2024 Predictions: Key Trends Identified by Business Leaders and Health Care Experts in Value-Based Care
In this exclusive commentary for First Report Managed Care, health experts and business leaders share insights into predictions for the 2024 value-based care landscape. Insights highlight trends in behavioral health, AI integration, patient-centric strategies, and more.
"The financial and operational challenges that hospitals have faced in recent years stemming from rising labor costs and fewer workers are likely to persist into 2024. As a result, more and more health systems will turn to virtual nursing solutions to overcome these roadblocks. In many cases, we have seen that health systems can fund the launch of virtual nursing programs with the savings created by replacing costly and inefficient one-to-one sitters with virtual sitters."
—Adam McMullin, CEO, AvaSure. AvaSure provides the leading virtual sitting and virtual nursing solutions to systems with nursing and staffing shortages that are challenged to significantly reduce labor costs without sacrificing patient health outcomes. .
"More providers and payers will integrate behavioral health into aligned care programs in 2024, knowing that such alignment brings favorable patient outcomes and efficiencies and reduces duplicative services. CMS is driving this trend with its AHEAD program, which promotes such integration.
As this care transformation takes root, data sharing and SDOH data capture will be imperative components to realize success."
—Rahul Sharma, CEO, HSBlox. HSBlox makes a platform for administering value-based care programs.
"In 2024, we expect AI to become even more integral to value-based care organizations because of the technology's ability to synthesize massive amounts of data to generate patient insights delivered at the point of care. By knocking down traditional barriers to prospective workflows, organizations can better understand their population's true prospective risk and quality profiles and start to impact care with better outcomes."
—Jay Ackerman, president and CEO, Reveleer. Reveleer uses AI-enabled health care technology data and is an analytics company committed to advancing sustainable value-based care for health plans and risk-bearing providers.
"With the Centers for Medicare & Medicaid Services' goal to shift most Medicare and Medicaid patients to value-based care by 2030, it's time to eliminate the concept of 'discharge' and the implication that we're done with care. The transition to home is another care setting requiring support and technology to help people achieve the best health possible. It's time to embrace a key tenet of value-based care–not a series of episodes, but a relationship."
—Cindy Gaines, chief clinical transformation officer at Lumeon. Lumeon makes clinical workflow automation solutions for health systems.
For further insights regarding value-based care and at-home care services, read our latest interview with Cindy Gaines.
"There has been a long-standing separation between physical and behavioral health care providers. Technology has been the mainstay for tracking and trending patient progress and evaluating value-based care regarding their physical health. The behavioral health community must utilize similar models to receive payments and incentives. An electronic health record (EHR) with specialized behavioral health content, scales, scores, and measurable outcomes is critical to successfully delivering and reimbursing holistic care."
—Mary Russell, senior director, Clinical Implementation, CliniComp. CliniComp offers an architecture framework that can solve the problems of adaptability, scalability, reliability, and real-time performance within a complete EHR offering.
For further insights into value-based care for physical health, read our latest interview with Mary Russell.
"On the value-based care front, the 2024 Medicare Physician Fee Schedule Final Rule further aligns the Promoting Interoperability (PI) requirements for clinicians and hospitals. This rule doubles the minimum MIPS PI timeframe clinicians must report on in 2024, from 90 to 180 days. I expect to see some direct effects like clinician scores possibly going down if they were doing well in Quality but struggling to meet the Promoting Interoperability measures. We'll also see practices having to more carefully schedule EHR updates and transitions to ensure 180 uninterrupted days of PI performance. From a patient perspective, we'll start to see many more practices doing what hospitals do, including increased patient access to information via a portal or APIs and sending information electronically between doctors. This is pretty standard in the hospital space and primary care, but with the increase to six months, practices will have to rethink their workflows and strategies. If implemented properly, these requirements can help patient and caregiver satisfaction, especially among younger patients."
—Randy Marsden, vice president of Value-Based Care, Anatomy IT. Anatomy IT helps health care providers deliver exceptional patient care through technology and cybersecurity solutions.
"With recent polls showing 60% of eligible US voters favor Obamacare, the nation appears well on its way to recognizing health care as a right rather than a privilege—signaling the end of 80 years of experimenting with employer-funded healthcare. This shift toward health equity will likely unleash a decade of creativity as incumbent business models struggle to survive the slow movement toward public funding and conquer the real problem: cost. Capitation and value-based care programs in the past have ultimately failed to deliver lasting impacts, but a new dark horse is emerging in this race. Medications might well lead the way toward cures, healthy aging, and yes, cost reduction, but only if policymakers can find the balance between health impact and traditional business models, which will allow public and private payers, as well as the pharmaceutical industry, to step up and make the potential a reality."
—Cameron Deemer, CEO, DrFirst. DrFirst provides health care technology solutions that shatter information silos and solve care collaboration, medication management, price transparency, and adherence challenges in health care.
"In 2024, applications of generative AI will unlock unparalleled consumer access to their health data and information to learn more about their conditions. This will allow easier access to social determinants of health data to enter medical discussions and guide care decisions."
—Justin Norden, MD, MBA, MPhil, partner at GSR Ventures. GSR Ventures is a $3B AUM venture firm investing in early-stage digital health companies.
"By improving data quality and using it to develop and implement targeted interventions, health care organizations can help to create a more equitable health care system for all in the new year. Data quality matters because it allows health care organizations to accurately identify and understand the social determinants of health (SDOH) impacting their patients' health. This information can then be used to develop and implement targeted interventions to address these issues, such as providing referrals to social services programs or partnering with community organizations to improve access to healthy food and housing. Overall, using high-quality data to understand and address SDOH is essential for creating a more equitable health care system in 2024 and beyond."
—Gregg Church, president of 4medica. 4medica provides real-time clinical data management and healthcare interoperability software and services, providing clinicians with a unified view of patient information across disparate care locations.
"While 2024 will see a much-needed increase in early screening for dementia through primary care providers, these tools must be available to minority populations that suffer from higher rates of the disease but that have less access to primary care."
—Alvaro Pascual-Leone, MD, PhD, co-founder and chief medical officer of Linus Health. Linus Health is a digital health company focused on enabling early detection of Alzheimer’s and other dementias.
"2024 health care will be a tale of two cities: scarcity and satiation. The clinician labor shortage will intensify and drive virtual care companies to partner with clinician networks rather than build their own. GLP-1 medications will leave patients feeling full and lead to the most significant weight loss in history."
—Guy Friedman, CEO and co-founder, SteadyMD. SteadyMD is a B2B telehealth infrastructure provider that powers high-quality telehealth patient experiences for leaders and innovators in health care in all 50 states.
"Health care in 2024 will witness the rise of a symbiotic relationship between technology and clinicians to care for each person at the best time in the most cost-effective way. Value-based care will see AI combined with apps, telehealth, and remote patient monitoring, significantly enhancing the ability to provide chronic care management, post-procedural, and rehabilitative care right in people’s homes. This tech-driven, proactive approach will enable a more personalized experience and add value to the care provided."
—Pawan Jindal, MD and CEO at Darena Solutions. Darena Solutions provides fast health care interoperability resources (FHIR)-enabled interoperability for electronic health records (EHRs), providers, and payers.
"The health care landscape is transforming due to rising costs, access challenges, and technology disparities. As we move into 2024, patients, payers, and health systems will continue pursuing convenient, top-tier care beyond conventional hospital or provider settings. In response to this need, I foresee the rise of hybrid home healthcare models and clinical environments that feature state-of-the-art medical devices. These clinical innovations are tailored to elevate the patient’s experience and care while equipping the provider workforce with tools built for patient-centricity and comprehensive clinical data collection. These are critical components in pursuing value-based care and healthcare accessibility."
—Sean Brady, founder and CEO, Ventric Health. Ventric Health is a health care technology company and medical device provider focused on cardiovascular health.
For further insights into value-based care and Ventric Health's product offering, read our latest interview with Sean Brady.
"In the upcoming year, payers and providers will handle a surging demand for genetic tests driven by consumers seeking life-saving screenings and personalized diagnostics. With over 14 billion tests conducted annually, this exceeds the capacity of healthcare professionals and health plans. As the industry grapples with the quality, utility, and costs of genetic testing, I foresee a heightened focus on precise coding, evidence-based policies covering analytical and clinical validity, and the adoption of automated or expedited claim review processes."
—Pamela Stahl, president, Avalon Healthcare Solutions. Avalon Healthcare Solutions is the world’s first Lab Insights company.
"As the adoption of AI in health care continues to accelerate, the industry and regulators need to have a specific focus on the ever-improving abilities of large language models (LLMs). Next, we need to train LLMs on bigger, more diverse, and more equitable data sets to remove any bias and inequity, which is reflected in the recent Executive Order issued by the Biden Administration."
—Tim O'Connell, MD, founder and CEO, emtelligent. emtelligent is a clinical-grade natural language processing (NLP) software company and serves health systems, payers, and life sciences companies.
"In the coming year, I anticipate a greater emphasis on environmental, social, and governmental (ESG) issues across pharmacies—including health systems and hospital pharmacies. Namely, a big focus will be on the social and governmental issues involved in improving the work experience for pharmacists, many of whom participated in strikes or walkouts this year due to the pressures of the job. Looking closer at pharmacists’ daily duties, numerous opportunities exist to eliminate or automate time-consuming, non-essential tasks. Medication reviews, for example, are essential for every prescription to protect patients’ safety and health. Still, pharmacists often receive a lot of irrelevant information during this process that slows them down while frustrating patients waiting for prescriptions. Streamlining this process so that only the most relevant information is presented during these reviews can protect patients’ safety while enabling pharmacists to spend their limited time counseling patients instead of navigating data and performing administrative tasks. That’s one of several ways we can improve pharmacists’ daily work experience and help address social and governmental issues affecting them and their patients."
—Bob Katter, president, First Databank, Inc. First Databank, Inc. provides drug knowledge that helps health care professionals make precise decisions.
"Health care does not have a demographic, and everyone, regardless of financial status, race, age, etc., will ultimately be a patient (a customer of a health care provider) during their life. It’s exciting to see the industry's progress in this area and the continued focus on providing more personalized experiences for all patients. For example, providers give patients better tools for price transparency and payment flexibility to reduce the financial hardship of receiving care. We still have room for improvement in this area, but we’ll see continued improvement and scaling as we move into 2024."
—Ryne Natzke, chief revenue officer, TrustCommerce. TrustCommerce is a sphere company that provides financial technologies to the nation's largest systems.
"As health equity continues to be a major focus in health care, and as more value-based care contracts seek to tie health equity to payments, I think we will see an increase in the application of AI and technology. To date, most vendor development in SDOH has been around the collation and provision of disparate data sources, served with analytics and insights to healthcare stakeholders. I anticipate increased patient-level SDOH insights being driven through AI technologies such as NLP and LLMs. In 2024, we will see continued scrutiny and evaluation of the utility of LLMs in healthcare now that the initial excitement and hype have begun to die down. We will see real success in administrative areas, replacing documentation burden and other labor-intensive tasks, and potentially begin seeing some success in low-risk clinical areas."
—Calum Yacoubian, MD, director, Healthcare Strategy, Linguamatics, an IQVIA company. Linguamatics delivers a health care NLP-based AI platform.
For further insights into value-based care as it relates to Medicare Risk Adjustment plans, read our latest interview with Calum Yacoubian.
“As we move into 2024, health systems will increasingly recognize the power of using focused virtual care teams to support their value-based initiatives in a cost-effective and scalable manner. One important use case will be annual wellness visits for ACO populations to support attribution, risk adjustment and care gap closure. Another will be remote monitoring to decrease readmissions or to manage patients with chronic diseases. Of note, these will be especially important in supporting equity for patients who cannot easily get into their offices due to time and travel constraints.”
–Lyle Berkowitz, MD, CEO, KeyCare. KeyCare offers health systems access to a network of independent virtual care providers working on KeyCare's Epic-based EMR and telehealth platform.
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