By Mike Noshay
The future of healthcare — nothing brought about more questions, and tested the healthcare industry more than the last two years. 2020 brought us challenges, unknowns, and reasons to reinvent how healthcare was delivered. 2021 brought several opportunities for innovation, to find solutions and to change the way things are done.
Last January the leadership team at Verinovum made several bold predictions about healthcare data that could shape the industry for years to come. In addition to predictions about COVID-19 and the future of telehealth, the team looked at more complex healthcare challenges that payers and providers would need to consider in the months and years to come.
Going into the last quarter of 2021, let’s look at how a few of the team’s predictions stacked up against reality.
Prediction #1 – The number of Americans willing to be vaccinated against COVID will be less than 50%.
When 2021 began, vaccines were just beginning to be distributed to a select group of healthcare providers following FDA emergency approval. At the time, the new vaccines promised to protect upwards of 90% of those properly vaccinated, but many were skeptical about the prospect of a new vaccine. These uncertainties and the fear of having adverse reactions created a barrier toward achieving the desired vaccination rates.
Through an ongoing educational and informational sharing campaign — with payers, providers, government entities, and community organizations working alongside and in conjunction with each other — the safety of vaccines has been widely publicized, however this prediction hit remarkably close to reality.
As of August 3, about 189.9 million people — only 57% of the total U.S. population — have received at least one dose of vaccine, according to latest figures from the CDC. About 163.9 million people, or 49% of the total U.S. population, have now been fully vaccinated.
Prediction #2 – Medicaid populations will rise.
During the beginnings of the pandemic, many Americans lost their jobs and their employer-sponsored health insurance. This caused an influx of Medicaid enrollments to ensure health coverage during the pandemic.
Kaiser Family Foundation data shows that Medicaid/CHIP enrollment is increasing amid the coronavirus pandemic as data from February 2020 to March 2021 show that enrollment increased by 10.5 million or 14.7%. Over this period, all states experienced Medicaid/CHIP enrollment growth ranging from 9.3 to 29.2%. Prior to the pandemic (March 2019 until March 2020) there was an aggregate decline of 1.3%.
Prediction #3 – Pediatrics will see an influx of childhood diseases.
According to the WHO, COVID 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.
In July 2021, U.N. agencies reported that nearly 23 million children missed out on routine vaccinations last year due to the COVID pandemic, the highest number in more than a decade, fueling outbreaks of measles, polio and other preventable diseases. This gap in global vaccination coverage has set up a “perfect storm,” leaving more children vulnerable to infectious pathogens just as many countries ease COVID restrictions.
Prediction #4 – There will be an increase in payer mergers.
In January, the team predicted that a decrease in in-person healthcare will lead to payers struggling to stay afloat. Fewer patients are seeking in-person care or are delaying elective procedures, while the costs associated with COVID treatment continue to rise as more Americans are hospitalized, at great cost to their insurers.
Verinovum predicted this would lead to a number of smaller payer mergers in 2021, which could cause disruption in coverage for members and headaches for providers. In June, a Fierce Healthcare article cited a handful of payer purchases/acquisitions, including Humana announcing it would purchase One Homecare Solutions from WayPoint Capital Partners in a bid to grow its value-based home healthcare offerings.
Prediction #5 – The 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. CMS may need to support hospitals as they deal with the continued high caseload that the pandemic has created, and as such, may suspend penalties.
Hospitals that are dealing with increased COVID infections cannot effectively handle the specific re-admissions targets in the CMS readmission penalty program. They are lobbying at the state level to suspend these penalties. Currently, the lobby pressure is growing, and many entities want the penalties temporarily suspended until after the pandemic abates.
Prediction #6 – We’ll see an increase in healthcare fraud.
With the significant new telehealth adoption rates, patients can “provider shop” more easily. As it turns out, in May 2021, the Department of Justice charged telehealth executives and doctors across seven federal districts with exploiting COVID to rake up $143M in fraud. Additional DOJ prosecutions relating to the Paycheck Protection Program, Economic Injury Disaster Loans and unemployment insurance benefit claims are also underway.
Prediction #7 – Many Medicare Advantage plans will face a decline in Star Ratings.
This year’s ratings saw significantly fewer MA-Prescription Drug enrollees in contracts with 4.5 stars. Data released by the Centers for Medicare & Medicaid Services states that “approximately 19.6% of enrollees are in contracts with 4.5 stars, equating to an 11.8 percentage point decrease as compared to the share based on the 2020 Star Ratings. Furthermore, enrollment in 4-star-rated contracts is 7.9 percentage points lower, while enrollment in 3.5-star-rated contracts is 17.9 percentage points higher, going from 15.8% in 2020 to 33.7% in 2021.”
Prediction #8 – We will see an increase in diagnosed chronic diseases.
The COVID pandemic has led many people to forego follow-up and treatment of chronic health conditions such as hypertension (high blood pressure). It is now quite evident that people with hypertension are also more likely to develop severe complications from COVID.
According to the CDC’s report in June, those with chronic diseases are particularly profoundly impacted by COVID. “Heart disease, diabetes, cancer, chronic obstructive pulmonary disease, chronic kidney disease, and obesity are all conditions that increase the risk for severe illness from COVID-19.”
In addition, Mayo Clinic researchers have discovered “new risk factors impacting the population health of those under the age of 45 when it comes to severe COVID-19 infection. Using data from 9,859 COVID-19 infections, researchers found that younger populations had a greater than threefold increased risk of severe infection if they had chronic diseases such as cancer, heart disease, or blood, neurologic, or endocrine disorders.”
Prediction #9 – 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, taking a toll on the mental health status of the majority of the population. With less access to in-person treatment services, we predicted that many people would go undiagnosed until in-person visits resumed.
The National Institute of Mental Health recently cited CDC statistics from a June 2020 survey of adults across the U.S. In the survey, “31% of respondents reported symptoms of anxiety or depression, 13% reported having started or increased substance use, 26% reported stress-related symptoms, and 11% reported having serious thoughts of suicide in the past 30 days. These numbers are nearly double the rates we would have expected before the pandemic. As in prior studies, this survey showed that risk factors for reporting anxiety symptoms or suicidal ideation included food insufficiency, financial concerns, and loneliness.”
Prediction #10 – Rural hospitals and clinics will continue to close their doors.
Prior to COVID, the risk of rural hospital closures was already great. According to a Center for Healthcare Quality and Payment Reform (CHQPR) report in 2020, “over 500 rural hospitals—more than one-quarter of the rural hospitals in the country—were at immediate risk of closure due to continued financial losses and lack of financial reserves. Almost every state had at least one rural hospital at immediate risk of closure before COVID-19. In 22 states, the stakes were significantly higher, with one in four rural hospitals at immediate risk.”
The report indicates that since the onset of COVID, 300 more rural hospitals are at risk of closure and 40% of all rural hospitals in the country are at immediate or high risk of closure.
Prediction #11 – The trajectory of telehealth will change from adoption to customization.
The healthcare industry has had to rapidly adapt to implement telehealth services in order to continue to treat patients. Verinovum predicted that implementations would create a need for many telehealth vendors to help fine-tune, improve, and grow telehealth services as the industry shifts to a more long-term plan.
According to Health Center Program Data,”43% of health centers were capable of providing telemedicine, compared with 95% of the health centers that reported using telehealth during the COVID-19 pandemic.”
During the pandemic, Telehealth has had multiple benefits by expanding access to care, reducing disease exposure for staff and patients, preserving scarce supplies of personal protective equipment, and reducing patient demand on facilities. Since then, the American Hospital Association has reached out to the US legislature to expand the ability of telehealth providers to deliver services, to ensure reimbursement for payers and providers, and to increase access.
Consumers want continued access to telehealth as well. Almost 88% of respondents in a recent Skyes survey reported that they will continue using telehealth for nonurgent consultations after COVID has passed, while almost 80% said it’s possible to receive quality care.
Prediction #12 – The final interoperability rule will shine a light on the data quality issues across the country.
In early January 2021 Verinovum predicted that 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.
We’ve now learned that data quality is absolutely critical during times like these, and in the careful delivery of healthcare–pandemic or not. Healthcare providers and payers must be able to exchange data that is reliable, trustworthy, accurate and illustrative of the entire patient picture. We need to communicate in numbers in terms of infections, deaths, recoveries, number of tests administered and infection rates. We need to know which states, communities, and individuals are doing well. We need to know where the hotspots are and plan accordingly.
From collection to retention to analysis, clean and accurate data can make the difference in decision making, leading to better outcomes for your business and most importantly, the patient.
Mike Noshay is founder and chief strategy officer of Verinovum of Tulsa, OK.