We have our eyes on the latest trends impacting the health care marketplace. Looking ahead to 2023, these include the prolonged presence of COVID-19, the importance of behavioral health, and the ongoing need for accessible and equitable health care for all. Telehealth has shown that it will continue to grow, as will pharmacy and physician costs. Let’s take a look together.
The novel coronavirus that causes COVID-19 continues to disrupt health care in 2023. Experts still encourage boosters and masking for all people, particularly for those aged 65+ and anyone with a chronic illness. The greatest concern is further mutation of powerful new variants that could cause surges in infection. We also need to better understand long COVID and its detrimental effects on the body.
The Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle estimates a leveling-off of COVID-19 through the winter, as less virulent variants become dominant worldwide.
IHME projects COVID infections in the U.S. will flatten to about 1 million per day as spring approaches, with deaths dropping to fewer than 350 per day. We encourage members to talk to their health care providers about staying safe, as the COVID-19 federal Public Health Emergency declaration will be lifted in May 2023.
The behavioral health crisis in the U.S. was worsened by the COVID pandemic. Provider visits have increased by 17% since 2019 and would likely increase more if provider networks and communities were not facing a shortage of behavioral health professionals.
Research from McKinsey shows that at least 60% of workers around the world have recently experienced anxiety, depression, burnout, sleep problems, and/or unmanageable stress. Employees want — and need — better opportunities to receive behavioral health care for themselves and their families.
Innovative services including telehealth, our Well360 Virtual Health app, and 24/7 on-call nursing support are helping to fill the gaps for members. These services make it easy and affordable to access effective behavioral health care in support of whole-person wellness.
Insurers, providers, and employers all have a continuing role to play in normalizing diversity, equity and inclusion (DEI) efforts in the health care arena. In 2023, that means:
Health equity is not only a trend for this year and the years to follow. It is a must-have. Highmark created the Enterprise Equitable Health Institute (EEHI) to advance internal and external DEI strategies — for every employee, patient, member, customer, and community. In 2023, we will continue to invest in efforts toward equitable care at all life stages, addressing bias in the health care sector, and ensuring that all people have an opportunity to thrive.
The Pharmacy Market Outlook recently published by Vizient projects a slight increase (3.6%) in overall drug costs in 2023. Consumers can continue to buffer against rising costs by working closely with their providers and payers to identify cost-reduction strategies such as choosing generic or biosimilar formularies, monitoring medication efficacy, and using mail-order and rebate programs.
Provisions in the Inflation Reduction Act should help older Americans thanks to changes in the way Medicare pays for drugs. We still have a long way to go in ensuring affordable health care with prescription drug coverage.
Estimates show that 26% of U.S. citizens have trouble paying for the drugs they need. Highmark continues to address high prescription prices by analyzing the efficacy rates of different medications and improving drug utilization rates. We are also educating our network providers on ways to help control our members’ costs.
The efficacy of virtual care will continue to play a role in overall wellness for people of all ages. Virtual care is rapidly changing the way non-acute care, post-hospitalization follow-up care, behavioral health care, health management of chronic conditions, and remote patient monitoring are done.
Many employers have increased benefits coverage for virtual visits — and patients appreciate the time-saving convenience. But we cannot lose sight of the patients who cannot access virtual services because of America’s persistent digital divide. These patients tend to be Black or Native American, non-English speaking, seniors, rural community residents, and/or Medicare or Medicaid recipients.
It’s about more than having internet connectivity, however. Even given the resources, millions of Americans lack the skills or confidence to navigate virtual health technology. Some patients also have trust issues in adopting this care delivery model as the technology is new and unfamiliar.
As an industry, insurers can seek solutions to closing the digital divide. This can mean helping patients set up their technology, walking them through the steps to join a virtual visit, or offering a telephone visit instead.
Many large hospital and health systems use MyChart, a tool within the Epic electronic medical record (EMR) platform, for two-way communication with patients. Time involved in messaging is not traditionally billable as clinical contact hours. Some systems, like Cleveland Clinic, want to change that. They made the local, national, and industry news when they decided to charge for messages to and from providers in their MyChart patient portal.
As care delivery systems evolve, the onus will fall on health insurers as more hospitals and health systems look to increase revenue with new fees. Reports indicate that Cleveland Clinic’s Medicare patients could incur up to $10 in out-of-pocket costs each time they send a MyChart message to a doctor. Patients with deductibles and the uninsured could expect to pay $50 or more, as the previously free service gets recategorized as a type of virtual visit.
Highmark will watch this trend as it expands in 2023 and work with our providers to create coverage policies. We want to ensure that our members receive timely advice and care, while also keeping costs in check.
Highmark continues to work both visibly and behind the scenes to innovate and improve health care delivery for our members and customers. Knowing what’s on the horizon for the months — and years — ahead helps us provide the highest level of quality and service to those who trust us for care. Let us know what we can do for you in 2023 and beyond.
Talk to your client manager today and we’ll help you find the right health plan for your company.
