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US Healthcare Outlook

US Healthcare Outlook
March 19, 2021

As we all know, Joe Biden recently became the 47th President of the United States. Under his presidency, many changes are expected to take place in various sectors including healthcare. After witnessing the healthcare revolution during the Obama presidency, could people expect a similar wave of change under Biden too?

The answer could lie on learnings and improved healthcare during Obama under ACA (or Obamacare) and the changes made under the Trump presidency. The first and foremost focus would be to combat the COVID-19 pandemic with better, easy, and accessible healthcare options. People saw a change in healthcare strategies during the Obama presidency. The focus was on the patients with good quality care, better decision-making tools, and consumers in charge of their healthcare. We can expect accessibility, affordability, and choice in healthcare under Biden as well.

The COVID-19 pandemic has made millions of lives and economies suffer across the world. The healthcare ecosystems and subsystems are getting stretched beyond their capacity by the torrent of infected patients. In many ways, digitalization is aiding the healthcare industry to battle against the pandemic in a better way. So people can expect more changes in digitalized healthcare. New technologies in the healthcare industry are on the way to ease patients’ welfare. This includes more access to affordable healthcare, reduced cost, healthcare at door-step, value-based care and much more.

Adoption of telehealth and telemedicine will scale-up more in the upcoming year with new advanced technologies.

Few of the major changes that we can expect are as follows:

  1. Digitalized healthcare- This pandemic has made many big players compete more fiercely but brought innovations in healthcare with the best use of the newest technologies. Under the new precedency we can expect widespread use of disruptive technologies:

    Claims processing can be improved with a blockchain platform that would process claims efficiently.

    • On-call care team using cellphones with artificial intelligence- Clinician’s mobile phones will work as a system of action, where physicians and hospitals will be treating the patients faster. This will in turn reduce dependency of in-person visits and no chance of getting infected in this pandemic. Artificial intelligence and telehealth’s newest technologies will be put to test
    • Virtual and augmented reality- These new technologies when implemented correctly will help patients with quality and easy healthcare through remote services which is a big need during and after the pandemic
    • Home-based care delivery models- Adoption of telehealth and telemedicine will scale-up more in the upcoming year with new advanced technologies. These will focus more on patients as the center of care and help them receive the safest and convenient care at their door-step.
    • Blockchain technology for improving claims processing- Claims processing can be improved with a blockchain platform that would process claims efficiently. This would reduce the amount of direct interaction between hospitals and patients.
    • The digital solution for chronic diseases – People with chronic diseases are in need of better and quality care. Digitized healthcare when integrated with other platforms, will help with more care-at-home and less in-person visits.
  2. ACA (Affordable Care act)- Trump administration tried to repeal the funding as well the regulations under ACA, mainly the individual mandate where every individual need not to have insurance through healthcare exchanges. The new President will try to keep the individual mandate. Bring on more power to enrollment through healthcare exchanges, more focus in providing funding and programs to educate people about healthcare options through ACA healthcare exchanges, and more affordable and subsidized Medicaid, in those states that have expanded it. Marketplace enrollments will also get expanded to small and big employers which did not pick a pace during the last administration due to less funding and had to shut down. The new administration will increase the funding to combat the high-priced care to provide insurance to each person and reduce the number of uninsured people.
  3. Value-based care – Trump administration was in favor of value-based care and brought up new regulations related to it. But the new president’s administration would emphasize and reassess what is done and bring on new regulations for process improvement. This includes re-evaluation of payment models for physicians, incentive programs, and creation of new models to provide better quality care directly to consumers through various platforms. CMMI (Center for Medicare and Medicaid Innovation) would be helping with innovations, guidelines, and regulations for these alternate models. Another major focus will be on building programs for dual-eligible beneficiaries.
  4. Medicaid programs- The Biden administration will want to expand eligibility for Medicaid and also expand it in those states which were held back under old administration. The focus will be to reassess current work requirements and other changes that are not aligned with the strategy and objectives for the Medicaid program. One important change that we will see is the administration’s ability to approve state Medicaid waivers.
  5. Medicare – With an increase in the aging population, every government in charge tries to keep every possible option for the elderly people. The focus is to provide more choice and better options of quality care to people in less time. An increase in funding to Medicare, lowering age limit, and many other programs will be top priorities and that people could expect under the new administration. Medicare Advantage providing more options, more coverage, and supplemental insurance to cover up and deal with chronic diseases would need focused actions under the new administration.
  6. Transparency in healthcare prices – With the need meet the healthcare demands of the consumers, the administration is trying to regulate plans, providers, and other entities to be more consumer-directed and consumer-centric. More transparency toward the cost of healthcare, more informed choice about the pricing, and quality of are some of the parameters to help consumers make better choices in affordable way. The new President will push for transparency in drugs cost and the overall pharmaceutical distribution system. New tools and more regulations to control the prices of health plans offered through insurers. More power to consumers to assess the cost related to their healthcare services to make informed decisions will be the focus of the new presidency.
  7. Drug costs – Many reforms and actions were taken under the Trump administration to control the drug cost. However, nothing has come to a fruitful end. With the pandemic still at large, the new drugs should be regulated and not over-priced. It is anticipated that new administration will re-assess all the pending proposals about pharmaceuticals, and will take actions within its executive authority, to reduce drug prices. Prices for over-the-counter drugs, specialty drugs, and generic drugs will be a focus under the new presidency.

There are many other domains where people are expecting changes. People want the new government to have more focus on accessible and quality care with the newest digital platforms. Thus, they can make better-informed decisions when it comes to accessing healthcare. People also expect better choices of plans, and better subsidies. How the expectations relate to reality remains to be observed in the upcoming months.