Health executives take out their crystal balls: Here are their predictions for 2021

What trends are healthcare execs watching out for in 2021?

We gathered predictions from executives at companies across the industry to compile a collection of the key topics to keep an eye on in the coming year. Topics ranged from behavioral health needs to data analytics to the social determinants of health.

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David Calabrese, senior vice president and chief pharmacy officer for OptumRx

David Calabrese
David Calabrese (Optum)

"The COVID-19 pandemic and its subsequent social and economic effects have taken their toll on the mental well-being of our society. 

Data from OptumRx analytics suggest that the incidence of mental health and substance use disorders is increasing; in March, the number of prescriptions for anti-anxiety medications increased 15%; for antidepressants, 14%; and for sedative hypnotics, 5%. OptumRx has leveraged its Genoa Healthcare footprint to provide support through telepsychiatry, the Optum Emotional Health line, virtual visits and complimentary, on-demand emotional support via the Sanvello mobile app to support individuals during the height of the pandemic.

Every day, we learn more not just about the virus itself, but about the considerations we must make as a society to address the health and economic impact caused by COVID-19. The pandemic has disrupted routines, creating the ideal condition for experimenting and accelerating change.

In this new healthcare environment, pharmacy benefit managers are uniquely positioned to help protect continuity of care, given the vast and diverse resources at our disposal. Our collective goal should be to build upon what we have learned during this time."

Marilyn Eckley, executive vice president of health services at AmeriHealth Caritas

Marilyn Eckley
Marilyn Eckley (AmeriHealth Caritas)

"My prediction for 2021 is that payers will work with providers to significantly invest in health equity training and that this will help improve outcomes in a measurable way for Black and brown populations. COVID-19 has illuminated deeply embedded inequities in our country’s healthcare system—and the imperative to develop a real path forward that bridges gaps.

The way in which COVID-19 has disproportionately impacted people of color is mirroring how other chronic medical conditions such as diabetes, addiction, obesity and hypertension have affected non-white Americans. We’ve known that racial disparities have been prevalent in healthcare for far too long.

Participation in health equity training is an essential step in helping to reform a healthcare system that is stacked against minority communities, and will help providers understand how health conditions can be caused, or exacerbated, by limited access to the social determinants of health, like access to transportation, food, safe housing, public safety, education and more."

Cindy Dyer, product manager at Lightbeam Health Solutions

Cindy Dyer
Cindy Dyer (Lightbeam Health Solutions)

"Undoubtedly, 2021 will be a catch-up year.

Since CMS permanently added telehealth and crafted new policies to expand it during the pandemic, virtual care will continue to be a focus in the new year, especially from a primary care perspective. Given the missed data opportunities throughout 2020, providers will take operations back to the basics to recapture HCCs and close care gaps to make up for lost time and data.

Additionally, in 2021, the weight of the CAHPS survey measures will increase by four times. Organizations that have done historically well with HEDIS must pivot to a greater focus on the patient experience."

Sheila Talton, founder and CEO of Gray Matter Analytics

Sheila Talton
Sheila Talton (Gray Matter Analytics)

"In stark contrast to previous years, advanced analytics capabilities will no longer be a luxury for payers in 2021.

As COVID-19 persists and payers continue to grapple with a volatile provider market and managing member populations, they will be increasingly seeking ways to build predictive analytics models and prepare for the future. Payers will see 2021 as an opportunity to leverage their data to improve member outcomes and effectively manage value-based contracts so they can come out ahead post-pandemic.

Understanding how members and providers will drive costs, quality and utilization and acting on those insights will be critical to success."

Hugh Lytle, founder, chairman and CEO of Equality Health

Hugh Lytle
Hugh Lytle (Equality Health)

"A primary care revolution [is coming]. With the recent advancement of turnkey value-based care solutions and models, payers can now partner seamlessly with independent practices to advance the triple aim and mutually improve one another’s earning potential.

In 2021, this will provide a desperately needed boost to previously anemic PCP earning potential and will reenergize entrepreneurial practices to hold on to their fiercely independent ways. Even more so, physicians who previously divested their practices or accepted direct employment as the only viable path forward will begin to reverse course, having been underwhelmed by the fruits of hospital-aligned partnerships.

Viva la revolución!"

Siva Namasivayam, CEO of Cohere Health

Siva Namasivayam
Siva Namasivayam (Cohere Health)

“The pandemic has highlighted, in stark terms, that we need to urgently fix not only the healthcare infrastructure but also the way we think about delivering higher-value care. These are not separate issues and, in my opinion, transformative change will occur when clinician-centered technology companies connect the dots that align physician decision-making, evidence-based care plans, patient outcomes and financial sustainability.

While there is a lot of impressive technology out there that is helping streamline individual pain points, my prediction is that payers and providers will realize that the real mandate is to automate insurance processes and decision support in a way that advances value-based care as physicians move away from fee for service.

Technology will be used as a way physicians, patients and health plans can collaborate to define entire care journeys that are aligned to value. And the ultimate winner will be the patient.”

Eric Rosow, CEO of Diameter Health

Eric Rosow
Eric Rosow (Diameter Health)

"The year 2020 has certainly been unprecedented. The COVID pandemic along with government regulation in the form of the Cures Act and ONC rulings will undoubtedly accelerate the sharing of data and breaking down of silos across the industry. As a result, I believe the healthcare industry at large and the payer market, in particular, will be forever changed as data access and exchange will become more fluid across entities. While payers historically have entertained an interest in leveraging clinical data, given it is more real-time and contains valuable information not found in claims data, we are seeing a real investment among our payer customers and the broader market in active pursuit of acquiring clinical data.

But I think payer organizations are going to be in for two big surprises in 2021 as they gain broader exposure to and experience with clinical data and patient access goes live this summer.
Clinical data is incredibly dirty, characterized by incompleteness, inconsistency, redundancy and disorganization. To get clean, quality data requires deep clinical informatics expertise and automation. I think payers are quickly going to find that the clinical data they now have broader access to is really challenging to use and will require parsing, semantic normalization and deduplication."

Paul Joiner, chief operating officer at Availity

Paul Joiner
Paul Joiner (Availity)

"There’s no doubt that everyone is happy to leave 2020 behind, but we would be amiss if we didn’t reflect on the positive changes that may impact healthcare forever. The COVID-19 pandemic put healthcare under the microscope and revealed the good, the bad and the ugly of our industry. The swift disruption forced many manual processes and communications between payers and providers to shift overnight to a more automated, electronic workflow. 

As payers adopted new policies around telehealth services and COVID-19 tests and treatment, providers needed an easy way to understand each plan’s policies and requirements. Additionally, payers had to transform many manual processes into electronic modes of communication. Prior authorizations, medical necessity, medical chart reviews, grievances and appeals, and even call centers all required a rapid adoption of more technology to ensure business continuity and, more importantly, continuity of care. 

As we move into 2021, the seal has been broken. The industry has proven its ability to adapt and adopt technology. In addition, payers and providers collaborated in a way that did not exist pre-COVID-19 as they worked together for improved efficiencies and better outcomes. I foresee 2021 as the year that payers and providers work as one and adopt automated and electronic processes and technologies that will enable better, faster communications."

G. Cameron Deemer, president of DrFirst

G. Cameron Deemer
G. Cameron Deemer (DrFirst)

"Payers led the way into HIT in the 90’s, but what have they done lately?

In the late 1990s, payers led the way into technology innovation by investing in and distributing e-prescribing and electronic medical record systems at low cost or no cost to providers. Some of these initiatives were successful enough to begin the process that federal and state governments finished by introducing incentives and penalties to encourage the adoption of these technologies.

Today it’s time for the payers to step up again. This time it’s about data, and the roles are reversed. The federal government and the states are working hard to create true interoperability by addressing not just the ability to exchange data, but the willingness to exchange data. New regulations aim to force data out from behind the competition-hardened barricades, where it has long been held hostage by vendors and provider organizations.

While this is important, payers could accelerate this process and improve patient outcomes as a result. We have seen a few payers step up to this challenge of releasing their closely held and difficult-to-access information—notably UnitedHealthcare through their Point of Care Assist program—but it’s time for the rest of the payer community to invest in data access, too. The path to the greatest impact on interoperability, in the shortest period of time, lies through the payer community."

Rob Cohen, president of Appriss Health

Rob Cohen
Rob Cohen (Appriss Health)

"States facing budget crunches and a worsening opioid crisis will benefit from innovative ways to cut costs. One emerging area that states with large Medicaid populations are focusing on is connecting a subset of this population—people who have been incarcerated and may have substance use disorder or mental health issues—with behavioral health services.

Getting people help to reduce behavioral health issues has the potential to save many lives as well as avoid unnecessary healthcare costs—and we’ll see momentum grow for Medicaid programs to tackle this issue in 2021."

Curt Medeiros, president and chief operating officer of Ontrak

Curt Medeiros
Curt Medeiros (Ontrak)

"The effects of the pandemic are far from over, and many healthcare delivery organizations are grappling with the huge wave of challenges coming at them. What we know now is that potential vaccines are giving us hope about how to end the pandemic and get back to some sort of normal. But there’s another crisis that’s looming and just starting to draw attention. One in three Americans is feeling the mental impacts of the pandemic in a hidden ‘fourth wave.’

For these individuals grappling with either new or rising behavioral health issues, there won’t be an injection or two that makes it go away, but there is hope. Behavioral health programs that couple technology with caring human interaction provide a solution and can become an ‘emotional vaccine.’ Using predictive analytics to identify people who haven’t yet been diagnosed will be a critical tool.

Leveraging telehealth, adoption of which is growing rapidly, will help improve access. Employing a whole-person approach that takes into account each individual’s specific barriers to care will be the key to engaging them into the long-term, successful treatments they need to produce durable outcomes."

Kuldeep Singh Rajput, CEO of Biofourmis

Kuldeep Singh Rajput
Kuldeep Singh Rajput (Biofourmis)

"In 2021, we'll see a continued move from 'pay-per-pill' to pay-for-value when it comes to drug therapy. This transition will be accelerated by technology such as clinical-grade wearables, remote patient monitoring, patient-facing apps and AI-powered analytics.

Increasingly, pharmaceutical companies are leveraging digital therapeutics that include these technologies in tandem with drug therapy to optimize treatment and to efficiently collect real-world evidence of efficacy, outcomes and ROI—as well as data on adherence and quality of life.

Expanding this approach will prove value in order to support reimbursements and formulary inclusion in an emerging value-driven environment."

Sean Carroll, CEO of Arcadia

Sean Carroll
Sean Carroll (Arcadia)

"Many patients deferred care in 2020, creating a situation in which providers will enter 2021 under severe economic strain while payers are recording surging profits. With a new administration likely to provide strong support for value-based care, payers have a strategic opportunity to use their robust balance sheets to help providers accelerate their adoption of risk-based payment models.

Providers are likely to be receptive given that those in alternative payment models reported stronger cash flow and patient relationships amid the COVID-19 pandemic than those in fee-for-service relationships—we've seen that consistently in our customer relationships. While part of payer support may come in the form of pricing flexibility, we believe payers will make substantial investments in technology and data infrastructure that serves as the foundation for value-based care: curated data-at-scale and point-of-need software tools.

Analytics-driven healthcare to accelerate a digital-oriented, consumer-centric future is the path ahead. Ultimately, 2021 will be marked by innovative, creative technology partnerships that go beyond just meeting new interoperability regulatory requirements and instead drive transformative, large-scale population health initiatives."