging the customer through personalized communication and educational and decision-support tools. Their commitment is clear, but their mission is far from complete. In 2019, I dug into just what it would take for health plans to engage their members. The findings were rich enough to support two reports that looked into how effective games and incentives are and also how appealing personalized coaching support is. Suffice it to say there is no magic wand to make this happen, given privacy concerns and fear over what health plans might do with information about the enrolled member if their health habits are, well, not so healthy. Unlike car insurance premiums, which increase when policy holders get in accidents, health plans cannot increase the premiums of those that are at risk of future health issues, nor can they discontinue coverage. But consumers’ concerns over whether that will remain the case in the future are palpable.

Financial wellness: That we must even talk about financial wellness is unfortunate. It is a result of three fundamental factors. First is that financial planning, budgeting, and forecasting amount to an equation with too many unknowns. Individuals are not always comfortable making assumptions, taking risks, and trusting a financial organization or advisor to view the intimate details of their financials. The second factor is the complications that taxes bring. The third factor is that the basics of budgeting are not instilled in people’s minds at young ages—as early as elementary school. Once an individual is out of school and working, with a credit card and debt, it’s too late. Employers that have gone through several economic cycles have seen the impact of financial stress on their employees and are now putting financial wellness benefits into place. An employer benefits study Aite Group conducted last year peeks into just what those financial wellness programs look like and the path ahead. I’d love to see the basics of financial wellness taught in elementary schools. Only then can we expect financial wellness to hit its goal. It will take several decades, but it would be so meaningful to see it come to fruition.

Revenue cycle management, or keeping healthcare providers in business: As consumers cancelled or postponed their medical visits throughout most of 2020, healthcare providers saw their claims volume—and in turn revenue—plummet. At the same time, they incurred a spike in expenses in a rush to procure critical equipment for their staff and patients. This double bind put them in financial straits, escalating the importance of medical bill collections, speeding up medical claim payments, and improving patient collections through financing.

These themes only scratch the surface of upcoming independent, primary research in store for 2021. I’m  revisiting fraud prevention and payment integrity, and evaluating the essential vendors focused on delivering those measures to health plans through artificial intelligence and advanced analytics. I’m keeping on deck both the budding industry of fintech and insurtech companies breathing new life into financial wellness, and the consumer-driven health world of health benefit accounts. Telehealth is also on my radar, with exciting developments in the form of initial public offerings, acquisitions, and the technology challenges to capture the last mile to the end user, in other words, connecting the telehealth app with the consumer, whether by broadband or Wi-Fi access or through a reliable 5G connection.

While the uncertainties ahead cast a cloud over 2021, I am excited about the imminent breakthroughs in healthcare, whether it be an effective vaccine, better health and finances, or improved payments for all of us.

And I hope that 2021 finds you in good health.

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