Top health industry issues of 2021: Will a shocked system emerge stronger?

Healthcare organizations and their front-line clinical workforce have absorbed the brunt of the pandemic and the emotional toll of witnessing the deaths of hundreds of thousands who could not have loved ones present. Physicians are now dealing with sicker patients because of delayed care during the pandemic.

The healthcare system in 2021 also faces a tremendous challenge in responding to the nation’s mental health crisis, as 32% of US consumers surveyed by HRI said they had experienced anxiety or depression as a result of the pandemic.

In this year’s Top health industry issues report, PwC’s Health Research Institute (HRI) examines how the healthcare industry is expected to face the uncertainty of 2021, building resilience for long-term survival by developing its own forecasting systems, reshaping business portfolios post-pandemic for financial stability and growth and creating a more nimble, modern supply chain.

As we have seen, organizations need resilient infrastructures and supply chains to absorb future shocks. They need detection systems to spot financial trouble ahead and identify the right partners or deals. Healthcare organizations can use the lessons of 2020 to prepare themselves for the year ahead, and consider new business models.

Virtual health reshapes healthcare delivery

For millions of Americans and their healthcare providers, the pandemic was an introduction to telehealth, often with uneven results. Caregivers, with varying levels of telehealth experience—tried suddenly to meet patients where they were. Many virtual visits happened on nontraditional health platforms such as mobile phones, through texts and messaging apps. In the year ahead, the industry will work to determine which virtual visits make the most sense, and where and how they should take place.

Payers may wrestle with how to reimburse and, in some cases, provide virtual care. Pharmaceutical and life sciences companies may have to determine where they can and should plug in, literally. Providers may continue to improve the patient experience and be careful not to create new disparities in the health system through lack of technology access.

Key insights:

What works well (and not so well) for virtual care

Specialties, such as mental health, that may find a stronger footing via virtual visits

Health leaders should pay equal attention to revenue and customer experience

With 95% of large US employers covering telehealth, up from 56% in 2016, business leaders will have a say in how virtual care is used and how it should be woven into the healthcare system.

Clinical trials are changing—for good

In the face of a pandemic that forced nearly everyone, from patients to clinical trial coordinators, to stay home, at least temporarily, pharmaceutical and life sciences companies have been asking: How much can be done remotely? Quite a bit, it turns out.

Forced to minimize in-person clinical trial visits, these companies are now trying to find ways to conduct trials with few in-person interactions. The COVID-19 crisis has increased the appetite for change across the industry as sponsors, contract research organizations (CROs) and patients see benefits in a more decentralized model.

Payers and providers, awash in data about members and the populations they serve, including social determinants of health metrics, may be able to help pharmaceutical and life sciences companies develop trial protocols that serve more diverse populations. These trials could decrease the burden on trial participants, for instance, reducing the number of trips they have to make to a hospital or physician’s office, and make participation more attractive. For trial investigators, likewise, a decentralized approach, with more virtual elements, could make participation more attractive, too.

Key insights:

How the regulatory environment is shifting

Embracing virtual tools to transform clinical trials

Almost all pharmaceutical and life sciences executives (98%) surveyed said they expect digital investment in clinical trials to increase next year.

Digital relationships can help improve the clinician experience

Well before the pandemic, many physicians were already facing heavy workloads, with too many administrative tasks and wanting more from digital technology, specifically electronic health records systems (EHRs). They still tussle with endless drop-down menus, alerts and regulatory reporting requirements that sap their efficiency and ability to provide a good experience for patients. That may be changing in 2021. Digital technology, if made right, could be the antidote to countless pain points that physicians encounter every day, leading to more efficient and satisfied doctors, happier patients and more patient referrals.

In 2021, HRI expects more investment by payers in process automation, such as provider contracting. Look for enhanced portals through which providers can see what is happening to different claims, or straight-through processing, which aims to automate handoffs between different systems.

Health systems are expected to make the shift in automation from the back office of finance and human resources to the doctor’s office in 2021. Providers likely will begin to understand and then predict physicians’ behaviors and what influences their referral patterns. They are expected to invest in marketing technologies that can recommend targeted outreach strategies for use by physician liaisons, who can deploy them to strengthen relationships with doctors and create demand. They will likely work to integrate these tools with scheduling and patient outreach platforms so that they can intervene and proactively adjust patient scheduling, avoid cancellations and keep physicians happy.

Key insights:

Healthcare organizations can achieve efficiency with better digital relationships

Applying the right digital tools for clinicians can be an opportunity for growth

Nearly all respondents to HRI’s survey—94% of provider executives, 92% of life sciences executives and 91% of health plan executives—said improving the clinician experience is a priority for their organizations as they enter 2021.

Healthcare forecasting for an uncertain 2021

A health industry that found itself fighting in the dark during the opening waves of the pandemic will need a forecasting system that provides a lens for the uncertainty ahead. Better sightlines can help health companies prepare for shifts in the insurance market, the economy, utilization, consumer behavior and future waves of infectious disease.

This capability to forecast the future could be as important to healthcare survival in 2021 as a mask may be for slowing the spread. No longer can healthcare organizations review the past 30 days of claims or historical behavioral trends to determine next steps. They need real-time insights to create the healthcare industry’s own forecasting system to alert healthcare leaders to the shifting fronts that may have a major impact on their business.

As the pandemic experience varies at different times across different regions of the country, local partnerships between health providers, payers, community groups and government agencies can help power a more informed response.

Key insights:

Dynamic strategic planning, advanced analytics and modeling

The regional forecast requires community leadership

Population-wide simulations can enable healthcare leaders to consider how interventions can maximize the impacts of their investments

74% of health executives responding to the HRI survey said their organizations would invest more in predictive modeling in 2021.

Health portfolios reshaped for growth

The COVID-19 pandemic placed some companies in a position to invest and evolve, and others needing to partner to survive. The shock of the pandemic has highlighted the need for many health organizations to diversify their capabilities and revenue streams to be more resilient, readying for impactful court decisions, increased focus on pricing and price transparency and the unknown. Some companies, as they better understand the impact of COVID-19 on their business, are expected to return to driving their pre-pandemic growth agendas. In 2021, HRI expects to see increased investment in and by healthcare companies to shore up gaps exposed by the pandemic and position them for growth.

Key insights:

Deferred care leaves health plans flush with capital

Some providers may struggle to survive while others can invest and evolve

Pharmaceutical sector sees flash of investment in vaccines with sustained interest in pre-pandemic growth areas

Nearly 50% of payer executives surveyed by HRI said their organization is investing in digital product support and educational tools such as mobile apps to improve the member experience.

A resilient and responsive supply chain built for long-term health

From managing the cost and tax implications of onshoring manufacturing to developing a network approach to redundancy, HRI expects the health industry in 2021 to start to reconstruct the supply chain to function more flexibly—as it does in the automotive and technology industries, for example. Where possible, the health system is expected to begin to triangulate supply chain risks, knowing as much as possible about their suppliers’ suppliers and establishing new collaborations to secure the supply chain through diverse geographies and sourcing materials. These actions will likely mean near-term incremental investments into supply chain capabilities, resulting in marginally higher direct costs. However, they could lay the groundwork for a more flexible and responsive supply chain that could rapidly scale up or down to meet customer needs.

Key insights:

The rippling costs of supply chain disruptions

Take a cue from tech or automakers—apply a dual sourcing strategy to add redundancy without disrupting established networks

94% of life sciences executives and 86% of provider executives said that improving their supply chain overall was a priority in 2021. Specifically, improving supply chain transparency was their top priority.

Spotlight - Interoperability 2021: A key to emerging stronger

New federal rules requiring providers and payers to free patient data from behind their own organizational walls for patient apps and broader data sharing could lay a foundation to power forward a more consumer-centric healthcare system after the pandemic. But only about a quarter (24%) of providers and health plan executives surveyed by HRI say their organizations view the new federal rules on interoperability as a strategic opportunity. Most view new federal data-sharing requirements from a compliance angle.

But HRI research suggests that a compliance-focused approach could leave traditional healthcare organizations behind as the push toward interoperability attracts disrupters. As the rules force organizations to liberate patient health information, some organizations will emerge as the winners, by earning consumer trust, synthesizing the data and providing innovative products and services. For 2021, healthcare organizations need strategies to make sure they are not excluded.

In this new environment, providers, insurers and new entrants should think about how they want to play. Beyond achieving compliance, organizations may find ways to tap into operational efficiencies, and new sources of internal value, by building out their interoperability program. A comprehensive strategy that considers how the rules can lead to a more effective healthcare system that puts the consumer in the center would put the organization on offense in this new data-sharing environment.

Only about 44% of provider and payer executives surveyed by HRI said their organizations are heading into 2021 having identified a leader to guide their interoperability efforts within the organization.