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With more than 10,000 people in attendance, HLTH 2022 was inspiring and covered a wide range of subjects from health equity to the future of the digital health investment environment. Some of the sessions are laser-focused on current developments, but many have forward-looking themes that will be useful to pay attention to as 2023 comes into view.
Mental Health Conditions
Speakers from Optum, Talkspace, and Morgan Stanley come together to provide an overview of today’s market from the perspective of payers, employers, and providers. Significant workforce/network adequacy challenges faced by mental health platforms are noted, but also possible solutions include the Centers for Medicare & Medicaid Services (CMS) coordinated care model and the use of trainers to supplement licensed clinics. Key among the identified challenges is the need to establish a set of benchmarks to measure outcomes to align payments with providers. The current variety of Healthcare Effectiveness Data and Information Sets (HEDIS), CMS star ratings, and private standards prevent a more uniform rollout of broader employer plans and commercial plans.
The Power of Data
Sarah London, CEO of Centene, gave a compelling overview of how, as a managed care organization for the state Medicaid program, Centene has begun to identify the best-targeted solutions for a given population. Centene data is generally focused on the social determinants of health (eg, food security, transportation) that are fundamental to delivering superior clinical outcomes with a low-cost data collection approach. For example, paying for transportation to allow a patient to see their clinician, or buying prescribed pharmaceuticals for patients to assure access given financial constraints. With this approach, Centene is building a strong database of high-level, community-based resources to augment traditional clinical services as a way to drive more value-based care for the Medicaid population.
Value-Based Care (VBC): Success or Failure?
Representatives from Oak Street, Homeward, Eleanor, and Mayo Clinic discussed how far VBC has come but also how far it has to go to achieve its promise. All know how to take risks when targeted populations (eg, rural primary, complex behavioral health, urban Medicaid, primary care) are identified and creative solutions are developed (eg, mobile clinics). But the scalability of VBC to a wider population with diverse clinical needs remains more challenging. The need to address VBC around the edges as opposed to a single universal solution or program emerged as a theme to 2023.
Digital Health: Boom or Doom?
Are digital health firms ready to tighten the belt from their investors? Will there be consolidation in the sector? When do the investment gates and initial public offerings open again: ’23, ’24? These are some of the issues discussed by speakers from OMERS, Morgan Stanley, Zus, and Redesign Health.
The panel generally agreed that the ’20/’21 gold rush ended abruptly this year and that a major recession and a full recovery in valuations and investment momentum are unlikely to return until ’24. Inevitably, consolidation will happen with me-too companies merging, fueled by very active and large tech and retail players in certain sectors (eg, One Medical / Amazon, Walgreens / Summit in primary care).
Investors will choose a focused strategy that demonstrates the benefits of top-line revenue growth. The panel suggested corrections, although painful, could actually help the sector as a whole by allowing the dominant model to rise to the top and penetrate at scale with systems, plans, and entrepreneurs. Business-to-business platforms like Zus?a utility/tool platform for digital health operators?provide an example of a new niche that could open up opportunities for others.
Substance Use Disorder (SUD) Recovery: The VBC Model That Works
Cooper Zelnick, Chief Revenue Officer at Groups Recover Together (“The Group”), a national hybrid in-person/virtual SUD recovery operator, discusses how his firm has harnessed elusive outcome data requested by payers, demonstrating their treatment protocols improve outcomes (a key metric for SUD patients) for members remaining in treatment after 6 months. The population has a high chance of long-term recovery compared to those who do not complete the term, thereby reducing the total cost of treatment.
This allows the Group to engage in risk-based contracts using three tools:
- Free cell phones are sent to all patients to improve access.
- Use of tablets for virtual visits to maintain engagement.
- The use of 360-degree video capabilities in online discussions to create a group therapy environment.
The Group’s compliance data triples that of the industry as a whole, providing them with powerful data for planners and employers. The new and innovative strategies discussed at HLTH 2022 ensure that health care delivery continues to evolve, and face new challenges and exciting opportunities beyond the horizon of public health emergencies.
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