According to the Centers for Medicare & Medicaid Services, U.S. healthcare spending in 2019 reached $3.8 trillion, or $11,582 per person. Unfortunately, a report published by the Journal of the American Medical Association (JAMA) noted the healthcare industry wasted between $760 billion and $935 billion that same year. The data indicates that the system is under an incredible amount of strain. As a result, patients and providers are debating and reimagining the future of the healthcare system and health insurance through technological developments and the U.S. legal system.
To learn more, check out the infographic below, created by the George Washington University’s Healthcare Master of Business Administration program.
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What Patients and Providers Want
Patients, healthcare providers, and payers all agree: The U.S. healthcare system is inefficient. Fortunately, as advancements in tech-driven healthcare continue, the results have the potential to yield improvements in patient care in a more efficient, cost-effective manner.
Surveys indicate just 19% of Americans are “very satisfied” with the quality of American medical care. Patients also desire to see improvements in several aspects of care delivery, such as meeting whole-person health needs, how and when healthcare is received and using tech to address patient requests.
Additionally, patients want to see improvements in insurance plan selection. Among patients considered more likely to shop for a plan, 49% of those polled wanted a more affordable plan, 44% wanted better coverage even if that meant a higher price, and 11% felt dissatisfied with their insurer’s COVID-19 response.
The Healthcare Provider’s Perspective
Like patients, healthcare providers want to see improvements in healthcare. Their desired changes are different, however. Physicians and other healthcare professionals want relief from the burden of practice demands and mandates surrounding reimbursements and regulatory elements. They also want support for well-being and protection from burnout, as well as economic reform within the industry, including insurance. Additionally, they wish for resolutions to issues exposed during the coronavirus pandemic, such as a shortage of palliative care providers, fragile revenue streams, and supply chain weakness.
While patients and providers alike clamor for improvements, there are several roadblocks to meeting this demand. Some of the challenges to meeting patient and provider needs include a lack of investments, a lack of affordability, ethical and cultural issues, regulatory questions, and technical capabilities.
Healthcare and Technology
Developments in technology can have a direct impact on the health insurance industry, as they can encourage patients and healthcare practitioners alike to build healthcare strategies designed to promote wellness, provide easy access to health data and reduce doctor’s office visits. These strategies can not only allow patients to take better control of their health but also help lower costs for health insurers.
In 2020, 41% of American online adults had at least one primary care telehealth session. This percentage received a boost during the pandemic, nearly doubling since March 2020. The trend will likely continue. Forrester Analytics projects upward of 440 million telehealth sessions for 2021, with the telehealth market as a whole potentially reaching $43 billion.
Telehealth has been shown to keep costs down in numerous ways, such as improving appointment compliance, reducing overhead costs, reducing in-person liability, and improving patient retention. However, utilizing the service entails a few challenges. These hurdles include low or no reimbursement capabilities, patient tech challenges, liability concerns, lack of sufficient electronic health record (EHR) integration and integration with other technologies, and the challenges of developing telehealth-specific workflows.
Wearable Tech and Biomedical Systems
Wearable tech and biomedical systems take on many forms in order to help patients track their health. These include fitness and workout trackers, smartwatches, meditation aids, blood pressure monitors, biosensor patches, and electrocardiogram monitors. They can also include data-gathering devices for diabetic monitoring, as well as real-time heart attack detection and smart-digital stethoscope systems.
These devices and systems can help keep healthcare costs down through their predictive capabilities, such as promoting early detection of health issues and promoting value-based care through better prognosis. They also can keep costs down by integrating them into insurance plans, which could potentially lead to healthier patients and few claims.
Artificial Intelligence (AI) Applications
AI has numerous applications in healthcare, including algorithms that help identify disease, augmented reality systems, and predictive analytics that can detect early signs of patient deterioration and lead to proactive patient care and improved health insurance efficiency.
These applications can help keep costs down through increased diagnostic efficiency. They can also reduce human errors, which could reduce liability risk. Additionally, AI’s ability to accelerate scientific discovery can lead to improved medication and treatments, which can also lower costs in the long term.
Preparing for the Future of Healthcare and Health Insurance
The combination of tech innovation and legislation will continue to drive change in the healthcare industry.
Seven factors are charting this course: reimagining value-based care, preparing for constant disruption, embracing virtual healthcare, managing mergers effectively, maximizing the value of the healthcare ecosystem, instructing healthcare professionals on how to use tech to optimize patient care, and caring for an aging demographic.
This last factor is particularly crucial, as 18% of the U.S. population will be age 65 and older by 2030. What’s more, 75% of adults 50 and older want to stay in their homes and communities as they age. This is beneficial, as home care is more cost-effective and can reduce economic waste.
Examples of How the Future of Health Insurance Is Changing
One of the ways health insurance continues to evolve is through the enactment of public option insurance laws, such as the ones enacted in Washington in 2019 and Nevada in 2021. Proposed federal laws and reforms, such as the Patient Protection and Affordable Care Enhancement Act, provide another example.
The healthcare business model itself is also changing through methods such as business building in healthcare, next-generation managed care, the fragmentation of care sites, integrated patient-specific care, and care delivery institution consolidation. Finally, the integration of promising new technologies into the healthcare delivery system can influence profound changes to health insurance.
Change for the Better
Widespread dissatisfaction with the high cost of healthcare delivery is motivating stakeholders to seek out new and better ways to deliver care at a reduced cost. As technological innovation drives change in the healthcare industry, savvy healthcare professionals who understand and embrace innovation can become leaders not only in helping to make healthcare more cost-effective but also in delivering positive strides toward better patient health.