Top 5 Actions for 2021
2020 brought us extreme challenges: the pandemic, the unavoidable reality of structural racism, and the refusal of a sitting president to recognize November’s election results. 2021 is off to a rocky start, but there is hope. And there is the opportunity to “make good change,” which is our version of Congressman John Lewis’ call to action.
This year’s Top 5 list is more than a compendium of what we think this year’s most important issues in health care are. It is a call to action, with some guidance on what you can do to take action, and how we can help. Woven throughout is our commitment to CARE (Creating Access and Realizing Equity).
1. ASSISTING STRESSED OUT HEALTH CARE ORGANIZATIONS
Challenges of 2020: The pandemic has caused most organizations – at least those that have been able to continue to operate in some manner – to rethink how they do business. Many have had to pivot to deal with a socially distanced and, largely if not entirely, virtual workplace and service delivery model. To survive during this challenging time, organizations have had to innovate and adapt at a pace many have never experienced. Frontline health care organizations have been particularly affected by this, as they have had to treat Covid patients and attempt to conduct regular business.
As difficult as this has been, there have been many successes. For example, even organizations that provide “high touch” services have successfully transitioned to more of a virtual service delivery model.
What We Expect in 2021: While it is critical to focus on the near-term, the challenges of today may also open the door for greater success down the road by presenting an opportunity to revisit why the organization exists and how it can most effectively advance its mission.
Making Good Change: To do this effectively:
· the organization must have a clear view of where it is heading (i.e. a vision and strategies that are aligned with its mission),
· the organization must also understand where it has and needs to build capacity,
· decisions on how to move the organization forward should be data-driven,
· internal and external stakeholders must be fully informed and engaged, and
· communications must be clear, consistent, honest, and open.
Adapting to the new norm, whatever that will be, will require the ability to face an honest assessment of where the organization falls short and the commitment, engagement, and buy-in of leadership, staff, and the Board to innovate and change. We stand ready to work with organizations to develop new strategies and execute them.
2. ADDRESSING STRUCTURAL RACISM
Challenges of 2020: During 2020, we were challenged with the dual crises of a global pandemic and the ongoing endemic of racial injustice which was laid bare by the murder of George Floyd and too many other innocent Black people. As the pandemic wore on, it put a spotlight on the health inequities and disparities for communities of color.
What We Expect in 2021: In response to these crises, many organizations have come forward and made commitments to addressing inequities in our society that had all too often flown under the radar. We fully expect to see investment in population health, public health, and health related social needs in the coming year. This will likely be bolstered by new funding from the incoming Biden-Harris administration as well as enhanced efforts at the state and local level. As the urgency from last summer dies down, we need to continue to demand change at the organizational, state, and federal levels.
Making Good Change: We at Day Health Strategies have taken an anti-racist stance and made commitments to addressing inequities which can be found in CEO Rosemarie Day’s message here. We will continue to help our clients do the same, from better serving underserved populations through establishing Accountable Care Organizations to assisting state-based exchanges in strategic planning for long-term sustainability.
3. TRANSFORMING DELIVERY OF HEALTH CARE
Challenges of 2020: The pandemic forced health care organizations to rethink their delivery of care models. Nonetheless, many people were forced to defer needed care such as cancer screenings and managing chronic illnesses.
What We Expect in 2021: The dramatic transformation in delivery of care that began in 2020 will continue in 2021 as organizations move out of crisis mode and begin to determine what’s needed for long-term sustainability. The crisis of deferred care will need to be addressed. Here are a few things we expect to see this year:
· Telehealth. Adoption of telehealth in the US has skyrocketed over the past 12 months due to the pandemic. This trend will continue, as most practices are now telehealth equipped and patients have come to expect this convenient option. The consequence of such rapid adoption, however, was that telehealth protocols and workflows were created on the fly. This year, we expect organizations to work on incorporating telehealth services into practices more strategically.
· Deferred Care. Health care providers will need to make up for lost time with their patients. Deferred screenings and chronic illness will continue to result in late presentation and worse outcomes. The national health ramifications could take years to fully see. The delivery system will need to offer population health level supports for chronic and terminal illnesses.
· Shift in care locations. Small clinics in retail locations are not new, but we expect the convenience of a price-transparent Walmart primary care visit to dominate this year, particularly due to the ever-present shortage of primary care clinicians and the significant numbers of physician practices that closed in 2020 due to the pandemic.
Making Good Change: Day Health Strategies has deep experience in health program strategy and implementation, including telehealth operations, population health programming, and other efficiency and outcomes improvement efforts. We look forward to assisting states and organizations with this important work over the course of 2021.
4. IMPROVING AFFORDABILITY OF HEALTH CARE
Challenges of 2020: Pressure on state government budgets has grown tremendously as tax revenues have fallen. States experienced an average 6.4% drop in revenue, with some drops exceeding 20%, and balanced budget laws on their books leave no option other than to cut services. Exacerbating the problem, the 8-14 million Americans who lost their employer-sponsored insurance are expected to join Medicaid, further stressing state budgets.
What We Expect in 2021: Household budgets are similarly being strained. This has led to renewed calls for the government to venture into price regulation, not only in pharma, but in healthcare delivery, like Maryland has been doing for years in its all-payer system. However, with providers serving as “health care heroes” during the pandemic, their high regard in the public eye will be a counterweight to such cuts, serving to postpone or even eliminate cost reduction initiatives.
Making Good Change: Moving forward with value-based care initiatives is a key way to solve these issues and it is yet to be fully realized. We will continue to work with state governments and policymakers to ensure that public dollars are spent to maximum effect. We stand ready to advise health care providers on trends affecting their industry as well as strategies to adapt successfully to these trends.
5. INCREASING ACCESS TO HEALTH CARE COVERAGE
Challenges of 2020: With unprecedented levels of job loss due to the pandemic, millions of people lost their employer-sponsored health coverage. This put increased pressure and demand on government-sponsored health insurance programs.
What We Expect in 2021: The Senate has flipped to Democratic control, but with filibuster reform unlikely to happen, advancement of federal public option legislation (which Biden ran on), will be all but impossible with staunch resistance from the Republicans. States, on the other hand, can still implement it, and Washington state is the first to do so. Public option programs should theoretically undercut the prices of private competitors (although Washington’s public option plans have thus far failed in this regard) but should also help increase competition and access to coverage where they operate.
State-Based Marketplaces, in particular, are finding new ways to provide coverage. In addition to public options, we have seen them offer highly popular special COVID enrollment periods, conduct creative outreach and enrollment efforts, determine plans to be sold by employing an active purchaser model, offer wraparound subsidies to further improve affordability, require standardized plan designs, and more.
Making Good Change: Day Health Strategies will continue its work with State-based Marketplaces, from those that are newly emerging to those that are long-established. We stand ready to assist with engagements ranging from convening stakeholders to formulate policy, to strategic planning, to organizational development, to managing IT implementations.