Key Trends Reshaping The Future Of U.S. Healthcare

Forbes / By Bishan Nandy 
 
Technology breakthroughs, legislative changes and a shift toward patient-centered treatment are all driving the U.S. healthcare sector's extraordinary evolution. This article reviews some of the major trends influencing healthcare, along with insights on how healthcare providers should adjust.
 
1. Telehealth: Expanding Access To Care

During the Covid-19 pandemic, telehealth emerged as a key means of providing care, reducing viral exposure and helping to reduce access issues. Services like video consultations and remote patient monitoring enable continuous care, particularly for chronic conditions. On a global scale, telehealth and telemedicine have seen significant growth and transformation, with increased adoption and advancements in technology, regulatory changes, a patient-centric approach and global reach.
 
2. Value-Based Care 

There has been a significant push from the government and the sector perspective to shift the traditional fee-for-service (FFS) model to a value-based care (VBC) approach. Led by CMS, a growing share of healthcare payers have moved away from fee-for-service payment, and more providers than ever before are engaged in some form of quality-linked payment.
A smaller cadre has begun experimenting with advanced forms of population-based payment and large-scale practice transformation to prioritize cost containment and better patient outcomes. One of the key goals is to have the "participation of every clinician and every beneficiary aligned to some value-based model by 2030." These alternative payment models motivate physicians to prioritize patient engagement, quality and safety, patient experience and, consequently, patient outcomes.
 
3. Behavioral Health Integration

The demand for behavioral health treatments has increased in the last several years, especially after the pandemic's increased awareness of mental health issues. Before the pandemic, "fewer than 5% of young adults ages 18–29 years old experienced serious psychological distress." This number rose to between 20% and 30% post-pandemic.
In response, healthcare organizations have been increasingly incorporating mental health into both primary and acute care formats, frequently using digital behavioral health platforms and teletherapy. This integration of behavioral health into the treatment pathways helps healthcare organizations better serve the diverse population of Americans who suffer from mental health and substance abuse issues by lowering barriers to mental health care, such as social stigma and geographic restrictions.
 
4. Population Health Management

Population health management is a care delivery approach that aims to enhance the clinical health outcomes of targeted groups of people through better patient engagement and care coordination, supported by efficient operations and financing models. It has been an effective model to reduce healthcare costs and improve patient outcomes.

Advanced analytics using data that includes demographic information, clinical information and social determinants of health enable a better understanding of population needs, tailoring of interventions to specific at-risk groups and improved outcomes. According to an article in the International Journal of Integrated Care, "Carefully designed financing arrangements linking payments to high quality care and outcomes can guide provider behavior toward population health care objectives." Providers can enhance population-wide health outcomes and lower hospital admissions and expenses by addressing these issues and putting proactive interventions into place.
 
5. Technology And Digital Health Adoption

Healthcare organizations are increasingly using data analytics and digital tools to support clinical decisions, streamline processes, enhance patient engagement and improve care delivery. A Medtronic article on healthcare technology trends indicates that advancements in technology will reshape the way healthcare is delivered around the world. The use of digital technologies and innovations such as artificial intelligence (AI), wearables and apps, machine learning, surgical robots and predictive analytics allow providers to improve patient experience and outcomes, optimize operations and provide better access to care.
 
6. Strategic Partnerships And Mergers

Healthcare providers are considering strategic partnerships and mergers with other community organizations with shared missions aimed at providing a better care continuum to patients. According to Kaufman Hall, strategic partnerships help health systems scale up operations in many ways, such as by providing resources to expand capacity, engaging with large employers and health plans to improve accessibility and obtaining capital at an affordable cost. In fields like telemedicine, behavioral health and home-based care, where collaborations can spur innovation and access, strategic alliances are especially more prevalent.
 
7. Cybersecurity

Healthcare organizations are increasingly focused on cybersecurity due to the growth of advanced digital health solutions and related innovations. Cyberattacks have increased, endangering operational continuity and exposing patient health information to the public. Some of the most prominent and significant methods of cyberattacks that occurred in the last few years, especially during the pandemic and in the post-pandemic era, include phishing, ransomware, distributed denial-of-service attacks and malware.
To mitigate these risks and preserve the confidentiality of patient information, healthcare providers are investing in cutting-edge cybersecurity measures like encryption, multifactor authentication and ongoing monitoring.
 
Key Challenges

As the U.S. healthcare system evolves, providers face financial pressures from inflation, fluctuating patient volumes and reimbursement shortfalls. A studyconducted by the American Hospital Association indicates that "economy-wide inflation grew by 12.4% between 2021 and 2023, more than double the 5.2% growth in Medicare reimbursement for hospital inpatient care." Smaller and rural providers are especially affected by this financial uncertainty, which restricts their capacity to make technological investments and implement innovative treatment models. Workforce shortages exacerbate burnout and strain care delivery. Additionally, navigating complex regulations around value-based payments, telehealth and data sharing remains challenging.
 
Conclusion

Organizations must embrace innovation while maintaining a focus on patient-centered care as the healthcare landscape in the U.S. continues to evolve. Healthcare providers may increase access, lower costs and improve patient outcomes by implementing telemedicine, hospital-at-home models, value-based care and cutting-edge digital tools. The future of healthcare lies in an integrated, innovation-enabled ecosystem that serves the needs of all stakeholders including patients, providers and communities.
 

More Americans Than Ever Suffer From Chronic Pain

Medscape / By Diana Swift

More Americans than ever are hurting with enduring, life-restricting pain. Like obesity, this condition is on the rise, according to figures in a new NCHS Data Brief from the Center for Disease Control and Prevention (CDC).

In 2023, 24.3% of US adults had chronic pain, and 8.5% had high-impact chronic pain (HICP) that frequently limited daily activities in the past 3 months. Both types increased with age and with decreasing urbanization level. Women were more likely than men to have HICP (23.2% vs 7.3%). 

Like obesity, chronic pain is multifactorial and is best managed with multidisciplinary intervention, said Jianguo Cheng, MD, PhD, a professor of anesthesiology and medical director of the Cleveland Clinic Consortium for Pain, Cleveland, Ohio. “It’s a complex mix of genetic, biological, and psychosocial dimensions that can cause ongoing pain out of proportion to the original limited injury that triggered it.”

While today’s longer lifespans are the primary driver of the increase, noted Martin Cheatle, PhD, an associate professor of psychiatry, anesthesiology, and critical care and director of behavioral medicine at the Penn Pain Medicine Center at the University of Pennsylvania’s Perelman School of Medicine, Philadelphia, another important factor is the more than 100 million Americans who suffer from obesity. “Obesity is a major risk factor for chronic pain conditions including advancing joint disease, low back pain, and diabetic neuropathies,” he said.

Age is an amplifier, agreed Beth Darnall, PhD, a professor of anesthesiology and perioperative and pain medicine and director of the Pain Relief Innovations Lab at Stanford University in Palo Alto, California, but the increases in chronic pain and HICP cut across age strata. 

“Across the board we see striking increases in chronic pain, such as a 5% increase for those 65 and older, and a nearly 2% increase in HICP in that same age group,” Darnall said, referencing the changes from 2019 data in the new NCHS Data Brief. “And an almost 4% increase was observed for the youngest adult age category,18 to 29. Some of our research is now focusing on how to best treat chronic pain in young adults.”

The rise in chronic pain is broadly linked to the overall decline in the health of the US population, as indicated by the CDC 2024’s Chronic Disease Prevalence in the US: Sociodemographic and Geographic Variations by Zip Code Tabulation Area…

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Telehealth Gets Short Extension, Physician Pay is Cut in Spending Bill

Healthcare Finance / By Susan Morse

President Joe Biden on Saturday signed a spending bill that averts a government shutdown, but some healthcare provisions that were in the original bill didn't make it to final passage.

Acute hospital-care-at-home and telehealth temporary waivers were continued, but were not given the long-term extensions that were included in a Dec. 18 bipartisan resolution. Both received short-term extensions until March 31.

The original bill extended telehealth for two years and acute hospital care at home by five years.

Stripped out of the bill is a provision to prevent the Medicare pay cut to physicians. This means physicians get a 2.8% Medicare payment cut on January 1, 2025...

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OASIS-E1 Manual Finalized

The Alliance / By Katie Wehri

CMS posted the final OMB-approved OASIS-E1 time points Instruments, effective 1/1/2025, are now available in a zip file in the Downloads section of the OASIS Data Sets webpage.  The Agency has also reposted the final OASIS-E1 Manual effective 1/1/2025. Alliance staff are in the process of reviewing the materials.

A change table OASIS-E1 Instruments March 2024 – December 2024 Changes, also available in the Downloads section of the OASIS Data Sets webpage, lists minor corrections from the draft to final versions. The final OASIS-E1 All Items instrument will be posted when available.
 

OIG Issues MA Plan Fraud Alert

Alliance Daily

The Office of Inspector General (OIG), U.S. Department of Health and Human Services, has issued a Special Fraud Alert warning about certain marketing schemes involving the Medicare Advantage (MA) program. These schemes involve questionable payments and referrals between Medicare Advantage plans, health care professionals ( HCPs) , and third-party marketers such as agents and brokers.

The Special Fraud Alert focuses on two types of remuneration that have been the subject of recent settlements under the False Claims Act and that implicate the Federal anti-kickback statute: (1) payments from Medicare Advantage Organizations (MAOs) to HCPs or their staff relating to MA plan marketing and enrollment; and (2) payments from HCPs (including payments from corporations that contract with or employ HCPs and payments from management services organizations with which HCPs contract) to agents, brokers, and others in exchange for referring Medicare enrollees to a particular HCP.

One area of risk involves MAOs, directly or indirectly, paying remuneration to HCPs or their staff in exchange for referring patients to the MAOs’ plans. For example, MAOs have provided gift cards or in-kind payments to HCPs and their office staff in exchange for those HCPs or their staff referring or recommending individuals for enrollment in a particular MA plan. In some cases, these tactics have resulted in individuals, sometimes without their consent, being enrolled in an MA plan when they wanted to stay in Original Medicare or another MA plan. Additionally, an MAO may use these payments to HCPs or their staff to selectively target individuals for enrollment that benefits the MAO

A second area of risk involves payments from HCPs to agents and brokers, such as payments from an HCP to agents and brokers to recommend that HCP to a particular MA enrollee or to refer the enrollee to the HCP. In some cases, HCPs make these payments to refer Medicare enrollees to the HCP to become designated as the primary care provider for the enrollee at their particular MA plan, which can carry a substantial financial benefit for the HCP. Enrollees are often unaware of these financial arrangements and may rely on the recommendation of an agent or broker in making HCP selection.

Abusive arrangements involving MAOs, agents, brokers, and HCPs may also lead to criminal, civil, or administrative liability under several Federal laws.

The OIG has developed a list of suspect characteristics related to arrangements involving the types of marketing activities described above. These characteristics, taken together or separately, could suggest that an arrangement presents a heightened risk of fraud and abuse.

  • MAOs, agents, brokers, or any other individual or entity offering or paying HCPs or their staff remuneration (such as bonuses or gift cards) in exchange for referring or recommending patients to a particular MAO or MA plan.

  • MAOs, agents, brokers, or any other individual or entity offering or paying HCPs remuneration that is disguised as payment for legitimate services but is actually intended to be payment for the HCPs’ referral of individuals to a particular MA plan.

  • MAOs, agents, brokers, or any other individual or entity offering or paying HCPs or their staff remuneration in exchange for sharing patient information that may be used by the MAOs to market to potential enrollees.

  • MAOs, agents, brokers, or any other individual or entity offering or paying remuneration to HCPs that is contingent upon or varies based on the demographics or health status of individuals enrolled or referred for enrollment in an MA plan.

  • MAOs, agents, brokers, or any other individual or entity offering or paying remuneration to HCPs that varies based on the number of individuals referred for enrollment in an MA plan.

  • HCPs offering or paying remuneration to an agent, broker, or other third party that is contingent upon or varies based on the demographics or health status of individuals enrolled or referred for enrollment in an MA plan.

  • HCPs offering or paying remuneration to an agent, broker, or other third party to recommend that HCP to a Medicare enrollee or refer an enrollee to the HCP.

  • HCPs offering or paying remuneration to an agent, broker, or other third party that varies with the number of individuals referred to the HCP.

These practices, alone or in combination, represent potentially abusive practices that could

implicate various fraud and abuse laws. Additionally, these types of suspect practices could result in various harms to Medicare enrollees and should be scrutinized closely by any parties to such arrangements.
 
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