The last few years have been a bumpy ride for all industries, with healthcare bearing a particularly heavy burden. From the onset of the pandemic to rising inflation and ongoing talent shortages, keeping up has been no easy task. However, challenges also bring opportunities, especially for those who can anticipate the direction we’re headed in.
We tapped our in-house experts to share insights into the healthcare trends shaping the industry and tips for navigating the months ahead. Here are three to keep an eye on:
1. Roughly Half of Healthcare Payments Made through Value-Based Care … and Growing
Whether you’re a fan of value-based reimbursement or not, research shows that adoption is ticking upward. Roughly half of healthcare payments are currently made through value-based reimbursement models. What’s more, CMS set a goal of having 100% of traditional Medicare beneficiaries and the majority of Medicaid beneficiaries in accountable care relationships by 2030.
Adopting the new revenue model can be overwhelming, with each payer having different programs, but it can also create an additional revenue stream for your practice, according to Steve Hunt, vice president of sales, healthcare, at i3 Verticals.
“Some programs offer reimbursement in addition to the traditional fee-for-service payments, meaning value-based care can be an addition rather than a replacement,” says Hunt.
However, many practices haven’t reached anywhere near the “maturity phase” for the adoption of the technologies required to support value-based reimbursement, which is a consideration for practices.
Tim Anderson, executive vice president of RCM, healthcare, at i3 Verticals, recommends that practices become “students of value-based medicine.” Understand how value-based reimbursement influences your revenue cycle, have conversations with your payers about how it works, and then learn how to best leverage it in your practice.
2. Patient Experience Overtakes the Future
During a recent conversation with Phallynn Espinoza, senior account executive at i3 Verticals, she shared an interesting experience. She researches new practices before meetings to discuss CMR or EHR solutions.
With this research, she sometimes notices practices getting hit hard in their online reviews, and it has nothing to do with the medical practitioners (patients often love them). It has everything to do with paper dependence and manual processes.
The reviews say things like:
- I received an unexpected bill more than nine months after my service.
- I tried to call with a question, and it took forever for staff to return my call.
- I had to wait ages for my lab results. I wish I could have just viewed them online.
Zach Tabor, director of software engineering, healthcare, at i3 Verticals, explains: “As you consider how to improve patient experience, talk to existing patients. Learn how experiences fall short, and identify the processes involved in those interactions.”
With these processes in mind, you can consider:
- Is the process repetitive? Examples are entering information manually into a spreadsheet or sending emails.
- Does the process have the potential for human errors? If so, the risk is often reduced with automation.
- Is the process rules-based? A process with clear rules is often a good candidate for automation.
If you answered yes to any of the above, there’s a good chance that automation will help improve those processes and the patient experience.
3. CMS Continues to Prioritize Health Equity
The Centers for Medicare and Medicaid Services has prioritized health equity in its Star Ratings. Furthermore, a recent survey found that 58% of health systems identified health equity as a top priority, up from only 25% in 2019. As health equity becomes increasingly important, providers and payers are both making changes, according to Angie Adams, vice president of product management at i3 Verticals.
For example, by proactively working to create initiatives, payers have begun to chip away at ever-complex health equity challenges. Many health plans have specialized opt-in programs for members who need more support, such as those with chronic health conditions. In addition, plans offer dedicated phone lines – staffed with nurses and created specifically for members who need pain management support, diabetes support, or other personalized assistance – to help them get the care they need.
Among healthcare payers, many are proactively working to identify health disparities and the populations with the highest needs, publishing peer-reviewed studies that offer insight into which programs help which populations. Payers can use this insight to make more informed decisions about what to integrate into benefits offerings.
As providers move into the future, supporting equity will likely continue to be a priority.
Aligning with healthcare trends 2024
Practices are working hard on the day-to-day and don’t always get around to proactively pivoting to adapt to upcoming industry changes.
However, when you keep track of emerging trends, figuring out which ones are most likely to hit your practice (and revenue), you can get ahead of trends, better serve patients, and support future growth.
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