Matthew is an associate editor of The American Journal of Managed Care® (AJMC®). He has been working on AJMC® since 2019 after receiving his Bachelor's degree at Rutgers University–New Brunswick in journalism and economics.
The National Business Group on Health released its list of healthcare trends to watch in 2020, highlighted by growing employer initiatives on high quality, high value healthcare, and an increased focus on mental health issues.
The National Business Group on Health (NBGH) released its list of healthcare trends to watch in 2020, highlighted by growing employer initiatives on high quality, high value healthcare, and an increased focus on mental health issues.
The report focuses on 5 key trends:
A Commitment to Quality & Performance
The transition to value-based care has become the topic of discussion for many employers, as 57% of those surveyed by NBGH were reported to be undertaking an active role in driving change within healthcare delivery. Ellen Kelsay, BA, chief strategy officer for NBGH, attributed this growing commitment toward quality and performance to the issues associated with the fee-for-service (FFS) model.
“The FFS model based on volume does little to address outcomes,quality, cost, or experience. Value-based models are structured in a way to address these critical underlying care delivery challenges. Physician and provider groups who enter into value-based models are incented to deliver care that results in better outcomes, quality and experience and eliminate waste and unnecessary care,” said Kelsay.
Centers of Excellence (COE), as well as high-performance networks and accountable care organizations are growing in use by employers, with 27% of those surveyed further expanding COE offerings to additional clinic areas including musculoskeletal conditions, fertility, and maternity programs. “Many COEs leverage principles of value-based care and alternative payment models to achieve improved outcomes not only in quality care delivery and outcomes, but also improvements in cost and patient experience,” said Kelsay.
Mental Health Matters
The necessity of mental health coverage has grown substantially amongst employees, a trend that has intensified disparities in access to behavioral healthcare. As mental health conditions are projected to be a significant factor of employer-sponsored healthcare benefit costs, surveyed employers are reportedly planning to offer more benefits and initiatives to support employees at all stages of their mental health and well-being journey, including extending initiatives globally to reach employees worldwide.
In the survey, 48% of employers said they will include anti-stigma campaigns and training for managers to help recognize mental health issues and assist employees. “Too often employees are reluctant to seek care due to associated concerns with stigma. Or when they do want to seek care, they are challenged by the lack of providers or the wait time to see a provider,” said Kelsay.
Additional tactics are being adopted by employers to address both the access and stigma challenges such as bringing counselors on-site, offering virtual and digital counseling, and reducing medication co-pays. “Virtual solutions go a long way to reduce these barriers. In fact, our survey respondents indicate the fastest area of growth and interest as it pertains to virtual solutions in the coming years will be in Mental Health,” said Kelsay.
Healthcare for Today’s Consumer
Expanding on the topic of virtual solutions, over half of the employers surveyed will offer more of these innovations in 2020 to accommodate growing employee interest. “Virtual solutions are essentially care delivery enabled via digital communications such as an app, device or video technology. Interest in these solutions has grown for a number of reasons including gaps in current delivery models, consumer preference, access and convenience. Virtual solutions bring healthcare to the consumer rather than consumer to healthcare,” said Kelsay.
Currently, virtual offerings are provided by employers in the areas of telehealth for acute problems (98%), mental health (73%), weight management (55%) and diabetes management (44%). “Looking ahead to 2021-2022, 38% are considering adding virtual care for musculoskeletal services and prenatal care (29%), as well as broadening telehealth to include specialty services such as dermatology (32%),” said Kelsay.
Simplifying the employee experience is 1 issue associated to virtual solutions due to the wide array of offerings, but the integration of these innovations into navigation and concierge services is seen as a possible solution to be developed in the next several years.
Rx Prices: You Ain’t Seen Nothing Yet
While most of these headlines have focused on positives within healthcare innovations, the major underlying issue of price additionally reemerges. The report details that more high-cost treatments with million-dollar price tags will hit the market, an issue concerning many employers as they figure out how to finance these therapies without it consuming their entire benefits plan. “Some newly emerging financial and reinsurance models are coming to market which may help in the near term,” said Kelsay.
For growth within specialty drug management, prior authorization under the medical plan is the most significant area of growth as 6 in 10 employers plan to implement it in 2020. However, as Kelsay notes, financing mechanisms are only the tipping point for this issue. “The true focus for long term viability needs to be on reform and transformation relative to prescription drug pricing, not on how to finance absurdly expensive therapies,” said Kelsay.
Spotlight on Advanced Primary Care Strategies
While primary care does not account for a large portion of US healthcare costs, it does influence nearly 90% of overall cost and quality through specialty referrals, prescribing, testing, procedures, and hospitalizations. The considerable impact of primary care has begun to warrant more attention by employers and presents a significant opportunity. “In order to affect an employee’s experience in primary care and improve quality and outcomes, employers are looking to shift to value-based advanced primary care offerings,” said Kelsay.
By 2020, 49% of employers surveyed will have at least 1 advanced primary care approach, a statistic that signals a transition from the FFS, encounter-based reimbursement to more comprehensive, patient-centered population health management. “In pursuing these efforts, employers are aiming to deliver a better patient experience to their employees seeking primary care, cultivating a value-based focus, and playing a role in expanding the traditional primary care model to treat employees based on all their health needs (e.g., social determinants of health) versus just treating the symptoms,” said Kelsay.