Challenges and opportunities in healthcare

With increasing accessibility and technological advancements, there have been several speculations about the growth and future of the healthcare industry.

It has become a necessity to understand the emerging markets and the challenges that the healthcare industry is dealing with in this course of time.

According to the recent survey organised by The Healthcare Executive Group (HCEG) amongst the experts of the industry, they have highlighted some of the critical challenges, issues and opportunities they expect to face in 2021.

Out of the listed challenges, the issues which stand out are rising costs of healthcare, shortage of primary care professionals and disparate international standards of healthcare.

Here are the top 10 challenges, issues, and opportunities that healthcare professionals should study:

1. Costs and transparency: It’s time to implement strategies and tactics to optimise medical and pharma costs and positively impact access and quality of care.
2. Consumer experience: Understanding customers, addressing their queries and assuring the consumers with convenient, timely, streamlined, and cohesive communication is an important responsibility
3. Delivery system transformation: To overcome the challenges related to social determinants of health it is important to improve the current systems. The transformation of medical and non-medical services via collaborations and partnerships between community-based and healthcare organisations need to be systematically organised to get better outcomes
4. Data and analytics: Leverage advanced analytics to get insights from new sources of disparate, non-standard, unstructured, highly variable data (history, labs, prescriptions, sensors, mHealth, socioeconomic and demographic) to improve health outcomes, reduce administrative burdens and facilitate effective and supportive transition from volume to value for payers and providers.
5. Interoperability/Consumer data access: Integrating and improving the exchange between people and workflows to derive value from aggregated data and systems (financial, admin, and clinical data, etc.) on a near real-time and cost-effective basis to all stakeholders equitably.
6. Holistic individual health: Identifying, addressing and improving the overall lifestyle of individuals for their well-being and a frictionless as well as connected healthcare experience.
7. Next-generation payment models: There’s a necessity in the market to develop integrated technical and operational infrastructure and programs for an equitable and collaborative approach to manage outcomes in the transition from volume to value like bundled payment and shared savings,  manage costs and risk sharing etc.
8. Accessible points of care: There is growing acceptance for telehealth, mHealth, wearables, digital devices, retail clinics, home-based care, micro-hospitals and other initiatives. They are moving care closer to home and office.
9. Healthcare policy: Current healthcare policies, regulations should be repealed/replaced/modified to mitigate political uncertainty/antagonism and lack of a disciplined regulatory process. Also, medicare-for-all, single-payer, medicare/medicaid buy-in, provider directories, association health plans, and short-term policies, FHIR standards etc. should be mandatory.
10. Privacy/security: To enhance and build consumer trust, it’s important to ensure the privacy of the consumers’ data and other healthcare information as well as stay ahead of cybersecurity threats to prevent them.

The pace of change and innovation is accelerating as the healthcare industry has moved to the centre stage in the national debate. Ferris W. Taylor, Executive Director, HCEG states, “It shouldn’t be surprising that the costs and transparency are at the top of the list along with the consumer experience and delivery system transformation.”

Data analytics, interoperability and technological advancements provide both, challenges and opportunities. Professionals need to be cautious about individual health, consumer access, privacy, and security too since these are also on-going challenges but remain priorities as well.

Predicting cost in the traditional health insurance environment is complex. Most of the plans still have to go a long way to get the right type of offering, whereas bundled value-based payments start to make cost transparency a little easier to predict.

To drive down the health costs for payers, consumers and system-wide, it is important to build and manage the payer-consumer relationship. Once a payer proves it can make valuable and trusted recommendations, the consumer can make the decisions that will not only lead to better health outcomes but also to reduced cost of care.