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Forbes Feature: Disruption And Change: Healthcare Trends And Predictions For 2024

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The healthcare industry saw significant changes in 2023, setting the stage for an equally dynamic 2024. Here, I would like to explore key trends and predictions reshaping healthcare—from policy changes to ownership shifts—financial challenges to pharmaceutical developments.


As we look ahead, it is evident that the healthcare industry will continue to evolve, presenting both challenges and opportunities for key stakeholders.


1. Policy Changes And Impact On The Industry

In 2023, healthcare policy changes exerted a profound influence on the industry, with far-reaching implications. Regulatory pressures from The Centers for Medicare & Medicaid Services (CMS), Congress, state legislatures, and the surgeon general led to significant shifts in prior authorization requirements.


Medicare Advantage and Medicaid experienced dynamic changes, presenting both challenges and opportunities for growth. Specifically, the tightening of the Medicare Advantage business model created ripple effects across the industry. Also, the reintroduction of the Medicare for All Act in 2023, with support from numerous lawmakers, kept single-payer healthcare advocacy in the national conversation despite its likely limited prospects in the current Congress. Furthermore, sweeping policy changes in the pharmaceutical sector are poised to reshape the industry, potentially affecting drug accessibility and affordability.


Leaders in the healthcare industry will likely need to reevaluate their prior authorization processes, adapt to dynamic changes in Medicare Advantage and Medicaid and consider potential impacts on drug accessibility and affordability; my advice for reacting to these policy changes is to stay informed, engage in proactive advocacy and be prepared to adjust business strategies to align with evolving regulations and market dynamics.


2. Consolidating Healthcare Ownership


Ownership dynamics within the healthcare industry witnessed significant changes in 2023, and I expect these trends to intensify. A notable example includes SCAN Group and CareOregon's merger into HealthRight Group, creating a $6.8 billion nonprofit health plan with 800,000 members. Blue Cross and Blue Shield of Vermont's affiliation with Blue Cross Blue Shield of Michigan is another instance of this trend. Throughout the year, major players engaged in consolidation, both horizontally and vertically.


In 2024, healthcare leaders may need to adapt to further consolidation trends. I recommend that healthcare leaders prioritize strategies that ensure patient-centric care remains a focal point amid these ownership changes. Look to collaborate strategically and maintain a keen watch on government-led scrutiny and purchaser disruption to navigate the changing landscape effectively.


3. Partnerships For Financial Survival In Healthcare


Stress in the financial landscape of health systems in 2023 prompted many healthcare organizations to proactively adapt to challenges. For instance, in April 2023, Presbyterian Healthcare and UnityPoint Health attempted to form an $11 billion system to expand reach and improve cost challenges. This partnership exemplifies health systems seeking financial survival pathways through collaborations to navigate the evolving healthcare landscape.


The shift away from a hospital-centric service delivery model toward ecosystem-controlled care management is a notable trend. To navigate financial difficulties, many health systems are exploring partnerships and asset acquisitions as hospitals grapple with workforce crises, high turnover rates and increased vacancy rates. This shift toward ecosystem-level care management is likely to continue into 2024, presenting both opportunities and challenges for patient access and care delivery as health systems seek financial survival pathways.


4. Balancing Access And Affordability With Drug Costs


Pharmaceutical developments in 2023 are also reshaping the healthcare landscape, particularly concerning high-cost drugs. Balancing access to these drugs while considering their cost implications is a complex challenge. Emerging drugs, such as cell and gene therapies, come with intricate delivery logistics and high price tags. Outcomes-based agreements, specialty pharmacy carve-outs and innovative approaches can help address the cost challenges posed by these drugs.


One notable example of drug pricing tension is the GLP-1 class of drugs. These drugs are used to treat diabetes and obesity and have recently become very popular for weight loss. Despite their growing popularity, debates have arisen over pricing, given that they can cost up to $1,000 per patient per month. Some health plans are hesitant to cover these drugs, both given the price and considerations over whether they are lifestyle drugs or necessary interventions for cardiometabolic health.


The pharmaceutical-based healthcare system is at a crossroads, and navigating the balance between access and affordability is essential for those in the industry. It's important to note how the scale of complexity and cost associated with these drugs requires precise care delivery and access management. The widespread demand for these high-cost drugs is likely to invite investment in delivery and administrative capabilities from new entrants.


5. Tech Innovates Operational Processes


Technology, especially artificial intelligence (AI), drives significant changes in healthcare's operational processes. AI is transforming patient triage, treatment recommendations and administrative tasks, enhancing operational efficiency.


Given the regulatory shifts that occurred in 2023, I believe there is an opportunity for this type of technology to help healthcare organizations adapt to policy demands. For example, healthcare technology can help health plans adapt to the electronic prior authorization requirements of the CMC.


Conclusion

In conclusion, 2023 brought exciting changes in healthcare, and 2024 promises to be equally transformative. The five key insights from this article highlight the major trends shaping healthcare, from policy changes to ownership shifts, financial challenges, pharmaceutical developments and technological advancements. As we look ahead to 2024, it is evident that the healthcare industry will continue to evolve, presenting both challenges and opportunities for key stakeholders.

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