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Commentary

Continued Agility and Expansion Will Look to Define Health Care in 2021


December 17, 2020

Eric ZernekeBy Eric Zerneke, CCO, andros

If there was one defining trend in health care in 2020 it was crisis management. Facing urgent needs of pandemic response required an increased focus on flexibility, communication, and agility across the health care spectrum. As we look forward to 2021, while there may be signs of an end in sight to the instability of an unpredictable year, the lessons learned will carry us forward and may lead to a more digital first, and consumer first, dynamic health care space.

During this past year, a number of challenges arose directly as a result of the pandemic. A rise in health care needs exposed weaknesses of administrative processes that were already struggling to keep up while simultaneously stretching healthcare systems and hospitals to their breaking points.

The shift to remote working environments revealed a level of digital unpreparedness organizations didn’t predict; and on a societal level, an explosion in unemployment resulted in millions of uninsured or underinsured, with additional ramifications in food and shelter insecurity and a rising mental health crisis. This crisis was set on the backdrop of a divided nation and a national election, with the uncertainty of national elections and court cases that could deeply impact key decisions industrywide.

In short, health care faced a number of immediate challenges in 2020 that needed to be met with resourcefulness and agility; and the lessons learned in this tumultuous year may signal a way forward as the industry expands and adapts to service as many citizens as possible and digitizes to serve plans, providers, and customers alike with clarity and efficiency.

A Digital Revolution in 2020

Of the many faults the pandemic exposed, there was perhaps none more prevalent than the insufficiencies and inefficiencies of legacy systems health care organizations rely on to keep provider networks running smoothly. As the pandemic made in-office workforces remote, previous processes that required manual forms and files became unmanageable. To accommodate these needs, it became clear that health care organizations must adapt and adopt current technologies to accelerate the digital revolution that has been sputtering for years.

As we move forward into 2021, the drive to digitize and increase the reliance on cloud-based systems across all aspects of the health care space will be crucial or health care organizations risk being left in the dust. Particularly in provider network management, taking a digital-first approach to provider provisioning, contracting, and credentialing will need to mark the way forward.

These new processes in automated credentialing can take pressure off of providers by reducing application times and streamline processes on the health care organization side by reducing errors associated with manual filing. The industry average for credentialing is between 60 and 90 days, which may as well be a lifetime on a health care system struggling to keep up with patient demand. Low standardization and disparate data systems coupled with antiquated manual processes are going to need to be replaced with AI-enabled, digital-first strategies in order to meet the needs of the market as well as the new reality of a remote workforce.

But the digital revolution isn’t just limited to health care organizations and providers. As our health care system adopts a more digital and consumer-centric model, it will be increasingly valuable to expand services to customers that can make health records more readily available, and plan options that can be easily customized and purchased in the marketplace.

Adapting to a Changing Paradigm

While COVID-19 was the defining force behind health care decision making in 2020, other outside factors including the presidential election, Supreme Court decisions, and local ballot measures cast an additional layer of uncertainty as health care organizations planned for the future.

The rise in unemployment has left millions uninsured; additionally, Proposition 22 in California—which states that rideshare companies aren’t required to provide health care benefits to drivers—has created an even larger base of uninsured citizens. The ramifications of this decision may be felt in the coming years as further ballot measures take the onus off of gig economy companies to provide insurance for employees. Health care organizations have begun providing new, affordable plan options to help serve this new market, and commercial coverage loss has been further offset by increased enrollment in these safety net plans.

With the election of Joe Biden, a candidate that has expressed a desire to expand government-run health care programs, coupled with an increasingly aging population and an unemployment and underemployment crisis, we may see a drive towards the further expansion of Medicare, Medicare Advantage, Medicaid and Medicaid expansion programs in 2021 and beyond. The effort to insure as many citizens as possible, and further migrating the uninsured to government-run programs, may be the healthcare industry’s driving force in the coming years.

Providing citizens with health care coverage is a broader concern, but to narrow the focus slightly, the types of services health care organizations offer will continue to shift in 2021. With the pandemic’s effects shaping the necessity—or lack thereof—for in-person interactions, the need to expand telehealth networks will be a top priority. Telehealth adoption was already on the rise, and as the health care industry takes a more digital and consumer-centric approach, these services will continue to be a growth sector.

In addition to telehealth, the pandemic helped place a greater emphasis on the need for expanded mental and behavioral health services. And, with increased economic precarity, there may also be a rise in partnerships between health care organizations and other entities, specifically in the non-profit sector, to provide everything from increased food assistance programs to addressing housing and other environmental concerns.

Moving Forward Stronger Than Before

With all of the challenges laid out on the table, it becomes clearly how woefully inadequate our current health care system will be going forward without mass adoption of the latest technologies in administration, provider network development, and patient services. If the industry is agile enough to meet the moment, we can see a revolution in health care that bends the cost curve, insures as many citizens as possible, and drives happier relationships between payers, providers, consumers, employers, and beyond. The inflection point we witnessed in 2020 will merely serve as a prelude to the radical change that will carry us through the coming years.

About Eric Zerneke

Eric Zerneke is the chief commercial officer of andros. In his role, Me Zerneke drives commercial strategy, including spearheading all sales, business development, and marketing. With more than 25 years of health care and technology experience, Mr Zerneke has brought various services and new market strategies from concept to reality and has been a catalyst in helping transform organizations. Prior to joining andros, he served as chief commercial officer for HealthFortis Associates, where he was responsible for driving the company’s strategic vision and overall business growth. Before that, he was executive director and director at athenahealth.

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