Shaping the future: How industry leaders can influence direction of health care

A combination of the pandemic, government regulations, technology and market forces have created a crossroads for the health industry.

“Right now, there are hundreds of decisions that you and your counterparts across the different sectors of the health care industry are making,” said Ken Leonczyk, executive partner with the Advisory Board. “You are making them now, you are making them for the future and the reality is that they are going to have a profound implication on what health care looks like. Our future is not set. This is a unique opportunity to shape the future.”

Leonczyk discussed just what that future will look like in the State of the Health Plan Industry: Unpacking the Potential Impact on Your 2022 Plans, a January 28 webinar sponsored by Fierce Healthcare. He shared his insights about six areas that will drive the future of the industry.

Value-based payment

The future may unfold in one of several ways.

“It’s a possibility that we will achieve the idealized value-based landscape where we as an industry move away from fee-for-service as standard operating behavior to a new world where providers are operating their businesses under a fundamentally different incentive structure,” Leonczyk said. “There also is a very real possibility that the future of value-based care will simply be a physician compensation model. This would be a world of more targeted risk models rather than full-blown population health risks.

“If we don’t see payers, plans and health systems working through their very real tensions in this area, we will see plans move to this physician compensation-only model. That’s not what’s best for the industry and the country.”

The issue is whether this becomes a new reimbursement standard for the entire industry or is mostly focused on physicians.

Physician alignment

An increasing number of physicians are aligning themselves not with hospitals but with alternative partners.

“This is about a lot more than where physicians choose to hang their hats,” he said. “It’s ultimately about how much hospitals are able to solidify themselves as the locus of control, the segment of the market through which all else flows vs. a world where hospitals are essentially commodities. There is no shortage of non-hospital partners that physicians can look to these days. Who wins depends on who can best partner with these physicians.”

Home-based care

Although this concept is nothing new, the pandemic has moved it to the front burner.

“We have been talking about the promise of home-based care for years in the industry, but the question of feasibility has lingered in the background,” Leonczyk said. “The question is, will it make financial sense for different segments? Can we secure sustainable funding for the models?”

The answer to this question will determine whether home-based care is a flash-in-the-pan or a long-term, permanent shift.

“I want to be clear,” he said. “There are some things moving into the home, but whether this is really as big as it has the potential to be really comes down to whether funding will maintain the momentum.”

Virtual care

Much of the conversation about telehealth overlooks an important point, Leonczyk said. “Everybody’s talking about telehealth and the digital move, but what I think the conversation has missed is who is delivering this care,” he said. “The industry conversation is around the flashy new startups, the private equity-funded digital health tools. They are doing some cool stuff, but they are nowhere near owning the telehealth market. It’s the patients’ own local providers who largely are owning telehealth delivery. This market is the incumbent players’ market to lose.”

In short, the race is on to define and own the future.

“Providers are the ones with the volumes and relationships right now,” Leonczyk said. “But for health plans, there is a race to set expectations of what telehealth really is. The questions and complications are only going to increase, but this is a great place for health plans to differentiate themselves and be early movers in this segment.”

Price transparency

Several scenarios are possible.

“There is a real possibility that this becomes more of a distraction than anything else, because the data are so convoluted that it’s unusable,” he said. “But if we move beyond that point, then things become more interesting. Either this is something that becomes a true market disrupter that encourages competition on the basis of price or it’s something that enforces current market dynamics by further emboldening the dominant players.”

Health equity

The decisions that leaders make today will set the course for the future of health equity. “We are facing one of two paths,” Leonczyk said. “One is the easier way, and it’s that we commit to health equity as a mission imperative, which will make an impact on people’s lives. The second path definitely is harder. It’s about making health equity a true business imperative, something that has real financial teeth behind it. This requires you to go out and make that business case instead of waiting for it to come to you from the government, because I don’t’ think that will happen. If this isn’t the time to push forward, I don’t know when it will be.

As Leonczyk emphasized, the industry may have an unprecedented opportunity to chart its own course. “This is our opportunity,” he said. “What do we want the future to be? Now is the time to actually do something about it.”