A couple of industry shifts have driven the rapid expanse of health technology.
A new report published by Visiongain titled the Mobile and Digital Health Technologies Market Report 2024-2034 has detailed the expansion of health tech. The report cites that the mobile and digital health technologies market is estimated at US$250.8 billion in 2024 and is expected to register a CAGR of 13.3% from 2024 to 2034.
There are two main items behind this market growth: adoption of digital health technology and advancements in mobile health applications and devices.
Adoption of Digital Health Technology
The healthcare industry has made big leaps in the last couple of years in adapting digital health technologies. The advancements the industry has seen are in part due to the adaptations taken around the COVID-19 pandemic. The pandemic pushed the industry to rapidly expand the use of remote care, making telemedicine platforms and remote patient monitoring the norm. Both of these items have equipped providers with much more accessible to their patients in a convenient method.
Advancements in Mobile Health Apps. & Devices
The report cites advancements in mobile health applications and devices as one of the main drivers of growth and innovation in the healthcare market. These new innovations have harnessed the convenience and widespread availability and functionalities of smartphones, and wearable devices to transform healthcare delivery and enable consumers to take control over their health and wellness. From symptom tracking to medication management, wearable devices and health applications have helped bring healthcare into a modern era where consumers can make use of the tech that already surrounds them.
A report from The International Telecommunication Union (ITU) cites that 90% of physicians utilize smartphones in their professional settings, and the majority of individuals rely on their devices like smartphones to access health-related information.
According to a Morning Consult survey in 2023, 40% of US adults used healthcare-related apps, which is a 6% increase from 2018.
Many health systems and patients have struggled with prior authorization procedures.
Prior authorization practices are staying in the spotlight. Health systems are looking for payers to do more to enhance the prior authorization process. While some health insurers have made strides, several states and health systems took matters into their own hands. From partnerships to policy reform, check out our five updates on prior authorization for payers.
In April Humana expanded its partnership with Cohere Health’s prior authorization platform for diagnostic imaging and sleep services. We reported on this partnership last month, read the full coverage.
A Kodiak Solutions report details that the final denial rate for inpatient claims in 2023 was more than 50 percent above the same rate in 2021.
Vermont governor Phil Scott signs a prior authorization reform bill. Among the items in the legislation, it requires health insurers to decide prior authorizations within 24 hours for urgent situations and two business days for nonurgent care.
At the start of this year Oregon-based St. Charles Health System partnered with insurer PacificSource to launch a pilot program to streamline automatic coverage approval for patients in need of cancer treatment.
Oklahoma signed a bill into law that changes several prior authorization procedures including approval timelines. It also requires payers to have prior authorization procedures published on the company’s websites to be available for patients and providers
A not-so-new feud between NewYork-Presbyterian Hospital and union health fund 32BJ has reached a fever pitch. The union fund was on the cusp of signing with Aetna to cover its 210,000 members when a hospital-sized roadblock popped up.
Due to the hospital's prices, 32BJ wanted to exclude it in its new contract. However, Aetna’s contract requires the insurer to get a signoff from the hospital in order to omit it from a client's plan.
According to New York Presbyterian, 32BJ owes the health system over $25 million in medical service bills and is barring 32BJ from signing with Aetna until those bills are covered. Without the payment, Aetna can’t offer the plan the union fund wants.
32BJ says it has no current plans to pay the hospital.
“We were totally shocked. That’s just not how business is done,” said Peter Goldberger, executive director of the union’s benefit funds, speaking to the Wall Street Journal. He added that NewYork-Presbyterian never brought up the charges prior to the union fund attempting to sign with Aetna.
The union health plan spends about $1.5 billion a year covering members—who typically hold occupations such as cleaners, maintenance workers and airport staffers—and their families.
Last year the union health fund spent roughly $22.5 million on care at NewYork-Presbyterian alone.
This led 32BJ to call off signing with Aetna, who they said they do not blame for the situation.
The union fund will continue with its current partner Elevance’s Anthem, which has not included NewYork-Presbyterian in its network since 2022.
The Price Problem
NewYork-Presbyterian’s prices reflect those of big hospitals that command premium rates with private insurers. These demands are high, and sometimes guarantee that the health system will be included in all of an insurer’s networks, even if a client doesn’t want them.
Contract terms like these negatively affect insurer’s clients, usually employers and unions, making it harder for them to guide patients to lower-priced health systems. Employers end up staying in them, despite not knowing what they are paying, and services potentially costing double what the government would pay.
Hospital prices have been a major pain point lately, and data shows they usually pay far more than Medicare rates. There’s also been pushback from other groups that say Medicare rates are far too low and don’t cover the cost of care. Regardless of where the numbers fall, employers need access to pricing data for their health plans.
On Monday the HHS research funding agency Advanced Research Projects Agency for Health (ARPA-H) unveiled its Universal PatchinG and Remediation for Autonomous DEfense (UPGRADE) program that will offer “multiple awards” to individuals/groups with the best pitches for a scalable cybersecurity platform that can keep the hospitals’ vast digital systems up to date.
The program hopes to implement a platform that will enhance and automate cybersecurity for healthcare facilities.
“It’s particularly challenging to model all the complexities of the software systems used in a given healthcare facility, and this limitation can leave hospitals and clinics uniquely open to ransomware attacks,” UPGRADE Program Manager Andrew Carney said in a release. “With UPGRADE, we want to reduce the effort it takes to secure hospital equipment and guarantee that devices are safe and functional so that healthcare providers can focus on patient care.”
The U.S. healthcare system struggles with continuously updating the security technology that is put in place. The release noted that when updating critical hospital systems, taking that system offline can be “very disruptive.” This often leaves vital data open for hackers and ransomware groups.
The UPGRADE program aims to address these issues by choosing a new platform that can proactively probe for vulnerabilities. While the agency is holding a Virtual Proposers Day on June 20, it has not yet announced open and closed dates for this solicitation.
There are four technical areas that the ARPA-H will be seeking in these outside proposals. This infographic breaks it down.
Unorganized mental health care is driving up utilization costs.
The inequities of mental health care are costly and prevalent throughout the nation. If left unaddressed, the U.S. will may spend almost half a trillion dollars in unnecessary costs for mental health care through 2024. That number could even escalate to $14 trillion by 2040 if left uncontrolled, according to a report from Deloitte and the Meharry School of Global Health.
According to the report, the U.S. currently spends about $477.5 billion annually in avoidable expenses related to mental health inequities. Year by year, the U.S. is expected to spend roughly $1.26 trillion on these inequities.
The report also shows that emergency department utilization, in relation to mental health inequities, costs the healthcare system about $5.3 billion annually. Projections suggest this may rise to $17.5 billion by 2040, if left unaddressed.
The problem is that many individuals don’t have access to quality mental health care, particularly communities that are already underserved. Roughly 57% of these groups don’t have access to care, according to the report.
This issue affects the health system as a whole, but payers in particular stand to face soaring utilization costs. If payers can shift their focus to mental health care management, they can implement care strategies that can make a big difference. If the groups facing these inequities acquire access to preventive mental health services, issues can be addressed early on and reduce emergency department visits.
Payers can help in closing this care gap by implementing innovative mental health care strategies through their care management platforms. If these issues are addressed the report suggests it could lead to a notable decrease in not only ER visits, but also a decrease in premature death and productivity loss due to cardiovascular disease, plus all the costs associated with its management.
Unorganized mental health care is driving up utilization costs.
The inequities of mental health care are costly and prevalent throughout the nation. If left unaddressed, the U.S. will may spend almost half a trillion dollars in unnecessary costs for mental health care through 2024. That number could even escalate to $14 trillion by 2040 if left uncontrolled, according to a report from Deloitte and the Meharry School of Global Health.
According to the report, the U.S. currently spends about $477.5 billion annually in avoidable expenses related to mental health inequities. Year by year, the U.S. is expected to spend roughly $1.26 trillion on these inequities.
The report also shows that emergency department utilization, in relation to mental health inequities, costs the healthcare system about $5.3 billion annually. Projections suggest this may rise to $17.5 billion by 2040, if left unaddressed.
The problem is that many individuals don’t have access to quality mental health care, particularly communities that are already underserved. Roughly 57% of these groups don’t have access to care, according to the report.
This issue affects the health system as a whole, but payers in particular stand to face soaring utilization costs. If payers can shift their focus to mental health care management, they can implement care strategies that can make a big difference. If the groups facing these inequities acquire access to preventive mental health services, issues can be addressed early on and reduce emergency department visits.
Payers can help in closing this care gap by implementing innovative mental health care strategies through their care management platforms. If these issues are addressed the report suggests it could lead to a notable decrease in not only ER visits, but also a decrease in premature death and productivity loss due to cardiovascular disease, plus all the costs associated with its management.
A big problem for payers will call for big solutions.
Editor’s note: Part one of this two-part article discussed the impacts that climate change will have on healthcare, and the role payers will need to step into to address climate change and protect their businesses. Part two looks at more detailed solutions that payers can implement so their business doesn’t get washed away.
Climate change is bound to majorly impact every health plan on the planet, but payers don’t have to be left stranded. Getting an early start on climate change planning before it gravely threatens health plans is the best option for insurance businesses to not be left high and dry.
“The climate crisis is a health care crisis,” says Baylis Beard, director of sustainability for Blue Shield of California., “As insurers, we are part of the healthcare industry, which means we have a responsibility to decrease our emissions and use our voice to lead the way to a more sustainable, healthier future.”
Climate change will impact payers in three key ways: high utilization, high costs, and weather-related events that will affect healthcare workers.
High Utilization
Creating a Plan
Payers should develop climate change response plans to focus on their high-risk areas, the areas that will eventually cost them the most to cover. That might include implementing digital care and telehealth solutions. Payers can create ways for consumers to educate themselves about high-risk areas, possible health effects, precautions to take, and resources available to them if they are located in a high-risk area. By leveraging care-management platforms, payers can provide information like inclement weather alerts and educational content to allow their members to stay informed in an accessible way.
Keeping track of member health will play a greater role as climate change advances, particularly with seniors and the Medicare Advantage population. Studies show that seniors in particular will be greatly affected: “Among other alarming facts, heat-related mortality for people above age 65 has increased by more than 50% in just the past 20 years,” according to a report from the Patient Safety Network.
Research
High-risk areas might not always be easily identifiable, and this may take some research to create an accurate response plan.
For example, California experiences frequent wildfires, and long-term exposure to smoke inhalation kills thousands each year. However, according to one study , only about 1,700 of the 6,300 deaths that occurred each year from smoke inhalation between 2006 to 2018 occurred in the West. This study shows that wildfire smoke had the most prevalent effects in the East because of how fast the smoke traveled. The point: don’t make assumptions without looking at all the data.
“Much of the research on the effects of climate change on health has been done with clinical data to understand health outcomes,” said Blue Shield of California’s director of sustainability Baylis Beard, “but the impact on healthcare utilization and costs is less understood.”
In order to uncover the true cost of climate change for health insurance, payers should focus on using science and evidence-based strategies. An article by the Patient Safety Network states: “Evidence-based strategies are required to accelerate healthcare decarbonization and avert the worst predicted harms to health and healthcare systems.”
Further, insurers can collaborate with climate change researchers and weather institutions to create comprehensive plans that take into account a vast array of climate data.This avenue can ensure the most accurate results can be reflected when payers analyze the financial impacts.
High Costs
Perhaps the biggest and most obvious effect of climate change will be higher costs. High utilization leads to high costs for payers, but what will also step into the spotlight? Supply chain malfunctions.
The United States’ healthcare sector emits about a quarter of total global healthcare emissions. In other words, the U.S. healthcare industry uses a lot of energy, and transports a lot of supplies. Climate change will bring about disasters that are very difficult to prepare for in this sector.
For example, a tornado that ripped through a Pfizer drug warehouse in North Carolina in July of 2023 destroyed medications as well as pharmaceutical raw materials, exacerbating the shortage of drugs used in surgery and cancer treatment.
Payers can work with outside organizations to create communication plans on how they will handle these events. But they must make sure the select the right partners. “We play a role in creating the right incentives in the value chain and choosing sustainable partners,” said Beard.
Climate Change Affecting Healthcare Workers
The biggest issue in healthcare is the labor shortage. Climate change will worsen this. Extreme heat and weather will affect certain occupations more than others.
For example, studies show that climate change will have a big effect on emergency response workers. The Journal of Emergency Medical Services published an article stating: “Prolonged heat waves strain EMS staff and resources, emphasizing the need for strategic planning and collaboration with other agencies.”
Payers should collaborate with their health systems to ensure there are resources for these workers when they feel strained. Along with EMS workers, doctors and nurses facing intense burnout from high volumes of patients after weather-related events will also increase. Implementing AI and automation to cover tedious tasks and mitigate stress is one tactic that can help.
Virtual Care
Virtual care is going to play an even bigger role as the climate crisis worsens. The healthcare industry has already gotten a jumpstart on this type of care because of the COVID-19 pandemic. Telehealth and virtual care have been shown to decrease emissions as well as water use. While virtual care can have its limitations, including broadband issues and limited access to technology, it can provide care when physical access to a health system is just not possible. Payers should look at updating their virtual care models and implementing new forms of virtual care. For example, Blue Shield of California has implemented a new virtual care platform that connects members with virtual primary care services for patients to access providers via mobile phone, tablet, or personal computer.
“This virtual care platform also helped provide critical health care services to a town badly damaged by the Camp Fire where many residents were forced to drive long distances to see a doctor,” Beard said.
The Opportunity to Lead
Health insurers can take the lead on climate change in several ways.
For instance, the Boston Consulting Group suggests that “Insurers should collaborate with climate research and university institutions and should assist governmental and academic institutions in climate-health policymaking discussions.”
Health plans can look to create new insurance products and specified insurance models to address climate change health effects. Payers can explore implementing wider disease coverage and climate specific products. Looking to other countries may also help in generating new ideas. For example, Japan has implemented heatstroke insurance in response to climate change, costing members roughly 70 cents a day; in a single day they sold about 7,000 policies in June 2022.
Payers should also focus on underserved populations, as these groups often experience the worse climate change effects while contributing the least to pollution and carbon emissions. Collaborating with other institutions and agencies could be beneficial in this implementation.
Payers can also look to generate new opportunities by establishing health services that go beyond insurance. Climate change is already having an impact on payers’ portfolios, and this is a great way to diversify. Partnering with private equity firms to expand care delivery and creating tools for optimizing emergency-room triage and resource allocation are a couple of options that payers can explore.
The COVID-19 pandemic brought about several CMS waivers that aimed to expand telehealth access and coverage. Now we’re seeing those waivers that were set to expire at the end of 2024, extended.
The House Ways and Means Committee has voted to advance the Preserving Telehealth, Hospital and Ambulance Access Act (HR 8261) which would continue pandemic-era CMS Medicare waivers for telehealth access and coverage through 2026. It would also extend the CMS Acute Hospital Care at Home waiver for an additional five years, to the end of 2029.
While there is support for having these waivers be made permanent, for now a new bill would extend the telehealth waivers for two years and the Hospital at Home waiver for five years.
A few policies in this bill include: allowing Medicare patients to continue to receive telehealth services in their home, no geographic restrictions for originating sites for telehealth services, and allowing the use of audio-only communication platforms.
Many CMS waivers that were set to expire in 2024 are being extended.
The Centers for Medicaid and Medicare Services have extended the flexibilities designed to help states keep eligible individuals enrolled in Medicaid through June 2025, revising the initial expiration set for the end of 2024.
The waivers were originally set to expire by the end of 2024, but will be extended for six more months, according to a memo to states written by deputy CMS administrator and director of the Center for Medicaid and CHIP services Daniel Tsai. Other unwinding-related section waivers will be extended through June 30, 2025
According to a memo to states written by deputy CMS administrator and director of the Center for Medicaid and CHIP services Daniel Tsai, many states were expected to finalize the Medicaid unwinding process by June of 2024. However, due to several state extension waivers from CMS, several states will continue renewals past this date.
Loss of Coverage
Originally, HHS estimated that roughly 15 million individuals would lose Medicaid coverage. According to KFF news, over 21 million individuals have been disenrolled from Medicaid since April 2023.
Of that number, around 69% were disenrolled for procedural reasons, for example, not returning mandatory paperwork; not because they were ineligible for the program. The total Medicaid/CHIP Enrollment as of March 2023 was 94 million individuals, almost a third of the national population.
CMS looked at this massive volume of renewals following resumption of normal operations and called for the states' use of the timeliness exception to delay procedural disenrollments. This gave states time to conduct targeted outreach to encourage beneficiaries to return the renewal form.
CMS has approved a total of 398 waivers 52 states and territories, including Puerto Rico and the U.S. Virgin Islands. The waiver uptakes varied greatly by state: South Dakota requested a single waiver, while Indiana and Tennessee requested 15 each.
CMS also noted that this extension of flexibilities to streamline renewals will enable states to shift limited resources to reduce processing time at application when needed.
Payers
Health plans have faced much scrutiny as Medicaid unwinding moved along, and many payers still profited. Initially, payers said they expected the overall risk profile of their members to go up, due the fact that those remaining in the program would be sicker.
During the pandemic Medicaid enrollees’ health costs were lower, and several states made the decision to exclude pandemic-era cost data as they moved to set up payment rates for 2024; which worked in the favor of Medicaid health plans.
According to KFF, there are still 24 million Medicaid beneficiaries awaiting states to determine eligibility.
UnitedHealth continues to make headlines months after the cyberattack.
UnitedHealth has remained in the news since the Change Healthcare cyberattack earlier this year.
CEO Andrew Witty recently testified in front of the Senate and provided some updates surrounding the attack—including how it happened—the details of UnitedHealth Group’s (UHG) security controls. Witty also stated it was his decision to pay the large ransom.
From the initial cyberattack, to lawsuits, to divestitures; here are five updates on UnitedHealth Group.