After the recent election, many observers have tried to understand the implications for different sectors of the economy. At Forward Advantage, we analyze important industry data points and trends to understand the impact on healthcare, our customers and our business. We hope this blog post and our predictions help interpret recent developments associated with the election, the potential impacts on healthcare and the health IT ecosystem that supports it.
Expanded Response to the Pandemic
The FDA has issued an emergency use authorization for two vaccines produced by Pfizer and Moderna. This bodes well for controlling the spread of COVID-19 and eventually returning to an open society which will help boost the economy.
President-elect Biden is moving ahead with a Coronavirus Task Force t o address the pandemic. He may work with Congress to tweak the Coronavirus Aid, Relief, and Economic Security Act in favor of providers by forgiving Medicare loans and changing reporting requirements for funding. Another financial relief package is also likely to be a priority.
The Senate Remains in Play
Although the Presidential election results are final, two Senate seats remain undecided. The Democrats have a narrow path to gaining control in runoff elections in Georgia scheduled for early January, but significant funding is pouring into the state by advocates on both sides of the aisle. The outcome will drive the ultimate direction of healthcare policy and impact many other government programs and sectors of the economy.
What Could Happen Next?
The ACA is Likely to Prevail
The U.S. Supreme Court, which now has a clear majority of justices appointed by Republican presidents, heard arguments this month. Early signs indicate they are leaning toward leaving the ACA in place, with any adjustments up to Congress.
Other Policies are Likely to be Pursued
Unless Democrats capture the Senate, Biden’s public option for Medicare-like coverage and his move to lower the age to 60 is unlikely to prevail. With executive orders and other administrative actions, Biden could roll back restrictive Medicaid expansion waivers with work requirements and encourage more states to expand to bigger populations. He could also reimpose limits on short-term health plans, which lack the consumer protections established by the ACA.
Lawmakers may look to slow or even reduce Medicare spending by dialing back growth adjustments and making targeted spending reductions, but this probably won’t happen until healthcare providers are in a more stable, post-pandemic position.
Possible Bipartisan Action on Surprise Billing and Drug Pricing
Democrats and Republicans released plans for legislation banning surprise medical billing, but both payers and providers have opposed certain bills. At some point, there are likely to be restrictions on when additional charges can be applied and to what degree in a Biden administration HHS department. However, a total ban isn’t expected. Enhanced disclosure rules are also likely, so patients are fully informed of their potential financial liability in advance.
2021 Predictions for Healthcare IT and Its Customers
The impact on health IT vendors will depend on the overall financial health of their customers and key drivers from a regulatory perspective. It will take some time for industry providers to recover from the dramatic reduction in patient volumes during the pandemic. Payers have fared somewhat better with fewer claims to pay, but there are increasing pressures to rebate excess premiums.
Below are our predictions for healthcare IT and the organizations it serves:
• Current regulations are likely to remain. Rules regarding interoperability, information blocking, ADT notifications and price transparency are likely to prevail, even though the deadlines for compliance will remain extended. Providers and payers will still need to invest in information systems and operational processes that support compliance with these requirements.
⋅ For EHR and Practice Management system vendors, tools that reinforce the ability to manage COVID-19 diagnosis and treatment will be increasingly vital, as well as capabilities to accurately track vaccine distribution and administration. Reporting requirements are also likely to remain stringent and more voluminous, requiring investment in analytics and reporting systems that provide better automation.
⋅ We predict the focus will be on tools that are tightly integrated with EHRs and other clinical systems and use more robust technology like FHIR APIs, rather than the loosely coupled smartphone solutions using unreliable connectivity such as Bluetooth. 5G will also have a positive impact but probably only in highly populated urban areas in the near term.
• The CMS requirement for ADT notifications will motivate vendors to provide solutions that help support customer compliance, either by modifying existing products or by developing new ones.
• Patient identification remains a pressing priority and better patient matching will be crucial to effectively track the distribution and administration of a COVID-19 vaccine.
• Cybersecurity remains a priority for healthcare organizations in the face of increasing attacks and breaches. This requires additional investment in a wide range of capabilities such as endpoint and network monitoring systems, AI-based screening and detection tools, risk management programs and improved end-user training. Identity governance, administration and access management are also increasingly important to manage authorized users and their associated access privileges.
• Improving the overall patient experience will be a priority for healthcare organizations as many patients transitioned to telehealth and urgent care options. To compete effectively, health systems need to deploy digital health solutions that support better communication and engagement with patients across the care continuum. A key factor will be to capture the data from patient interactions, aggregate it in a centralized repository for analysis and then use the insights to deliver more personalized and relevant patient experiences.
2020 has unquestionably been a year of turmoil, and the recent election was no different. Biden is our President-elect, but much remains in flux. Our role at Forward Advantage is to predict the needs of customers and adjust our offerings accordingly. However, much of our success is due to feedback from our customers. As always, we want to hear from you! Feel free to share your own findings and predictions for the coming year.