Suffice it to say, 2021 was quite turbulent. The healthcare industry was put to the test in many ways, but it has also continued to rapidly adjust and evolve—from the overwhelming strain on hospital systems and frontline workers, to skyrocketing digital health investments, to the implementation of new federal policies and mandates, and more.
It’s clear the healthcare sector’s rapid pace of change won’t be slowing down any time soon. Here are four healthcare trend predictions to monitor in 2022.
1. Virtual Primary Care Will Be Put to the Test
Now more than ever, the concept of virtual primary care (VPC) is positioned by employers and health plans as an opportunity to transform downstream healthcare delivery. Many organizations are hoping to take advantage of the pandemic-induced telehealth momentum to create a wide-reaching and long-lasting VPC model. While 2021 was the year of building and/or selling VPC, 2022 will be the year of seeing how it works at scale.
Scaling VPC will be far from easy, however. It will require much more than recreating our current analog processes (many of which are broken) in a digital format. The models that succeed are those that will:
- acknowledge that the average healthcare consumer will still need in-person care
- be able to seamlessly “stay with” the patient as they move between in-person and virtual
- develop ways to remain provider agnostic, steering to high-value care based on cost and quality rather than contractual obligations, partnerships, and acquisitions
- coordinate and collaborate with local primary and specialty provider organizations that have already built trust and relationships
- Avoid unnecessarily increasing utilization, duplication, and cost
- Align their incentives to move from fee-for-service virtual care to evolving forms of value-based care
- engage with the patient year-round, not just for an annual check-up.
Provider quality, patient experience, and provider recruitment and retention will also be critically important, as will increasing awareness among consumers, including educating them on what exactly VPC is and how to best engage. It’s key for consumers to understand that virtual care can and should be used for more than urgent needs. We will likely see consumer education on VPC start in 2022, but it will ultimately take longer to be fully realized.
2. The Impacts of Transparency in Coverage and the No Surprises Act Will Start to Unfold
Last year included much discussion about the new price transparency regulations—Transparency in Coverage (TiC) and the No Surprises Act (NSA)—from what they are, to who they impact, to how to prepare, and more. These conversations will continue, as some of the regulations require further definition and don’t go into effect until 2023 or 2024.
Though it will take years to realize the full impact these rules will have on medical spend, we’ll finally start to see how some of these regulations will play out, as the NSA and part one of the new TiC rules—posting machine-readable files outlining in-network rates, out-of-network allowed amounts, and prescription drug pricing—officially went into effect on January 1, 2022. More specifically, we’ll begin to see how enforcement of these regulations will unfold. Employers and insurers seem to be on the right path to addressing machine-readable file requirements in 2022, but establishing a compliant, member-facing transparency experience for 2023 seems less certain for many.
We’ll also see some of the direct impact of the NSA on patients—hopefully, less and less will face surprise bills. However, we’ve already seen conflict between the providers and payers when it comes to arbitrating and absorbing the extra costs, as they’re supposed to. Because of this, it’s imperative for consumers to know about the NSA and what it means for them and their family members so they can ensure they’re not paying bills they never should have received.
In 2022, we’ll start to learn more about the impact and enforcement experienced by providers, insurance carriers, employers, and the individual, but we won’t understand the global benefit until 2023 and beyond.
3. Don’t Blink: Digital Health Is Changing and Innovating Faster Than Ever Before
In the first three quarters of 2021, digital health companies raised a total of $21.3 billion—more than the entirety of 2020. Some notable digital health fundraising wins in 2021 were: $600 million for Hinge Health, $190 million for Spring Health, $189 million for Sword Health, and $133 million for Virta. (We’re proud to say all four of these organizations are Castlight Ecosystem partners!) With more capital comes more expectations, so all companies that raised funds in 2021 will be under pressure to start delivering on their valuations.
In addition, we saw many mergers and acquisitions in the market—Labcorp acquiring Ovia Health, Headspace merging with Ginger, Amwell purchasing both SilverCloud Health and Conversa Health, and so forth (like our recent news with Vera Whole Health!). We see all the ingredients and signs that this consolidation trend will continue in 2022 given greater growth expectations and an increasingly competitive landscape. In this environment, inaction is a major risk.
In the next twelve months, we’ll really start to see the impact of these bets—large investments, mergers, and acquisitions—and if they’ll lead to success, which will hinge on whether or not these companies are able to naturally conform to consumers’ lifestyles and preferences, earn trust, promote compliance, and deliver clinical outcomes and cost savings. And in this heavily saturated market, brand recognition will be critically important, as it will indicate scalability and allow companies to both activate users and keep them engaged in the long term.
As the old adage says, fortune favors the bold. We believe the best digital health companies in this brave new world will be those that continue to evolve by finding the best way to scale, add new capabilities, manage the total cost of care, and meet the demands of their target population.
4. Workforce Changes Will Affect How Consumers Experience and Engage with Healthcare
The pandemic has forever changed what our workforce looks like. Employees are voluntarily leaving their jobs, workforces are becoming more decentralized as remote work continues, and individuals may settle into new employment models that leave them uninsured, underinsured, or wanting benefits and their health plan to better fit their new personal lifestyle.
For these reasons and more, there will be a shift in how the average individual and family experiences healthcare in the U.S., and this will bring challenges, such as finding the right (cost and quality) care that aligns with new employment, geography, and coverage.
But this shift will also bring opportunity—group and individual plans that start competing more on innovative benefits, new plan designs that rationalize virtual and in-person care, and the motivation to establish local and accountable care models that navigate individuals to the right care. We can likely expect plans on the ACA exchange to continue innovating and differentiating their offerings to attract and retain new members.
Healthcare delivery and health insurance coverage won’t substantially change in 2022, but expect to see both start to build and innovate around the new way many people work and live.