HIT Perspectives – January 2022
6 Health IT Trends to Pay Attention to in 2022
By Tony Schueth, CEO & Managing Partner
This is the time of year when all of us in health care review where we’ve been and what is facing us in the coming year. To be sure, addressing the COVID pandemic will continue to be a major trend in 2022. There are others that will influence business models, patient care and patient satisfaction. Here are some trends that we think will be influential as 2022 rolls along.
1. Addressing regulations and policy
Regulatory enforcement. The Federal Trade Commission (FTC) has vowed to ramp up enforcement in the areas of privacy and security. Over at the Department of Health and Human Services (HHS), enforcement might be more of a mixed bag. On one hand, the enforcement toolbox will be augmented by discretionary or future action for some regulations. For example, the Centers for Medicare & Medicaid Services (CMS) just announced discretionary enforcement with compliance with the payer-to-payer data exchange provisions of its 2020 final rule on interoperability and patient access. This will continue until rulemaking addressing implementation challenges is released later in 2022.
On the other hand, more sticks could be added. Stakeholders should expect a final rule drop from HHS’ Office of the Inspector General with respect to its enforcement responsibilities for information blocking. HHS cold issue a rule spelling out “appropriate disincentives” for providers, as directed by the 21st Century Cures Act.TEFCA (Trusted Exchange Framework and Common Agreement). With the overarching documents now published, implementation will begin for TEFCA in 2022Starting in Q2, the government will begin accepting applications for “qualified health information networks” (QHINs) — supernodes which will form a more national network in support of a half dozen initial exchange purposes, including treatment and individual access services. Entities such as health information exchanges (HIEs), health information networks, health systems, and payers must determine with which QHINs they want to do business (participation is voluntary) as their potential single on-ramp to other networks and entities in the country. At the same time, state funding for HIEs will be drying up, so payers and providers may need to scramble to find alternative arrangements for data exchange before suitable QHINs come online.
- Continuing focus on price transparency. We also expect regulatory requirements to be strengthened with respect to standards for the real-time benefit check (RTBC). Rules concerning RTBC adoption by Medicare Part D sponsors and Medicare Advantage Plans (published in 2020 and 2021) omitted any reference or use of a particular standard, such as the National Council for Prescription Drug Programs (NCPDP) real-time prescription benefit standard. This will likely be resolved by the Consolidated Appropriations Act of 2021 (HR 133), Health Extenders, Sec. 119. In the meantime, stakeholders should be complying with — or getting ready to comply with — those rules, as well as the numerous state activities concerning the RTBC.
- Pushing for additional burden reduction. We expect a continued push by Congress and the federal government for burden reduction via the use of electronic prior authorization (ePA). So far, CMS has made no announcement to change or delay the 1/1/22 enforcement date for required use of the NCPDP SCRIPT standard for ePA for Part D-covered drugs for Part D-covered patients. We anticipate a proposed rule from CMS that would create new requirements for government insurers — such as the Affordable Care Act exchange issuers and Medicare Advantage plans — to streamline prior authorization using the NCPDP SCRIPT standard.
- Revisiting HIPAA (Health Insurance Portability & Accountability Act). HIPAA was passed in 1996. Many stakeholders think it should be revamped to better align with today’s business needs, such developments as APIs, and updated or new standards that evolved since the act’s passage. Is 2022 the year?
2. Implementing interoperability
A lot of activity around interoperability will be taking place in the coming year — both in terms of complying with regulatory requirements and operationalizing them.
2022 will be a year for compliance with interoperability rules. Currently, electronic health information (EHI) that cannot be “blocked” is limited to the data elements represented in the United States Core Data for Interoperability (USCDI Version 1). But that changes on October 5, 2022, when the full scope of the ONC (Office of the National Coordinator) regulation’s definition of EHI comes into effect. In the meantime, ONC encourages the regulated community to make all EHI available.
Organizations must recognize that interoperability is a strategic imperative — and act on it. It’s more than just checking the box to meet federal mandates and adapting infrastructure. Stakeholders, payers, providers, and vendor entities need an interoperability strategy that is tied to the overall enterprise strategy. Topline revenue and margins cannot be improved without an enterprise strategy that puts interoperability front and center.
3. Digitizing care
This year, we should see continued efforts to digitize care and administrative processes. Expect prioritization in:
- AI (artificial intelligence). Health systems and payers plan to adopt more AI-driven automation tools to improve and optimize healthcare operations and clinical workflows as well as improve risk adjustment and revenue streams. They also will leverage AI to process mountains of health data and get insights that lead to better care, identification of disparities in care and lower costs.
- Blockchain. Many health care organizations will be looking to blockchain for trust in data origin and the secure transfer of data. Blockchain will help improve both the drug supply chain and efficiency of clinical trials.
- eConsents. Health care entities should be reviewing their consent processes and starting to digitize them. It’s not just about the technology changeover and what that entails, including consent management. Payers and providers must implement processes and data exchange methods that reflect members’/participants’ consent preferences and ensure consent follows them. Entities that do so can retain and expand the member base, as well as create competitive advantage.
4. Creating data platforms
Data is a commodity. Health care stakeholders will continue to form partnerships to create new platforms to make data easier to access and use, as well as unleash its power to transform health care. For example, Walgreens is establishing an internal, tech-enabled health care startup with the goal of creating a new patient platform that blends physical and digital tools. They, in turn, will help individual patients find, get and manage care. What’s unique about this effort is that the startup wouldn’t fully build the platform itself; rather, it will be done through a series of partnerships to create a “company within a company.”
5. Meeting patients where they are
Patients are in the driver’s seat when it comes to their health care and data. Payers and providers will be finding new ways to meet patients where they are in 2022. Expect to see innovations in:
- Changes in sites of care. Health care delivery continues to transition to alternative care sites. Some see opportunities in going where services are needed, such as rural areas. Dollar General, for example, will be adding clinics to their stores to support care in rural areas and “health deserts.”
- Consumerism. Consumers are looking for the same kind of convenience and quality in accessing and obtaining health care services as they have come to expect from other industries, such as airlines and hospitality. CVS, for example, is acting on that trend by closing some stores and trying to capitalize on digital growth from online shopping and turning its stores into “health care destinations.”
- Telehealth. Telehealth will continue as a tool to meet patients where they are, especially for those with behavioral health issues.
- Digital therapeutics (DTx). 2022 will continue to see accelerated moves to DTx. Opportunities include virtual care and treatments for chronic diseases and behavioral health issues. Health plans will increase coverage of DTx, while the Food and Drug Administration will be receiving many more DTx applications.
6. Improving diversity and equity
Health care has been working to improve equity and diversity. While headway has been made, the need for improvements again were laid to bare in the wake of the COVID pandemic and recent social unrest. Looking ahead to 2022:
- Diversity, equity, and inclusion (DEI) will be a priority. In 2022, health care organizations will be investing in business-level DEI strategies. Many will create new governance (such as a chief health equity officer) to give equity and inclusion a seat at the organizational table. Strategies will be developed to bring diversity and equity in the workforce, services, products and clients. Metrics and data for measuring progress will be needed and a push to develop them is likely in 2022.
- Social determinants of health (SDOH) will gather momentum. In 2022, new SDOH metrics will be emerging that will be interoperable and included in various data systems and technologies. Payers and providers will analyze their membership/patients, costs and outcomes in terms of SDOH. Payers will include SDOH in their benefit designs and coverage, while CMS is likely to issue new guidance. Efforts will be undertaken to transform the nation’s public health system to address barriers to equity and lack of diversity. Organizations that move ahead quickly with SDOH adoption will have competitive advantage.
- Electronic health equity will be a focus. Broadband availability is problematic in some areas, which puts digital health solutions out of reach for many underserved populations. Work will continue in 2022 by the FTC and others to address these disparities and increase equity in health care delivery and outcomes. At the same time, payers and providers will be increasing efforts to electronically reach underserved populations in more user-friendly and culturally appropriate ways.
Looking ahead. There is no doubt that 2022 will be a year of change, and Point-of-Care Partners (POCP) is here to help. Our team of experts tracks trends and can create strategies to help your organization meet the challenges ahead in 2022. Reach out to me at firstname.lastname@example.org.