By Jeff Margolis
The functionality, accessibility, and affordability of U.S. healthcare has been a front-and-center issue for a long time. The COVID-19 crisis only enlarged the magnifying lens on the industry.
In 2022, as we began to emerge from the dark cloud of the pandemic, there were some rays of sunshine in terms of healthcare progress. For starters, Congress acted in a bipartisan manner to provide funding for research and vaccines, and oddly enough spent little energy arguing about whether people deserved healthcare.
The Inflation Reduction Act of 2022, signed into law by President Joe Biden in August, included important health provisions. Among them: lowering prescription drug prices in Medicare through price negotiation with manufacturers; requiring drug companies to pay rebates if prices for drugs used by Medicare beneficiaries rise faster than inflation; capping out-of-pocket drug spending for Medicare Part D beneficiaries at $2,000 annually; and extending for three years the enhanced Affordable Care Act subsidies that Congress passed in 2021 as part of the American Rescue Plan Act.
In the second half of 2022, there was enough confidence in vaccination and control measures around COVID-19 to start thinking about a new normal in healthcare. Data affirmed that those who maintained overall better health and well-being fared far better than those with underlying conditions and less healthy lifestyles. But it also reminded us that even very healthy people can be overcome by novel diseases.
Our healthcare system still needs significant improvements, starting with industry and government decision-makers getting on the same wavelength more often. The 2022 election cycle gave us non-productive, hyperbolized political rhetoric that split U.S. human beings into labels of high needs, elderly, and “everyone else.” And the industry has still not made an adequate systematic shift to understand people as individuals vs. simply putting them into categories based on their economic and geographic demographics.
But let’s take solace in the fact that government officials, policymakers, and employers are starting to understand that healthcare is broader than just reactive sick care.
We deserve a healthcare system that does more than fix us when we’re sick. Our daily living—the actions we take regarding nutrition, fitness, sleep, mental health, relationships, and financial management, and how social determinants impact these actions—is the biggest factor in our health and total well-being. Yet, our healthcare system primarily treats sickness rather than working to prevent it in the first place.
Here are some healthcare predictions for 2023:
- Inflation and insurance affect the industry. Unfortunately, inflation in sick-care labor and supply resources is going to disrupt some of the progress from 2022. Local and regional hospital systems are going to struggle to cover costs. Though inflation related to sick-care costs will get in check by late 2023, the insurance rate increases for 2023 and 2024 will be brutal.
- Adversaries look for common ground. Politicians will keep publicly attacking pharmaceutical and insurance companies as the cause of the economic challenges to healthcare, but they will work together in the background as private industry supports the innovation imperative.
- Mental health gets more attention. Mental health will get a long-awaited day in the sun. There will be bipartisan and private-industry support for expanded mental health resources, ranging from severe conditions to stress management and resilience building. In addition, issues such as loneliness among the elderly and teenage populations will start to get traction.
- Therapies and personalized medicine continue to advance. Progress will accelerate in therapies that address some of the scariest health conditions, such as difficult types of cancer and dementia. And the application of individualized genomics, metabolomics, and proteomics will more commonly become embedded in personalized treatments available in multiple academic medical centers and in leading specialty and community hospitals.
- Businesses see healthcare through a wider lens. Large employers are going to outpace governmental approaches to health benefits and address total well-being while emphasizing primary care connections to consumers through digital, virtual, and physical means.
2023 needs list: To move from sick care to healthcare
Here are a list of needs for 2023 in the journey to move from sick care to healthcare:
- A wider perspective in benefit plans. Medicare, Medicaid, military, and commercial plans need to be looked at through the lenses of physical health; mental health; social health; financial health; and, to the extent possible, individual purpose. These categories should start to show up more clearly in descriptions of benefits in addition to doctor visits, hospital visits, drugs, ER visits, etc.
- Better communication by employers. Employers, who by and large already believe in total well-being, need to communicate the broader set of total health and well-being benefits more clearly and educate their employees on what is available.
- Cost focus by CMS. The Centers for Medicare & Medicaid Services (CMS) needs to take a step back and look at how less costly support for lifestyle and daily living (e.g., nutrition and reducing loneliness) can dramatically reduce the cost of traditional medical care.
- Combined data usage. Consumer permissions to combine non-healthcare data with healthcare data in the best interest of their health need to become commonplace when enrolling in health benefits.
Imagine a world in which the healthcare system actually works with people on improving their total health—a world where healthcare is proactive instead of reactive.
Jeff Margolis is author of Not Just in Sickness … But Also in Health: Moving Beyond Sickcare to Health Optimization for All. He is former CEO and chair of Welltok and TriZetto. He is currently a Blackstone senior advisor and serves on a number of public and private company boards of directors.