Change Healthcare and the HealthCare Executive Group (HCEG) has released the 9th Annual Industry Pulse Survey report. One-third of healthcare executives surveyed, the largest single block, believe non-healthcare market entrants could upend industry business models. Meanwhile, Social Determinants of Health (SDoH) initiatives are disrupting healthcare delivery and reimbursement, with a significant number of respondents planning to offer programs addressing care coordination, transportation, food insecurity, and other factors for members over the next 12 months.
Additional findings show nearly 40% of respondents said a market in which the majority of value-based relationships include both upside and downside shared-risk remains three to five years off – a concerning finding that might indicate payers and providers continue to struggle in their efforts to scale complex, value-based care and reimbursement models from pilot to production.
“As if insurance market changes, value-based care, consumerization, and regulatory uncertainty weren’t enough, this year the industry is facing a new breed of market entrants and innovators whose impact remains unknown but could be substantial,” said David Gallegos, SVP, Consulting Services, Change Healthcare. “Even the largest healthcare organizations don’t have the people and processes to move on all these fronts alone, yet they can’t ignore these changes.”
Other findings include:
- Consumer demand for better access, price/cost transparency, and convenience are all paving the way for external competitors that provide a highly refined consumer experience to enter and disrupt the market.
- Artificial Intelligence (AI) and advances in analytics will address lagging business models and a growing talent gap.
- Cybersecurity initiatives are a lower funding priority despite the rise in breaches, with 40% of respondents citing sophistication of attack outpacing prevention capabilities.
The overall report provides a timely perspective on more than 16 topics, including general market trends, population health, value-based care, consumer engagement, clinical and data analytics, risk sharing, SDoH, cybersecurity, and more.
“For the first time, external market disruption (#7) appears on the HCEG Top 10 list, while transformative issues like consumerism (#2), analytics (#1) and payment reform (#4) remain multiple-year priorities,” said Ferris Taylor, Executive Director of HCEG. “Is it concerning that the transition from volume to value has been on the HCEG list for ten years and still looks to be five-plus years off? If traditional stakeholders aren’t able to transform healthcare, outside parties will!”