“We are living through a historical shift in the way we practice and how we deliver care to patients. Our health care landscape is constantly changing right now, and we expect it will be radically different for both physicians and our patients long after the pandemic passes.”
- Gary Price, MD, President, The Physicians Foundation
COVID-19 created a seismic shift in healthcare, leading to the rapid adoption of telehealth and changes in federal regulations. These changes—among other factors—will impact the way HCPs practice medicine in 2021 and beyond. Some of these factors are a direct result of the pandemic while others aren’t. All will impact patient care though.
We’ll explore 5 key healthcare trends for 2021 that will impact HCPs—covering changes in communication, compensation, decision-making, and patient populations.
The key to success in 2021 will be meeting your customers where they are and understanding what adjustments they’ll be making. This will, in turn, inform what implications these will have on your commercial strategy and any modifications you need to make.
#1: Rapid Adoption of Telehealth and Growing CMS Coverage
Telehealth is in demand more than ever, accelerated by the pandemic. Many patients could not or would not visit their doctor out of fear of COVID-19. Technology is making remote care possible—from video conferencing to wearables, apps, and devices that empower patients to manage their own health without stepping into a clinician’s office. The Cardea SOLO ECG, for example, is a cardiac monitoring system that includes wearable tech, automated ECG data analysis, and reporting software. It allows patients at risk of Atrial Fibrillation to be monitored remotely from the safety and comfort of their home.
To make it easier for HCPs to meet this soaring demand for telehealth, the U.S. Health and Human Services relaxed certain regulations. HIPAA-covered HCPs can now provide telehealth to patients using remote technology even if it isn’t fully HIPAA-compliant. And under a telehealth waiver, the Centers for Medicare and Medicaid Services (CMS) now permit beneficiaries to receive telehealth services wherever they are. CMS also expanded its list of covered telehealth services and who can provide them.
Telehealth is likely here to stay. In one survey conducted in April last year, practitioners reported only 9% of their patient interaction took place via telehealth. But during the pandemic period, that number jumped to 51% and was expected to stay at 21% post-pandemic.
Business Strategy Implications:
As the pandemic continues to spread, you’ll likely have to re-evaluate your commercial strategy. For starters, think about how you can virtually connect with key stakeholders and can create conditions for success. The increased comfort among patients, providers, and payers in using telehealth and remote care should be reflected prominently in product design and pipelines. This trend could create momentum for more seamless monitoring, communication, data analysis, and provider interfaces.
Clinical trials may need significantly different approaches to patient recruitment and follow-up. There are now more opportunities for conducting virtual or decentralized trials, site-less clinical trials, and use of other non-traditional approaches that do not involve in-person visits.
It may be helpful to consider how your product will be discussed or how its use will be monitored with a patient during a virtual health visit. Can you explore opportunities at the point of care? OptimizeRX, for example, allows life sciences companies to distribute information to providers through its EHR platform.
What virtual solutions can you use to replace in-person meetings? Your customers may not be as available to meet in person even in the near future. Companies should consider how to prioritize and scale new digital capabilities to enable digital touchpoints with their customers (such as online customer service representatives and professional education). Some companies should consider other digital capabilities (i.e. shifting investment to digital media or digital detailing) to further strengthen go-to-market models.
#2: CMS’s Evaluation and Management Code Changes
On January 1 of this year, CMS released the 2021 Medicare Physician Fee Schedule. Beyond making some telehealth expansions permanent, the final rule also includes changes to evaluation and management (E/M) codes.
Specifically, the “Patients Over Paperwork” initiative simplifies billing and coding for office-based E/M services—and includes higher relative values for those services.
For years, providers have grappled with the amount of data entry that was required for E/M visits. As such, the initiative aims to decrease administrative burden, audits, and unnecessary EMR documentation while increasing payment accuracy. Key parts of the final rule—effective January 1, 2021—include:
- Physicians can choose an E/M code based on the total time spent on the date of the encounter or medical decision making.
- If the E/M code selection is based on time, that time will be based on the total time spent on the visit instead of just face-to-face time.
- History and exam will no longer be factored into E/M code level selection. (They only have to be medically appropriate.)
Business Strategy Implications:
Knowing about these E/M updates and their implications for your customers is key to better understand them. To prepare for the transition, your customers have likely been educating themselves on the changes, creating and updating relevant policies and procedures, and making sure the EMR can support the changes.
The revised coding structure allows doctors to bill for the time used for chart review, coordination of care, and follow up associated with patient care—something that was not the case in the past. Physicians may end up spending more time on these activities—gathering more details about a patient pre- or post-visit and improving collaboration among specialists, as examples. The impacts of these coding changes will likely be greatest for specialists working with complex patients. The outcome could be better coordinated and improved patient care.
#3: The Pandemic’s Impact on Physician Compensation Models
Medical practice revenues nationwide fell 32% on average during the pandemic. What’s more, about 58,000 primary care practices were projected to close by the end of June last year while others have laid off or furloughed staff.
Some practices have been able to weather the pandemic. But they plan to adjust their compensation models for 2021 and beyond due to revenue shortfalls from nearly a year of minimal elective procedures and the loss of in-person appointments.
COVID-19 has exposed the limitations of fee-for-service care, resulting in a surge of interest from providers, insurers, and government agencies in pivoting to value-based care. The drop in fee-for-service patient visits due to COVID-19 has decimated physician and hospital revenue. By contrast, value-based care has been less affected, since patient health outcomes—not the number of visits or treatments—determine reimbursements.
Some practices will accelerate the adoption of value-based care. But doing so won’t be easy, especially for providers who are struggling financially.
Others will refocus on a volume-based compensation model (tied to RVUs), requiring physicians to see more patients and do more procedures to achieve a compensation target (to make up for lost revenue during the pandemic). In some ways, this directly contradicts the massive pre-pandemic movement towards value-based care.
Business Strategy Implications:
2021 will be a year for revenue recovery. Each practice and healthcare system will try to accomplish this differently.
Volume vs. value always has implications for patient care. Depending on a practice’s focus, it directly impacts time spent with the patient and potentially results in over or under prescribing certain procedures, among other outcomes. Whether an organization is doubling down on value-based care or revisiting volume targets could mean longer-term shifts in the volume of scripts written and procedures ordered that are tied to your products. Understanding how these revenue recovery efforts may impact your customers’ behaviors and mind share may be the key to more appropriate sales estimates and messaging.
These shifts may also require extra work from physicians when they are already exhausted. Understanding that HCPs are burned out is the first step to creating more empathetic marketing and engagements—such as offering mobile-friendly material that they can review on their own time. Or providing educational, evidence-backed content (such as case studies) that delivers real value. Another idea: To save your customers some time, think through how they might explain your messaging to their patients.
#4: Rapid Growth of Artificial Intelligence in Medicine
On New Year’s eve last year, AI company BlueDot detected a cluster of pneumonia cases in Wuhan, China. BlueDot uses AI to track, locate, and report on infectious diseases spread. BlueDot alerted a variety of clients, including those in healthcare, government, business, and public health. It had discovered COVID-19—nine days before the WHO alerted the public. This is just one example of the power of AI in action.
AI continues to flourish as a powerful tool to improve cost, quality, and access. Accenture reports that growth in the U.S. AI health market is expected to reach $6.6 billion in 2021. And in just five years, the health AI market is predicted to multiply ten-fold.
A 2019 study of global AI healthcare markets estimated a 41.7% compound annual growth rate (from $1.3 billion in 2018 to $13 billion in 2025) in six high-growth areas: hospital workflow, wearables, medical imaging and diagnosis, therapy planning, virtual assistants and drug discovery.
Business Strategy Implications:
If you have an AI solution, this is an exciting time for your company. As you likely know, the FDA is working to determine the right level of oversight for a variety of AI products. The pandemic has increasingly placed healthcare AI and the need for clarity around FDA regulation in the spotlight. If you don’t have an AI solution, you still have a tremendous opportunity to think through how your product offering could benefit from leveraging AI.
To start, define a vision and strategy for how you can take advantage of AI and what you expect to get by investing in it. Think about where, when, and how you can embed AI into your business operations and strategies. For instance, are there ways you can use AI to enhance your existing products, create new products and services, or make processes more efficient?
Next, think about what you need to do to make your AI vision a reality. For example, what technology capabilities, data, and systems do you need? Do you have the right talent? What can you do in terms of risk management, auditing and testing so that your AI systems meet compliance and regulatory requirements? Think about how you can also scale AI use at your organization.
Also, consider how you can work hand-in-hand with the AI solutions your customers may be implementing. Some practices may be leveraging AI in a way that helps them determine when your product is offered or appropriate for use. It would be helpful to understand if your customers are employing these tools.
#5: Evolving Patient Populations
With COVID-19 cases surging across the nation, many elective procedures are on hold. An alarming number of hospitals are facing bed or staff shortages. Even when facilities can still handle non-urgent procedures, patients may be reluctant to come in.
Some people may continue to prefer virtual visits. This may play out in the form of a different mix of ethnicities and ages, chronic conditions, and/or insurance coverage coming into practices, participating in virtual visits, or being lost to care. Evolving patient populations and those who visit in person vs. those who desire virtual visits will have an impact on a practice’s revenue this year.
Business Strategy Implications:
For life sciences organizations, it’s important to understand the patient types your customers see. Diversity in their patient population can influence the type of products they are most interested in or have access to. Understanding your customer’s patient population mix can also help you:
- Define more appropriate sales targets and performance metrics
- Deliver messaging, content, and campaigns that truly resonate
- Guide product development for synergistic products or services
- Prioritize the projects or initiatives that matter most
- Engage your customer in more thoughtful, insightful conversations
These trends above provide actionable intelligence to help you be a better partner during these challenging times. And that, in turn, can lead to a healthier bottom line for you.
Want guaranteed commercial success in 2021?
Grey Matter Marketing is a full-service, award-winning PR and marketing agency working exclusively with healthcare companies. With a knack for market adoption strategy and content marketing that engages and drives action, we can help you reach your customers in way that resonates as they navigate through 2021. Because what you do (or don’t do) matters. For more information, contact us.