Value Based Care – 2024 Health IT Predictions

As we kick off 2024, we wanted to start the new year with a series of 2024 Health IT predictions.  We asked the Healthcare IT Today community to submit their predictions and we received a wide ranging set of responses that we grouped into a number of themes.  In fact, we got so many that we had to narrow them down to just the best and most interesting.  Check out our community’s predictions below and be sure to add your own thoughts and/or places you disagree with these predictions in the comments and on social media.

All of this year’s 2024 health IT predictions (updated as they’re shared):

And now, check out our community’s Value Based Care predictions.

Jake Pyles, CEO at CipherHealth
The path to value-based care is anything but a straight line. And for all the chatter about meeting CMS’ 2030 VBC deadline, real progress toward meaningfully shifting care models has been difficult to find. In fact, I’d say that 80% to 90% of our customers are fully entrenched in a fee-for-service model. And with national healthcare spending reaching a full 18% of GDP, that isn’t surprising. Soon, market forces, combined with the looming 2030 deadline, will spur real action. But as hospitals and healthcare systems face foundational, systemic challenges in shifting to value-based care, it may happen in fits and starts.

Cassie Choi, Co-founder and chief health equity & people officer at Pair Team
1. Community health workers will become a pillar of the healthcare community. As value-based care increasingly becomes a priority for people, community health workers will play a pivotal role in bridging the gap between healthcare delivery and building trust within communities. Major players in the healthcare industry from governments to organizations will invest in training and integrating community health workers to help transition to more patient-centered healthcare services.

2. Digital health will be critical for advancing health equity. In addition to community health workers, the integration of digital health solutions will be imperative for addressing health disparity and advancing health equity. Telehealth, mobile health apps, and other digital platforms will be leveraged to provide remote consultations, health monitoring, and health education, in addition to ensuring patients are better connected to their care partners.

3. Nurse compensation is needed to improve the healthcare system. Recognizing the pivotal role nurses play in patient care, there will be a growing emphasis on improving nurse compensation to enhance the overall healthcare system. With legislation currently being drafted for nurses to receive the same reimbursement doctors and physicians do, this will likely become a top-of-mind topic in 2024.

Bobbi Weber, Vice President of Product Marketing and Customer Success at QliqSOFT, Inc.
To accelerate meaningful progress of value-based care in 2024, organizations will expand on their commitment to transcend health and gender inequities and engage marginalized populations largely through more proactive community-based outreach and care coordination. A population health-based approach that incorporates social determinants of health and sexual orientation and gender identity will significantly improve community health outcomes. For example, scalable campaign automation and chatbots can achieve value-based equitable care targets while easing administrative burden to counter burnout.

Rick Dean, CEO at OncoHealth
In 2023, Medicare Advantage (MA) health insurance companies began acting on and planning for massive changes to Part D coverage in response to the Inflation Reduction Act (IRA). Beginning in 2024 and taking full effect in 2025, MA plans will take on significant costs when the Part D drug spend for a member reaches the catastrophic phases of the benefit. Specialty medications like anti-cancer drugs, which continue to increase in costs, will cause health plans to seek to reduce these costs through plan management formulary redesign, adequate risk adjustment and utilization management rather than transferring costs to beneficiaries via premiums. For members, the good news is that for each plan year, their Part D out of pocket costs will now be capped at $2,000.

The IRA also gives the Centers for Medicare & Medicaid Services (CMS) negotiating power for single-source, brand-name drugs that do not currently have a generic counterpart available in the market. In 2024, only 10 drugs will be part of the negotiation, but this number will rise over subsequent years and the market will need to decide which route to take as a response to this new development, such as reducing overall costs of prescription medications or making changes to coverage for certain drugs. Because they will be responsible for footing a larger portion of the bill, Medicare Advantage insurance plans will also be more motivated to ensure that patients are receiving the most cost-effective medications available to them. The IRA will have far-reaching and significant impacts on health plans in the coming years, so these companies must explore every possible avenue to ensure long-term success.

Jay Rughani, Investment Partner at Andreessen Horowitz
The US healthcare system is on an unsustainable trajectory. Providers are experiencing increased burnout, health systems are facing growing labor shortages, and the economy is shouldering ballooning healthcare costs.

In addition, clinicians are being asked to do more with less: navigate complex billing systems, variable coverage schemes, and increasing documentation burden, all while taking greater responsibility for the proactive management of their patient’s health.

In 2024, with thoughtful technology deployment and the right policy infrastructure, AI will help make human healthcare more human, while improving economics for providers and reducing waste for taxpayers. More specifically, health systems and providers will use “AI teammates”, such as AI physician assistants, which will bridge the workforce gap and eliminate mindless administrative work, allowing providers to spend their time communicating with and supporting the personal needs and priorities of their patients.

Dr. Kevin Vigilante, Executive Vice President at Booz Allen
In 2024, we should refocus our approach to quality measurement and reporting. Today it focuses on helping healthcare organizations receive performance incentives rather than serving the direct interest of patients. Despite spending billions of dollars on quality measurement, individuals still struggle to select good physicians, surgeons, and hospitals, avoid unnecessary procedures, and make health care choices based on sound evidence. The system’s narrow focus on measurement to support organizational incentives does not serve patients optimally.

I foresee a pressing need for the healthcare industry to reevaluate its measurement practices and ensure they evolve. There’s also a critical need to simplify quality measurement by fostering a mindset that places patients’ outcomes and decision-making needs at the forefront.

As we step into the new year, it’s imperative that discussions about quality measurement remain at the forefront until we’re back on the right path – one where patient outcomes and well-being are the true benchmarks of success in healthcare.

Julian Flannery, Founder and CEO at Summus
Simplifying healthcare costs: There will be a pivot towards value-based care as it gains momentum. The focus will be on delivering not just healthcare, but health ‘value,’ with a clear message: better patient outcomes won’t just be a goal; they’ll be the baseline for financial health in the industry.

Addressing the physician shortage: Ongoing doctor shortages and improving job satisfaction are on the industry’s to-do list. The industry needs innovative solutions and greater emphasis on efficiency so healthcare professionals can thrive. Employer-sponsored specialty care can help alleviate shortages.

Bringing human connection back to healthcare: Physicians are more focused than ever on building strong, trustworthy relationships with their patients. The prediction is clear: the future is high-touch, prioritizing patient-centric care. Empathy impacts health outcomes, and virtual specialty care excels in providing the time, comfort, care, and understanding that patients desire.

Improving the cancer journey. Cancer will continue to be a leading healthcare cost driver for employers and persistent drug shortages will impact treatment availability. Employers can take actions now to ready themselves to support their workforce.

Eric Lisle, Co-Founder & CEO at Southeast Primary Care Partners
Looking toward 2024, one cannot ignore the stark realities that persist within the healthcare system. The unrelenting pressure on payers, exemplified by CMS reductions and a continual financial squeeze, has set the stage for strategic realignments and cost reduction strategies across the board.

The industry is witnessing an upsurge in payer consolidation efforts. The recent Humana/Cigna news will be the first of many health plan mergers in 2024 as payers seek to align strategies and optimize resources. The inroads made by payers into the provider space will free up resources to move money directly to providers to enhance care delivery.

Value-based care efforts will continue to be front and center in 2024. I expect the focus to shift toward specialist care, aligning their services with already underway value-based initiatives to further cost reduction shared saving strategies.

As the economy continues to recover in 2024, I anticipate a reduction in care management programs that are not showing adequate savings. This programmatic reduction will echo across healthcare as providers work to reduce duplicative technologies in their practices. One-trick-ponies will be replaced with (or consolidated into) solutions that solve multiple pain points, helping to improve balance sheets while providing the same level of care.

Anthony Hudson, Senior Principal, Technology at IQVIA
Although there has been an increase in automation, streamlining the process of triage, evaluation, complaint determination and reportability decisions will be the determining factor in organizational success. The distinction between the success of organizations will not be their use of intelligence technology but rather in how they are collecting data and implementing intelligence to analyze the data. Their access to data and data quality will be much more indicative of how far technology can take us.

As quality is better understood and valued, organizations that approach quality management as a tool to drive continual improvement, as opposed to one that looks at quality as a nuisance and cost burden, will be more successful at improving outcomes. A few organizations are already doing this through automation of key quality management processes to drive efficiency and to provide a system-wide view of quality process performance, reviewing trends and intervening where necessary. Those who can transform their thinking to look at quality as an incredibly beneficial steering tool while embracing automation will be those who succeed.

Michael Palantoni, Vice President, Platform and Data Services at athenahealth
Championing the community will be the playbook for VBC moving into 2024. In the new year, independent practices will need to get creative in the transition to VBC, but it’s the industry’s responsibility to support in their effort to do so. In 2024, we’re going to see smaller providers being innovative with their approach. Instead of acquisitions and consolidations, new types of collaborative networks will sprout up; hybrid MSO-ACOs.

In the same vein, ecosystem-oriented design and national platform-to-platform data exchange shrink wrapped for independent practices will be essential, especially when it comes to network wide data access for population health initiatives, identifying high-risk patients, supporting interventions, and closing gaps in care. The question is no longer ‘how long until VBC is here,’ it’s here now, but the industry needs to think critically on ‘how does fee for service end,’ which relies on the smallest providers transitioning.

Kevin Riley, CEO + President at Zyter|TruCare
The Rise of Risk-based Contracts Will Drive a One-third Surge in Value-based Care Adoption
Expect an even faster shift toward how healthcare services are delivered and paid for through Risk-Based Contracts in 2024. Value-based Care (VBC) is a pivotal move from the traditional fee-for-service model, prioritizing outcomes and quality of care over sheer volume. This transition is steering the industry towards a more patient-centric approach while encouraging providers to focus on preventive care and overall wellness.

The projected growth in value-based care, from $500 billion to a potential $1 trillion, underscores the momentum and direction of the healthcare system. As we approach 2024, the culmination of contractual changes, increased patient engagement, and refined financial arrangements suggests that we’ve reached a tipping point in this evolution.

The statistic indicating that 70% of Individual Medicare Advantage members opted for value-based care providers in 2022 highlights a significant acceleration toward this model. It showcases a growing patient preference for healthcare providers that prioritize value and outcomes.

Concrete examples like the partnership between Banner Health Network and Blue Cross Blue Shield of Massachusetts demonstrate the tangible outcomes of embracing risk-based contracts. Such collaborations underscore a shared responsibility among stakeholders for both financial and care quality outcomes. These stories serve as beacons in the industry, emphasizing the commitment to improving care quality, efficiency, and patient outcomes.

The healthcare landscape continues to evolve, and these shifts toward value-based care indicate a positive direction where the focus is on providing better, more effective care for patients while creating a more sustainable healthcare system overall.

The Number of Healthcare Organizations Effectively Coding SDOH Data in EHRs will Double
Anticipate a transformative shift in Population Health Management, with a forecasted doubling of healthcare organizations turning to vendors for proficiently coding Social Determinants of Health (SDOH) data for their populations at risk. In response to the health equity imperative, this type of ask aligns seamlessly with HHS initiatives like Healthy People 2030.

The fact that nearly eight in 10 healthcare organizations actively collect SDOH data emphasizes the broad impact of factors like education, housing, nutrition, transportation, and the environment. The practical implementation of SDOH-related Z codes within the ICD-10-CM framework will enable organizations to identify social risk factors and unmet needs. As outlined by CMS, data analysis becomes a cornerstone, offering avenues to enhance quality, care coordination, and the overall care experience.

In 2024, healthcare organizations will turn to vendors to facilitate robust data analysis and reporting of SDOH findings. Organizations can efficiently inform executive leadership and Boards of Directors by partnering with vendors, enabling them to make data-informed decisions and seize value-based care opportunities.

Collaborating with vendors extends to sharing findings with social service organizations, providers, health plans, and consumer/patient advisory boards, fostering a collective approach to address unmet needs. The inclusion of a Disparities Impact Statement highlights the commitment to advancing health equity through a comprehensive and vendor-supported data-informed approach, marking a pivotal evolution in the industry’s landscape.

Neil Batlivala, CEO and co-founder at Pair Team
1.We are going to see value-based care arrangements for social based organizations. This means shelters, food pantries, etc. will be paid based on clinical outcomes for members and patients. While this will become more common, Neil predicts it will not work in the long run, due to the complex payment model, which physician organizations already have trouble navigating.

2. The AHEAD Model (All-Payer Health Equity Approaches and Development) is going to see a lot more attention in 2024. As states aim to curb health care costs while improving overall population health, the voluntary model focused on state accountability for care quality and outcomes will grow in popularity and advance health equity by reducing disparities in care.

3. There will be a revival of lifeline phones for patients. Health plans will pay for these free phones and give them to patients in homeless communities and underserved populations. They drastically improve providers’ and plans’ access to patients, resulting in better health outcomes.

4. The 2020s are the years of Medicaid standardization. In 2024, reporting on specific quality measures from adults enrolled in Medicaid will be mandatory for states, and we will continue to see more standardization follow suit.

Mohan Badkundri, Vice President of Development at HSBlox
As healthcare organizations seek to avail themselves of the benefits of value-based care and alternative payment models, they will continue to modernize their technology platforms and tools. AI and machine learning will be essential building blocks to realizing a ‘network of networks’ required under VBC programs. More value-based networks direct to employers also will make their debuts in the new year.

Anton Kittelberger, Co-Founder & Co-CEO at 9amHealth
Now that both Lilly and Novo Nordisk have GLP-1s for weight loss approved, we will see a lot more employers covering GLP-1 for weight loss. The demand for the medication will simply force employers to cover them.

We don’t foresee legislation prohibiting off-label use of medications, however, health plans and medical boards will likely crack down on inappropriate use of these medications outside of the “right” clinical criteria to prevent abuse. As use of GLP1’s expands, both patients and clinicians will start to see the limitations of these drugs and become better available to identify patients who will truly benefit and need to be on them. This will naturally drive more responsible prescribing because as clinicians, we’ll know when to use them and when to try other avenues.

Dr. Gary Curhan, Chief Medical Officer at OM1
2024 – understanding the implications for weight loss drugs: This year, the cultural phenomenon around weight loss drugs, or semaglutides, exploded. From celebrity stories in the media, to problematic prescribing at medspas, and the impact on pharma and the supply chain, the hype hit from all angles.

In 2024, the industry will gain additional understanding of the impact of these weight loss drugs on other medical conditions, from heart failure to mental health, for patients. In 2023, we saw semaglutides have varying beneficial impacts on existing comorbidities – like heart disease, while in the same vein, rare and severe problems for others – such as stomach problems and complications with anesthesia. Novo just announced at the AHA meeting that Wegovy reduced risk of MI and cardiac-related death. They had previously reported that it also reduced symptoms in patients with HF.

Real-world patient data over this last year will provide insights into determining why certain drugs worked better in specific patient populations and not others, while critically examining health equity and disparities of who had access to medications, and why. Investigating datasets across populations, will provide pathways for the industry to explore semaglutides for diseases outside of obesity, driving improved, and tailored care plans.

In 2024, the industry will move from hype to understanding critical insights on the magnitude of weight loss, impact on comorbidities, and how the industry can better personalize care for specific patient populations when it comes to weight loss medications moving forward.

Matt Eisendrath, President and Chief Commercial Officer at Full Spectrum
GLP-1 drugs will ultimately provide opportunities for growth in drug and device therapies. The GLP-1 drugs will continue to negatively impact MedTech stocks in early 2024 but will ultimately be seen as a complement and not competition to traditional MedTech. Chronic diseases, such as diabetes, are such significant and growing problems that there will be room for drug and device therapies to grow, often used in some combination for patients.

Kevin Coloton, Founder & CEO at Curation Health
For 2024, healthcare providers need to move away from a reactive-only approach as we transition from a fee-for-service (FFS) to a value based care (VBC) model. If we consider the transition best defined in a baseball analogy, it’s a pitcher and a catcher. In FFS, most outpatient activities rely on the patient scheduling the appointment, coming in for the care encounter to see a provider to manage a care need- being the catcher. In VBC, instead of receiving the visit, its healthcare teams reach out to engage patients (or throw the pitch) to see them across an annual continuum to ensure they are managing acute and chronic conditions – often taking more than one visit. VBC means being prospective in the current calendar year to understand when the patient needs to be seen, how much time the provider needs to manage clinical challenges, and how frequently the patient needs to be seen across the next 12 months to manage care needs.

Be sure to check out all of Healthcare IT Today’s value based care content and all of our other 2024 healthcare IT predictions.

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