2023 Expert Healthcare Predictions

Jake Beechy, Vice President

New Expanded Care Concepts

Rural healthcare providers have been under immense pressures, especially throughout the pandemic, stemming from increased costs of care coupled with low reimbursement. In fact, rural hospitals incurred $5.8 billion in Medicare underpayments and $1.2 billion in Medicaid underpayments in 2020, the most recently data available. Meanwhile the growing rate of closures has dramatically impacted overall access to care in these vulnerable communities.

CMS has been seeking ways to expand care and access, through the Rural Emergency Hospital (“REH”) model, waivers related to the 340B program, and expansions in coverage such as those designed to provide additional coverage to new mothers. Yet, the expanded care fails to keep up with the growing inequality of care. CMS will be forced to offer additional novel concepts, such CoP relaxations, physician payment incentives, or changes to quality assessments impacting reimbursement (which are not statistically reliable due to low volumes) in order to ensure more and more providers are driven to the brink, and the gap in care does not continue to widen.

Preston Sisler, Vice President

More COVID-19 Creative Solutions

The COVID-19 pandemic has required a constantly evolving response for healthcare providers.  Since the early days of the pandemic, staffing shortages have been a top concern for healthcare leaders.  Everyone likely knows or has read about the toll the pandemic has taken on the healthcare workforce.  Healthcare leaders have started to implement new programs and human resources functions specifically aimed at promoting workforce retention and community recruitment efforts in the face of employee burnout and other staffing issues.  In 2023, look for healthcare systems to roll out more creative solutions to invest in permanent staff, return focus to patient care, and ensure a continued pipeline of employee recruitment.

Rob Monroe, Vice President & General Counsel

Consolidation in Tightening Capital Markets

While recent inflation growth has been tempered as we approach 2023, the increased cost of capital will likely continue far into the new year. As a result, the financial challenges for smaller healthcare companies and independent provider/supplier entities will continue to be exacerbated. Consolidation of smaller providers and suppliers into established, larger health care corporations is likely to accelerate throughout the year. The increasing interest of larger non-healthcare firms in acquiring or establishing a presence in the healthcare market will contribute to accelerated consolidation.

Retail Expands Reach in Primary Care Markets

The COVID Public Health Emergency increased the role of pharmacies and other retail business into the primary healthcare marketplace. This growth will increase in 2023, the post-pandemic period and beyond. Broad community presence, sophisticated distribution systems and the ability to control costs allow for competitive pricing versus traditional primary care providers and suppliers. The desire to diversify product line offerings with complementary primary care product lines will further drive pharmacies and retailers into this healthcare sector.

Frank Banfer, Consultant

Critical Thinking and Listening

Leaders will have to increase both critical thinking and listening skills. Why is that? Well, applying the Business Scorecard (Harvard Business Review, 1992), we’ve observed decreases in financial health, employee satisfaction, client/patient satisfaction, and wellness for the past several years. The only area we’ve observed an increase in is innovation. One tool within the innovation toolbox is design thinking. Or, simply put, actively engaging the customer/client in a discussion about three things: (1) what is the goal; (2) what is really happening in this moment; and, (3) how are we going to achieve the goal? The key here is active engagement. In other words, leaders need to be engaged and “plugged in” to what is actively occurring. For example, taking some time every week to shadow staff in the real-time work environment. Or, structured one-to-one’s on a monthly basis to allow team members an environment to have an open dialogue with leadership. This allows your team to have a forum to explore issues and align responses to organizational missions and values. Or in other words – increasing your team’s overall critical thinking and listening skills.

Monica Hon, Vice President

Increase in Unique Healthcare coverage expansion focused on at risk populations

Lessons from the pandemic led to a more focused look at inequities in the provision of healthcare with several national studies and pilot programs addressing at risk populations in 2022. We’re going to see even more in 2023, with more healthcare coverage plans focusing on the unique needs of diverse populations. Addressing populations affected by inequitable healthcare while expanding network participation, we will see healthcare coverage expansion addressing racial inequality, cultural needs and group/community specific plans, like the SCAN Affirm product which includes LGBTQ+ Health coverage.

Natasha Shukla, Consultant

Standardization and Transparency

Over the last two years, Congressional and CMS directives for providers have trended towards standardization and transparency. Most recently, CMS promulgated rules for both the Price Transparency Rule and the No Surprises Act.  With CMS beginning to issue Price Transparency audits in the upcoming year, and recently proposing a rule to streamline processes related to prior authorizations, the movement towards standardization is likely here to stay. The trend aligns with CMS’s larger goals of advancing equity and access by prompting standardized data collection processes and providing patients with greater insight into healthcare pricing. As providers look towards 2023, they can expect additional guidance on implementation of existing rules from CMS as well as new rulemaking on streamlining common processes.

Ryan Bailey, Vice President

COVID-19 PHE Lasting Effects

The unknown termination date of the COVID-19 Public Health Emergency will continue to have lasting effects. With staffing shortages continuing in many markets, organizations will rely on the continued availability of COVID-19 relief funding, such as the Federal Emergency Management Agency (“FEMA”) to help mitigate the financial effects of long-term dependence on contract labor. Additionally, capacity constraints continue to burden many inpatient operations. The CMS PHE waivers have allowed for quick expansion and implementation of additional acute care beds, so long as in line with state licensure, since April 2020. Numerous facilities continue to rely on these waivers. Providers in this situation should not wait until HHS issues the impending 60-day notice prior to termination of the PHE to design their strategies for winding down these temporary expansions, and/or seeking formal approval of the same long-term through traditional federal and state processes. Certificate of need activity in applicable states, and potentially even more mergers/acquisitions, may ramp up in CY2023 as a result.