Health Care 2023: A Pressing Need to Move from Reactive to Proactive
By Jeff Margolis
The functionality, accessibility and affordability of U.S. health care has been a front-and-center issue for a long time. The COVID-19 crisis, which began in March of 2020, enlarged the magnifying lens on the industry.
As we start to emerge, somewhat, from the dark COVID cloud, there were some rays of sunshine in terms of progress that health care made in 2022. For starters, Congress acted in a bipartisan manner to provide funding for research and vaccines, and oddly enough spent little energy arguing about whether people deserved health care or not.
The Inflation Reduction Act of 2022, signed into law by President Joe Biden in August, included important health provisions. Among them: lowering prescription drug prices in Medicare through price negotiation with manufacturers; requiring drug companies to pay rebates if prices rise faster than inflation for drugs used by Medicare beneficiaries; capping out-of-pocket drug spending for beneficiaries in Medicare Part D at $2,000 annually; and extending for three years the enhanced Affordable Care Act subsidies that Congress passed last year as part of the American Rescue Plan Act.
In the second half of ’22, there was enough confidence in vaccination and control measures around COVID-19 to start thinking about a new normal in health care. Data affirmed that those who maintained overall better health and well-being fared far better than those with underlying conditions and less healthy lifestyles. But it also reminded us that sometimes, even very healthy people are overcome by novel diseases.
Looking ahead, our health care system needs significant improvements, starting with decision-makers in both the industry and government getting on the same wavelength more often. The 2022 election cycle affords the opportunity for non-productive, hyperbolized political rhetoric that splits U.S. human-beings into labels of high-needs, elderly, and “everyone else.” And there is still not an adequate systematic shift across the industry to understand people as individuals vs. simply putting them into categories based on their economic and geographic demographics
But let’s take solace in the fact that elected government officials, policy makers and employers are starting to understand that health care is broader than just providing access to reactive sick care.
Americans deserve a health-care system that supports health in our daily living and doesn’t only fix us when we’re sick. It is our daily living – the actions we take regarding nutrition, fitness, sleep, mental health, relationships, financial management and how these are impacted by social determinants – that make up the vast majority of what governs our health and total well-being. Yet, our health-care system primarily treats sickness with limited support for preventing illness.
Here are some health-care predictions for 2023 and things I think need to be done in ‘23 to move from sick care to health care:
- Inflation and insurance affect the industry. Unfortunately, inflation in sick-care labor and supply resources is going to disrupt some of the progress from 2022. Local and regional hospital systems are going to struggle to cover costs. Though inflation related to medical sick-care costs will get in check by late ‘23, the insurance rate increases for 2023 and 2024 will be brutal.
- Adversaries look for common ground. Politicians will keep publicly attacking pharmaceutical companies and insurance companies as the cause of the economic challenges to health care, but they will work together in the background as private industry supports the innovation imperative.
- Mental health gets more attention. Mental health will get a long-awaited day in the sun. There will be bipartisan and private-industry support for expanded mental health resources, ranging from severe conditions to stress management and resilience-building. In addition, a focus on issues such as loneliness among the elderly and teenage populations will start to get some traction.
- Advancement in therapies and personalized medicine. Serious progress will accelerate in therapies that make some of the scariest health conditions less scary, such as difficult types of cancer and dementia. And the application of individualized genomics, metabolomics and proteomics will more commonly become embedded in personalized treatments available in multiple academic medical centers and in leading specialty and community hospitals.
- Businesses will see health care through a wider lens. Large employers are going to zoom out ahead of governmental approaches to health benefits and address total well-being while also emphasizing primary care connections to consumers through digital, virtual and physical means.
2023 Needs List – To Move
From Sick Care To Health Care
- A wider perspective in benefit plans. Medicare, Medicaid, military and commercial plans need to be looked at through the lenses of physical health; mental health; social health; financial health; and to the extent possible, individual purpose. These categories should start to show up more clearly in descriptions of benefits in addition to doctors visits, hospital visits, drugs, ER visits, etc.
- Better communication by employers. Employers, who by and large already have a belief system in total well-being, need to communicate the broader set of total health and well-being benefits more clearly and educate their employees on what is available.
- Cost focus by CMS. The Centers for Medicare & Medicaid Services (CMS) needs to take a step back and look at how less costly support for lifestyle and daily living (e.g., nutrition and reducing loneliness) can dramatically reduce the cost of traditional medical care.
- Combined data usage. Consumer permissions to combine non-health-care data with health-care data in the best interest of their health need to become commonplace when enrolling in health benefits.
Imagine a world in which the health-care system actually works with people on improving their total health – a world where health care becomes proactive instead of reactive.
About Jeff Margolis
Jeff Margolis (www.jeffreyhmargolis.com), the Forbes Books author of Not Just in Sickness … But Also in Health: Moving Beyond Sickcare to Health Optimization for All, is former CEO and Chairman of both Welltok (A Virgin Pulse Company) and TriZetto (A Cognizant Company). He is currently a Blackstone Senior Advisor and serves as a director on a number of public and private company boards of directors. Margolis is widely recognized as a healthcare IT entrepreneur and innovator based on his 35-year track record of successfully applying technologies to address the complex problems facing the healthcare industry.
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