The following is a guest article by Mike Noshay, MSE, Founder and Chief Strategy & Marketing Officer at Verinovum.
As 2020 comes to a close, healthcare industry leaders are looking ahead to 2021 with excitement and anticipation. This year has brought a number of challenges and opportunities for innovation, but how will they shape the future of healthcare data? I’ve put together a list of 12 new truths for 2021 – bold predictions about healthcare data that may shape the industry for years to come. In addition to predictions about COVID-19 and the future of telehealth, I dive into more complex healthcare challenges that payers and providers should consider as they round the corner into the next year.
1. The number of Americans willing to be vaccinated against COVID will be less than 50%.
In the past few weeks, two frontrunners have emerged in the race to a COVID-19 vaccine. While both have promised to protect upwards of 90% of those properly vaccinated, many are still skeptical about the prospect of a new vaccine and list negative vaccine reactions as their main barrier toward accepting a future vaccine.
It would serve payers and providers well to begin speaking about the benefits and importance of the vaccine to dispel any misconceptions prior to the vaccine’s wide distribution. Using mediums that will reach both members and providers can help spread education about vaccine candidates and can help improve adoption when the vaccine is available.
2. Medicaid populations will rise.
Many Americans have lost their job, and therefore their employer-sponsored health insurance, due to COVID-19. Many of those people are enrolling in Medicaid to ensure health coverage during the pandemic. This has caused a two-fold problem – With a weakened economy, people need Medicaid coverage. On the other hand, states’ ability to fund the influx of Medicaid enrollees is waning. In 2021, we will see states pushing for more federal funding to avoid having to cut Medicaid member benefits and provider reimbursements.
3. Pediatrics will see an influx of childhood diseases.
According to the WHO, COVID-19 has disrupted the supply chain for many life-saving childhood vaccines globally. Disruptions, including lack of transportation, economic hardships, and pandemic restrictions have resulted in missed routine childhood vaccinations and larger vaccination campaigns, including more than 30 campaigns for measles worldwide.
Researchers believe that these missed routine vaccines and larger campaign interruptions may reverse the progress made for a number of infectious diseases, including diphtheria, HPV and measles.
4. There will be an increase in payer mergers.
Due to the impact of the pandemic on in-person healthcare, many payers are struggling to stay afloat. Fewer patients are seeking in-person care or are delaying elective procedures, while the costs associated with COVID-19 treatment continue to rise as more Americans are hospitalized, at great cost to their insurer.
At Verinovum, we anticipate that this will lead to a number of smaller payer mergers in 2021, which could cause disruption in coverage for members and headaches for providers. If this happens to your practice or plan, you should work to troubleshoot any gaps in member care and provide guidance to members to reduce unexpected coverage loss.
5. CMS will temporarily suspend any additional Hospital Readmissions Reduction Program Penalties.
The Centers for Medicare & Medicaid Services recently released the latest round of the Hospital Readmissions Reduction Program penalties, which will impact nearly half of United States hospitals due to their history of readmitting Medicare patients. The data used to calculate the penalties spanned July 2016 – June 2019 and therefore excludes readmittances related to COVID-19. CMS will need to support hospitals as they deal with the continued high caseload that the pandemic has created, and as such, may suspend penalties.
6. We’ll see an increase in healthcare fraud.
With the significant new telehealth adoption rates, patients can “provider shop” more easily. This could lead to an increase in duplicated testing, images and treatment. Payers and providers will need to pay particular attention to a patient’s health record to ensure the completeness of their clinical data.
7. The trajectory of telehealth will change from adoption to customization.
The healthcare industry had to rapidly adapt to implement telehealth services during the COVID-19 pandemic. Many providers had to hastily implement telehealth solutions in order to continue to treat patients. However, hasty implementations have created more problems than solutions. In 2021, we predict that many telehealth vendors will be replaced, and many “bug fixes” will be released by vendors to help fine-tune, improve, and grow telehealth services as the industry shifts to a more long-term plan.
8. Many Medicare Advantage plans will face a decline in Star Ratings.
The Wall Street Journal recently reported that there has been a significant reduction in cancer screenings and diagnoses due to COVID-19. These reductions may adversely impact Star Ratings measures for cancers, including breast cancer and colorectal cancer.
Currently, Verinovum is offering a Tailored Medicare Advantage Data Gap Assessment to help payers identify these critical clinical data gaps to help ensure Medicare Advantage Star Ratings do not dip in 2021 due to a reduction in preventative cancer screenings.
9. We will see an increase in diagnosed chronic diseases.
Due to fewer patients seeking primary care services in the midst of COVID-19, the number of chronic disease diagnoses will increase in 2021 as patients return to in-office healthcare visits.
10. The percentage of people with diagnosed mental health disorders will increase.
A number of Americans are either working from home or unemployed due to the pandemic with no end in sight. This is taking a toll on the mental health status of the majority of the population, and with less access to in-person treatment services, many people will go undiagnosed in 2020. We predict an uptick in mental health diagnoses in 2021 when patients can return to in-person healthcare visits.
Those diagnosed with mental health conditions may require more care, medication, and healthcare touchpoints than those without. For those undiagnosed, payers and providers will need the most reliable data they can get to be vigilant.
11. Rural hospitals and clinics will continue to close their doors.
With an increase in patients due to COVID-19, a reduction in funding from state and federal offices, and a decrease in resources, many rural health systems will be forced to shut their doors in 2021. This will put an increased burden on suburban and urban health systems as they struggle to keep up with their own capacities on top of new patients from rural systems.
12. The final interoperability rule will shine a light on the data quality issues across the country.
The final interoperability rule, which requires payers to initially make data accessible to patients and then to other payers, will drive some grave realizations across the healthcare industry. The ONC rule (formerly coined TEFCA) will help make patient health data more broadly accessible but has no controls for data quality. As such, This is likely to cause a rift across data contributors and data receivers.
While there is no way to know whether the healthcare predictions above will come to fruition, being prepared to respond to changes in the healthcare industry can help your company succeed in both the short- and long-term. The first step in preparation is making sure you have access to clean and curated clinical data to be able to quickly answer questions and solve problems as they arise.
To learn more about Verinovum and how they can help your organization cleanse, curate, and enrich your clinical data, please visit www.Verinovum.com.
About Mike Noshay, MSE
As Chief Strategy & Marketing Officer at Verinovum, Mike is responsible for all prospective client interactions, including client success and support, strategic planning, marketing, and business development. Mike has an extensive background in finance, business, and entrepreneurship. He was previously Director of Business Development & Innovation for Oklahoma’s Health Information Exchange, MyHealth Access Network, and is also a former Teach for America Corps member. Mike is recognized in the healthcare and IT industries for his creativity and entrepreneurial development expertise. He is skilled in opportunity recognition, idea creation and implementation.
Verinovum is a market leader in clinical data curation and enrichment, enabling payers, providers, and partner organizations to improve operating performance and quality with actionable data. By delivering clean, complete, and accurate data, Verinovum supports healthcare organizations in their efforts to access the right information, in the right format, at the right time, so it may be tailored and curated to fulfill specific use cases and achieve mission-critical clinical and business goals. Discover more at Verinovum.com.