Looking to the Future – 2021 Predictions

Unlike past years when we have written a post evaluating how well our predictions for that year held up, let’s just say the COVID pandemic threw a monkey wrench into everything and move on. 

That being said, before I started pulling these predictions for 2021 together with the Chilmark Research team, I did take a peek at those 2020 predictions and surprisingly, some did hit the mark. My favorite, especially in light of these times: Behavioral health comes to the forefront. A spot-on prediction in this COVID age as we all grapple with the physical distancing required to stay safe.

Personally, I just long for a day when I can get together with others at a coffee shop to simple sit and talk. 2021 will grant that wish, but not likely till mid, late summer.

Now on to our baker’s dozen of predictions for 2021. Drum roll please… 

COVID-19 hangover lasts far longer than expected.

A vaccine may be on the way, but COVID-19 will leave a lasting impact well-beyond 2021. “Long-haulers” will seek pre-existing status for health insurance coverage – this may require legislative action if payers balk. Ranks of unemployed will remain high putting stresses on Medicaid and subsequently state budgets. Rural hospitals and small independent practices will see unprecedented closures as the Feds cut back on future relief packages. 

And lest we forget the children who with their teachers have struggled with remote, online learning. How they will recover is still unknown.

The unequal burden of disease for COVID-19 for minorities will intensify interest in SDoH and services that directly impact the disease burden.

Already there are signs that the Biden Administration will take health disparities seriously. Dr. Marella Nunez-Smith from Yale School of Medicine has been named as advisor for the COVID-19 Equity Task Force. VBC had already been a driver of adoption of SDoH analytics and services, but a senior cabinet member will likely provide even more focus in health policies over the coming years.

Shift in focus of health systems from acute to ambulatory

There have been many mergers and acquisitions in recent years between health systems as they look to expand their network coverage, consolidate market and demand higher rate fees. This has reached its limit and may be regressing e.g., Geisinger and Atlanticare parting ways. In 2021 and beyond the focus will be to build out the ambulatory network. This will include primary practices as well as ambulatory surgical centers (ASCs). Site neutral pricing for some 1,700 former, acute-only procedures is latest CMS action to drive this trend. Growing reliance on value based care is also playing an important role.

Commercial payers and even Blues step-up acquisition and partnership activity targeting ambulatory sector.

While Humana and UHG have a long history of acquiring ambulatory practices, only recently have other payers followed suit. 2021 will see more payers get in on the action as they seek to become more vertically integrated. Unlike providers, payers are flush with cash heading into 2021. This will create an environment of highly contested purchases for premium ambulatory assets with the best ambulatory services seeing very attractive offers.

Remote patient monitoring remains a side-show.

Despite all of the virtual care hoopla during the year of COVID-19, remote patient monitoring (RPM) will remain a challenge for most health systems to adopt and effectively deploy. Top challenges include reimbursement, scalability and last but certainly not least, patient engagement.

Self-insured employers will drive non-telehealth virtual care.

Behavioral health, wellness and mindfulness activities, musculoskeletal health, and first-step virtual triage will become the frontline solutions as employers look to return employees to the office and reduce overall benefit costs as delayed and elective care resumes.

Maturation of the FDA’s thinking on software-as-a-medical device (SAMD) is creating a clearer path for AI vendors in the clinical decision support/remote patient monitoring space.

Over the past several years we have seen doubling of FDA approvals for algorithms. With greater clarity on where the FDA is going in this space we expect to see even greater growth of approvals. Many of these approvals will enable more diagnostic devices in the home or deskilling of devices for layperson use in remote contexts.

Visages emerge of converging FinTech and HealthTech to optimize revenue.

It has been a tough year financially for provider organizations who have seen steep drops in procedures and emergency room visits, both key revenue drivers. Ensuring patients pay promptly has become very important to maintain cash flows. Coupling that with what has become increasingly apparent – patient satisfaction scores are tied to how easily a patient can pay for services and if those costs are clear and transparent (understandable and fair) – provider organizations are seeking more seamless patient pay solutions. There has been substantial developments in the financial tech (Fintech) world that will see these vendors look towards healthcare as a another vertical market ripe with opportunity. 

2021 will not be the year of the patient or member app.

Providers and payers will build the new FHIR-based APIs required by the Cures Act. Digital health companies and independent developers will jump on them and focus on better apps for people who work inside healthcare rather than apps for patients or members. The only exception to this are apps that help patients readily schedule appointments and pay for those doctor visits.

CMS and its CMMI division will begin rationalizing VBCM.

Since passage of the ACA and establishment of CMMI, CMS has launched a wide range of value based care models from bundled payments to ACOs, to Direct Primary Care contracting. Some have been successful in reigning in costs, others less so. In 2021 CMS and beyond, CMS will begin pruning VBCMs to those that are worth supporting and have seen wide-spread adoption. 

For some programs, there will be a retooling. In 20121, CMS will do a relaunch of MSSP, establishing it as the anchor for efforts to wean providers from FFS. The redesign will focus heavily on getting hospitals and health systems back into the program. It will further reduce reliance on quality performance on the assumption that relying on clinician professionalism is a better way to avoid stinting on care than surveillance. 

Digital health in the pharmaceutical sector will see more rapid adoption due to COVID-19.

Restrictions put in place to mitigate the pandemic made conducting clinical trials more difficult. While pharma has been a relatively slow adopter of digital health technologies, the present conditions are accelerating adoption of such to support more decentralized trials, capture patient reported outcomes all with the potential to lower costs and identify adverse events sooner.

COVID-19 vaccine adherence problems drive the need for new analytics and care management.

Because two doses will be one too many for too many patients, EHR, analytics, and care management vendors will need to roll out new COVID care gaps reporting with care management workflows to get those patients back to the clinic for their second shot.

Virtual care consolidation continues.

Funded by IPOs and an influx of investor cash, virtual care continues its run of acquisitions and partnerships. By the end of 2021 there will be four major virtual care platforms that include telehealth, chronic care management, and device offerings.

That is a wrap on our team’s top predictions for 2021 and we hope they provide you some guidance as to what is in store for the new year to come.

In the meantime, I hope all of you hold close those you love, either figuratively or metaphorically through the dark months to come. We are not out of the woods yet, even if we can see a light at the end of the tunnel. Let that light be your guide, your hope for better days to come.

Peace and Goodwill to All. 

John Moore, Founder and Managing Director