The key determinants of healthcare for 2022 are rooted in our experiences from 2021.

By Jane Sarasohn-Kahn, MA, MHSA

For my final Medecision blog post this year, I am looking back at healthcare in 2021 with the objective of identifying insights that will help the healthcare industry weather the uncertainties we continue to face and empower us to prepare robust strategies for 2022.

The Pandemic Persists

Of course, the big healthcare story as we entered 2021 continued to be COVID-19.

In  May 2021, about 14 months after the World Health Organization (WHO) called the coronavirus outbreak a pandemic, WHO assigned a new nomenclature for COVID-19 variants using Greek letters.

By this time, the new “variant of concern” was Delta.

Six months later a new letter—Omicron—was added to our COVID-19 lexicon, leaving health citizens around the world to face a second winter holiday season with questions about family celebrations, travel plans and return-to-work prospects that could involve vaccination and testing mandates.

U.S. Consumers “Shrug Off Omicron”

But Americans’ response to Omicron was decidedly different from their response to Delta. In early December 2021, Americans were “shrugging off” Omicron, according to an Axios-Ipsos poll. Although two-thirds of U.S. consumers said they were always wearing masks indoors, only one-third stopped dining indoors at restaurants.

Only one-fifth had cancelled holiday travel plans, indicating that most Americans were not willing to make major behavior changes to minimize their risk to the Omicron variant.

The Axios-Ipsos poll shows just “how much behavior is already baked in” nearly two years into the pandemic. “New facts don’t seem to be changing people,” Ipsos senior vice president Chris Jackson said. “They’ve already decided what they’re going to do, and they’re doing it,” namely getting on with the lives and lifestyles they want to live out.

Medical Costs and Debt Continue to Rise

Our healthcare industry overview of 2021 also shows the pandemic’s impact on financial and job markets.

We can’t separate the economy from epidemiology, an article in the Financial Times noted. Following the worst drop in per capita GDP in the U.S. since World War II, the national economy on a macro basis has recovered.

However, in the U.S., many people have not returned to work in a phenomenon some are calling The Great Resignation. For others in certain industries hard-hit by the pandemic, such as hospitality and leisure, jobs have not roared back. And still, other workers haven’t “resigned” per se but have had a reconsideration about personal values, purpose and work-life balance.

Furthermore, income inequality has worsened for many workers earning lower incomes. Medical and prescription drug costs are again appearing at the top of U.S. voters’ concerns, which receded in 2020 during the public health crisis. And three in four people in the U.S. are worried about medical bills, regardless of being insured or uninsured.

Medical debt remains a concern for health consumers, as well. Credit card company Discover recently found that “Americans with medical debt are more worried about making payments than getting better,” in the words of the financial services company. Many people with medical debt forego financial commitments such as making loan payments and contributing to retirement funds. Nearly three in four people with medical debt have more than $2,000 in outstanding payments.

Postponing Healthcare Continues

There is also evidence that some patients postponed needed healthcare and preventive screenings in 2021. For example, the American Cancer Society quantified a decline in cancer screenings and diagnosis. Furthermore, blood pressure levels were up in America during 2021, with patients at greater risk for stroke and other cardiovascular diseases. Contributing to this uptick in blood pressure were peoples’ changing behaviors during the pandemic such as eating habits, less physical activity, greater stress and poor sleep patterns.

Dr. Eduardo Sanchez, the AHA’s chief medical officer for prevention, spoke of the research, noting the importance of uncontrolled hypertension in historically under-resourced communities in the U.S.

U.S. healthcare providers and payers recognize the need for patients to “come back” to healthcare. Thus, patient access and engagement are top of mind in 2022 for healthcare executives, recently surveyed by the Center for Connected Medicine.

That means “meeting patients where they are,” a growing mantra in the midst of the pandemic, is a paramount strategy across providers and payers.

“We’re acknowledging the need to engage with consumers earlier in the care journey if we’re going to improve health and wellness,” Dr. Rob Bart, CMIO at UPMC, is quoted from the report. “In order to accomplish this, healthcare needs to do a better job of meeting patients where they are—whether that’s in the digital world or by making it easier to schedule and access in-person care.”

Mortality Is Up in the U.S.—and Health Disparities Persist

An important lens on mortality in the U.S. is so-called “excess deaths.” Excess mortality is defined by the CDC as the number of deaths from all causes during a crisis, above and beyond those expected under normal conditions. The pandemic has had a dramatic impact on mortality: deaths in the U.S. increased by 17% between 2019 and 2020, according to UnitedHealthcare’s report on the state of U.S. healthcare.

While the health status for some people—particularly white and Asian populations—improved during the pandemic, for people of color, the outcome wasn’t the same.

The health data emerging out of the pandemic has put a brighter spotlight on the health disparities and inequities that were already in place in early 2020. The role of social determinants of health (SDoH) gained greater attention and investment in 2020 and 2021 by health plans and care providers who have a better understanding of how broadband connectivity, food security and housing all underpin well-being and individual health outcomes. For healthcare providers, finding ways to communicate and collaborate with individuals, families and community-based providers to address SDoH as part of overall health and well-being will be essential for driving better health outcomes in 2022.

Meeting People Where They Are Via Telehealth

The use of telehealth spiked at the start of the pandemic in 2020 and has leveled downward in 2021. The Centers for Medicare & Medicaid Services (CMS) recently quantified the huge growth in use among Medicare providers and enrollees, calculating a 63-fold increase in the number of Medicare fee-for-service beneficiary telehealth visits, which hit 52.7 million in 2020.

To sustain the gains that telehealth achieved during the pandemic, a new association of advocates—called Telehealth Access for America—began lobbying for the virtual care industry in December. Founding members include AARP, the American Heart Association, American Hospital Association, providers such as Ascension and Johns Hopkins, CES (convened by the Consumer Technology Association), Teladoc, and the ATA, virtual care’s national association which has adopted the hashtag, #TelehealthIsHealth.

By September 2021, COVID-19 fell out of the top diagnoses list of patients seen via virtual care. Replacing the coronavirus as top reason for people seeking virtual care were mental health conditions, acute respiratory diseases and infections, joint/soft tissue diseases and issues, developmental disorders, and substance use disorders.

Mental Health, the Epidemic Beyond the Pandemic

In our healthcare industry overview of 2021 it is worth noting once again that mental health via virtual care platforms has sustained a relatively high level of adoption through the pandemic. New venture capital flowed to start-ups and maturing companies providing digital on-ramps to mental and behavioral health, with Pear Therapeutics scoring its public launch via NASDAQ at the end of the year.

In addition to financial health impacts, mental illness was a tandem toxic side effect of the pandemic. Anxiety, depression and stress especially affected young people, women and parents of school-aged children.

While COVID-19 was a big source of stress for people in 2021, financial problems topped the list of peoples’ top worries culled by VeryWell Mind. The pandemic, work and daily life stressors followed peoples’ personal finances this year.

“This was not the year we started talking about mental health, but it is the year that solidified the topic in our collective consciousness,” the VeryWell Mind researchers explained.

CVS Health asserted that COVID-19 is burning Americans out, finding most U.S. adults reporting a negative impact on their overall stress levels due to the pandemic, and two-thirds of people are concerned about the impact of the virus on the health of their loved ones.

Omnichannel Healthcare—New Digital Front (and Primary Care) Doors

Mental and behavioral health services are emerging as a part of healthcare’s evolving omnichannel approach to meeting people where they are across all aspects of health and well-being.

During CVS Health’s investor call on December 9, CEO Karen Lynch laid out the plans “to make bold shifts” in the company’s strategy. Among the five pillars of the plan is to “enhance omnichannel health experiences,” central for which primary care will be the focus point. CVS envisions a “next-generation primary care” to drive deeper engagement with patients, including preventive care, acute care, chronic condition management, care coordination and mental health.

Underpinning the strategy is digital transformation, with CVS enlisting the support of Microsoft to enable personalized healthcare.

In fact, retail health and wellness services surged in popularity in the pandemic, J.D. Power learned. And that consumer popularity resulted in increased customer satisfaction, loyalty driven by well-designed apps and digital experiences, and increased purchasing in the front of the store.

Consumers and Healthcare Shift “Home”

The last channel for healthcare is a person’s home, bolstered through the pandemic’s lockdown and #StayHome mandates that started new life-flows in 2020 that continued into 2021.

Hospital systems had already begun to pilot hospital-to-home acute care pivoting to people’s houses, and COVID-19 has accelerated this trend as many hospitals’ have hit full capacity for inpatient admissions driven by patients dealing with complications from the coronavirus.

That supply side has been met with a growing demand side among consumers who favor the idea of remote health monitoring and other technology-supported medical care delivered in the comfort and hygienic safety of home.

Consumers’ wearable technology adoption grew in 2021, tracked by the Consumer Technology Association (CTA). CTA further doubled-down on that observation with its 2021 Holiday Forecast of the consumer electronics items that people were planning to gift and those they wished to receive.

COVID-19 grew consumers’ interest in home and personal health and safety products for smart or connected health monitoring devices (e.g., for blood pressure or sleep), CTA found. In addition to wearable tech and remote health monitoring, there is growing development and adoption of voice-assisted technology like Amazon’s expanding portfolio of HIPAA-compliant skills. Most recently, Amazon announced a fall detection service, targeted to people safely aging at home.

All Organizations Are in the Health Ecosystem Now

With all the uncertainties in our planning assumptions for healthcare in 2022, we can count on one certainty: the healthcare ecosystem is morphing to an omnichannel landscape, meeting people where they “are,” embedding the best learnings from user-centered design, and driving a strong orientation to consumers’ values and renewed sense of value.

In the third year of living with COVID-19, we also know that organizations across industries—in and outside of “healthcare”—are adapting to the reality that every company is a health company. And as such, the environment is ripe for collaboration and creative engagement that puts patients-as-consumers front and center of our plans and aspirations to build healthcare back, better.

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