Healthcare 2023: The Year of Living Optimistically

Positive predictions that (almost) don't mention the pandemic or the recession.

The recession: If we're not careful, we might just talk ourselves into it. While recessions have very real drivers, it's also true that what we choose to focus on can impact outcomes. Talk doesn't get the job done, but a healthy dose of optimistic 2023 predictions might be a welcome change.

From Triple to Quintuple Aim

IHI President and CEO Dr. Kedar Mate and colleagues propose an evolution from the Triple Aim to the Quintuple Aim—adding workforce well-being and safety, and health equity to the existing targets of improved population health, enhanced patient care experience, and reduced costs.

In a February IHI blog, Mate wrote that "the Quintuple Aim is necessary precisely because we have not yet achieved the Triple Aim. My thesis is that the Triple Aim is not achievable without attention to health care burnout and inequity."

The influence of consumerism and HIT

Managed Healthcare Executive offers multiple consumer and tech-driven predictions for 2023. Talkdesk VP Patty Hayward writes that providers will see "competition from consumer-oriented brands" and that "big retail, tech, and payer organizations [will] move further into primary care and invest in delivery systems that look more like a great retail or hospitality experience."

Insightin Health CEO and founder Enam Noor adds: "Personalized services have become table stakes, and health plans that can deliver consumer-centric experiences to their members will have a competitive advantage over plans without the same approach."

Noting technology's role, Noor advises health plans to "design strategies and implement technology solutions that provide data-driven insights to better understand, anticipate, and address their members' needs in real time."

Other Managed Healthcare Executive contributors and industry leaders are equally optimistic that HIT can help:

• drive prior authorization automation
   
• link patient homes with traditional care settings for better prevention and outcomes
   
• manage growing data volumes through better interoperability and EHR design
   
• extract and identify more data to address social determinants of health

Turning the corner on value-based care?

Managed Executive also predicts that 2023 will be "a breakout year for value-based care."

Equality Health chief strategy officer Brandon Clark writes: "Across the past two years of the pandemic, we better understand that ground-up redesign is an imperative and not an option." Noting CMS' increased focus on VBC, Clark identifies other drivers: "The fee-for-service model is creating provider burnout at alarming rates, and the pandemic shed a major light on social and cultural health inequities."

Employers own their payer role

As HealthLeaders highlighted throughout 2022, employers appear fed up with healthcare costs. They will continue to take strong actions to counter them. Look for the Purchaser Business Group on Health (PBGH) and its dozens of large employer members to act on new strategic goals. This includes a "redirect" of member spend and purchasing toward affordable, whole-person, equitable care.

PBGH strategies include integrating public and private purchaser efforts. Across the industry, self-insured employers are also exploring direct contracting with providers. They are also taking advantage of new funding models such as ICHRA, or Individual Coverage Health Reimbursement Arrangement. Employers can use ICHRA to give employees a set amount of money to purchase coverage and offset cost-sharing.

Digital therapeutics learns more about commercialization

Consumer-driven healthcare is the rising tide that will lift many boats.

This includes wearables, other personal and home-based software and devices, and DTx, or digital therapeutics. DTx consists of "evidence-based therapeutic interventions that are driven by high quality software programs to prevent, manage, or treat a medical disorder or disease."

One of the biggest hurdles for DTx uptake, including solutions that require a prescription, is reimbursement scale. That can only come from payers and progress has been growing but slowly. But one X predicts that DTx companies will have the confidence to evolve their strategies.

Curavit Clinical Research co-founder and CCO Dave Hanaman predicts that DTx companies "will focus on the difficult last mile to commercialization." Hanaman forecasts a more even mix (60%/40%) between FDA approval for DTx devices and earlier market access.

"This 'last mile' is completely unchartered territory for DTx companies," he notes, with continued challenges matched by a more optimistic and aggressive approach.

Inspiration-driven innovation

It's easy to be a pessimist in healthcare. But hope often springs eternal in the innovation and tech sectors, despite 2023 market downturns. Just ask Solome Tibebu, founder and CEO of Going Digital: Behavioral Health Tech.

In her BH-focused newsletter, Tibebu acknowledges the field's opportunities and challenges: "Behavioral health care has a lot of problems. But it also does a lot of good. Most of us who work in behavioral health believe in its power to help people while still recognizing that it's far from perfect."

Tibebu adds meat to the bone, citing the "myriad of possibilities for using technology in treatment" that innovators have developed—from artificial intelligence to virtual to wearables.

"These are all promising tools in the 21st-century treatment arsenal," writes Tibebu, adding: "Behind every merger or funding announcement, behind every technological breakthrough —there are human beings who are parents, kids, friends, and loved ones. They have lives and they are struggling. They need to know that there are people who care, who are working to ensure that 'it gets better than this.'"