2024 Health Trends: 4 Experts Discuss Key Innovation Priorities

Scott Breidbart MD, Board Member, Advisor, Physician Executive

A senior physician executive in managed care, Breidbart spent a decade at Health Net. He also held Chief Medical Officer roles with Affinity Health Plan, Solera Health and Empire Blue Cross Blue Shield. He was also a Chief Clinical Officer with EmblemHealth.

What solutions can our industry develop to reduce costs in 2024? “The industry has attempted to moderate costs by shifting them (except in Medicaid) to patients. This ‘solution’ has not worked, and has resulted in poor health, increased costs for providers in collecting member cost share, adverse publicity for hospitals that attempt to collect medical debt, and anger among patients and providers alike. I think a zero-cost-share insurance solution is feasible and would be successful with careful product design, marketing and contracting.”

How will population health evolve in the new year? “Population health needs to incorporate items that were considered non-healthcare previously, such as transportation, housing, dependent care (babysitting, elder care), availability of exercise, etc. We need to have systems set up so people can avail themselves of what works for them.”

What will value-based care success look like for practices and providers? “Improved access and better patient success metrics. It will also include improved care, driven by the use of generative artificial intelligence (AI) for patient history, concerns and follow-up. And it must include an improved care experience. As practices have merged into larger groups, their customer service has worsened massively, probably due to cost-saving measures. This needs to change."

Prakash Patel, MD, Senior Advisor, Growth Curve Capital

Dr. Patel is a results-driven senior leader. His executive roles included serving as CEO of MaxHealth, COO of GuideWell Holdings, President of GuideWell Health, and EVP, President of Diversified Business Services for Anthem. 

Which industry issues are top-of-mind for you heading into the new year? “Material changes to the drug pricing and physician benefits management (PBM) industry and the ripple effect they will have for payers on their own overall business lines from P&L perspectives.” 

The other big area is in women’s reproductive rights and how that will impact providers and care access. With traditional Medicare, I expect there will be additional services covered to make it more competitive to MA plan likely after the election is over.

Increasing regulatory pressure on how and when and the true utility of PA/UM us by MA plans and likely even broader segments.”

What should be on payers’ minds in 2024? “Employers will continue to ramp up bypassing health plans to work with next generation TPAs and cost containment entities. Health plans are not differentiating themselves, and many have ‘me too’ programs. Medical cost management is critical as always but what’s too often missing is a connecting the dots on a more holistic, end-to-end approach to customer and member engagement to improve the service experience and deliver more value to members and employers.

Similarly, every payer’s Medicare Advantage plan looks the same. Too often their care and cost management approaches include onerous steps for members to get access to providers, obtain the service a provider wants to deliver and then the providers struggle getting paid.”

What’s the outlook for value-based care? “Increasingly, products and services that manage whole-person care will begin to show real outcomes, especially those that integrate lifestyle, physical and mental health around chronic conditions. We need to address complex polychronic condition management and recognize that there are limitations to only PCP led VB approaches. There will be increasing appreciation that high cost chronic care specialists need to be brought under value-based partnerships with PCPs, and even recognize the need for specialty management entities to partner with other specialty VB providers to address complex, high cost, chronic conditions to optimize outcomes. This could include integrated care models between nephrology and cardiology VB entities, or pulmonary and autoimmune provider partnerships.

No one provider entity can sufficiently, at scale, manage all of the outcome and cost risk. Payers and value-based primary care and specialty entities need to accelerate payment models to drive this VB 3.0.

Additionally, we will begin to see some generative AI-driven models begin to become embedded within value-based care deals but not to the extent of the hype surrounding all things Chat GPT today.”

Sally Welborn, Advisor, Welborn Advisory Services   

Welborn also serves as the Executive Director of Advisory Services for EHIR. She’s a board member at Vivante Health, Truveris and The Leapfrog Group and serves on the Advisory Board of Health Velocity Capital. She previously served as Senior Vice President of Global Benefits for Wal-Mart Stores, Inc., and Senior Vice President for Wells Fargo & Company.

Which critical issues does healthcare still need to solve as 2024 dawns? “We still haven’t gotten far enough in improving the quality of care and eliminating inappropriate care. We are still seeing—and paying for—‘never events’ and other safety issues occurring in hospitals and still seeing patients receive care that doesn’t follow evidence-based guidelines. The consolidation of providers and health systems is causing perverse incentives and more opacity for patients and payers.

Also, employers need to continue to demand that their carriers and PBM’s focus on and deliver solutions capable of impacting cost and quality. There needs to be a stronger will to make the difficult changes necessary in these areas.

Which innovations have the best potential for improving care quality in 2024? Any innovation that focuses on improving providers’ standard operating procedures. Too much of medicine gets delivered by physicians the same way it did the year before. And we know that a lot of that is unnecessary and not following evidence-based practices.

But change is hard. So, any innovation that can make it easier for a clinician to do the right thing for a patient could have a dramatic impact on care quality. AI and systems with defaults can enhance decision making.

What’s the biggest opportunity in the PBM space? A laser focus on the implications of specialty drugs, especially very expensive ones. Employers will have to make hard decisions on what will and won’t be covered and which medical management or authorization processes they’ll implement. It will just become too expensive to allow any drug to be covered just because a provider writes a script for it.