The beginning of a new year means it's time to take a step back and assess the state of things. HealthCare Business News went around the healthcare industry to find out what executive leaders had to say about the lessons from 2022 and what we can expect in 2023.

Here are some of the responses we received.

The role of diagnostic testing as both a tactical and preventative tool proved extremely essential through the pandemic. Utilizing a similar framework for advanced genomic insights across care disciplines, 2023 will usher in a massive opportunity for clinical professionals to extract the maximum amount of utility from an extensive and growing menu of high value diagnostic tests as they become a standard of care.

The promise of low-cost, high complexity genomic testing has been historically limited by a lack of data unification, practical workflow challenges, and clinical consensus. Increasingly, clinical communities are coalescing on the value pharmacogenomics (PGX) panels, somatic testing, and germline screening to assist in proactively identifying risks, mitigating adverse events, and driving improved clinical outcomes. For example, a simple test for DPYD deficiency can help prevent potentially fatal side effects during cancer treatments, yet these diagnostics can only truly be adopted as a standard of care if the insights from those tests can be routed to all clinical stakeholders within their existing workflow. After a decade-long push to create more open electronic data records for patients, we're finally at a place where the complex challenges to simple answers and decision support insights can be delivered through our complex care system architecture.
- Dr. Joel Diamond, practicing physician and Chief Medical Officer of 2bPrecise

Since the onset of the COVID-19 pandemic, virtual care and remote monitoring have introduced new and successful ways for health systems to deliver care, digitally. While the pandemic moves behind us, the consumer demand for convenient, at home care (when appropriate), remains. As health systems continue to work to meet this consumer demand, we’re seeing that this convenient care delivery model is not just a pandemic byproduct — it is a model that is here to stay.

This model, which we at AVIA call ‘Connected Care at Home,’ offers technology that safely delivers episodic and longitudinal care in the comfort of a patient’s home. We've identified nine capabilities where systems need to act, which range from table stakes like virtual visits and remote monitoring to care management and caregiver support. With effective implementation, health systems are realizing improved outcomes, cost savings, and multiple new revenue streams while better serving patients and clinicians, and staying relevant in the ever-changing, competitive world of consumerism.
- Sarah Carroll, VP of Center for Care Transformation at AVIA

The past year saw many advances and hurdles in cybersecurity and privacy, and 2023 is sure to hold even more. Healthcare’s growing reliance on the supply chain and integrated medical devices, for example, is directly correlated to increased vulnerabilities. As the number of connected devices has grown exponentially, so has the size of the attack surface the adversary can exploit – a trend on track to continue. The time to address risk is not at the patient bedside, and all involved entities should start recognizing their shared responsibility to protect their patients. In 2023, every stakeholder must ensure appropriate and reasonable safeguards are in place – from the manufacturer designing products using secure system lifecycle practices to the business associate demonstrating recognized security practices, and partners and providers assessing risk as part of the decision and lifecycle of the medical device.

Ransomware attacks have also been a significant issue, shifting them to the top of the priority list for the coming year. The threat actors targeting healthcare are highly capable, financially motivated, and have successfully extorted and disrupted the industry to the tune of multiple billions of dollars. In the face of this rising vulnerability and ransomware trajectory, organizations can future-proof by focusing on user awareness, protection of identities (passwords, multifactor authentication, and privilege access management), continuous detection and response, and continuous risk analysis and management. While there will never be an easy button to stop cyberattacks, learning from the experiences from the past year is critical to prepare for what might come next.
- Dave Bailey, VP of Security Services at CynergisTek (a Clearwater company)

As the industry continues to focus on identifying and solving health inequities across the care continuum, innovative health plans are turning to population health analytics to target gaps in care and engage their members to close those gaps. However, communities with specific social determinants of health concerns such as lack of transportation, housing instability, and food scarcity present greater difficulties when it comes to deploying effective member engagement programs.

Payers can improve health equity in 2023 by investing in reaching members where they are, using a multichannel, tailored approach that goes beyond identifying members’ preferred methods of communication and language. For example, rather than simply translating English materials into Spanish, plans should build trust with their members by taking into account their unique cultural backgrounds when crafting member communications. This will be especially important when the COVID-19 public health emergency (PHE) expires and up to 14 million people could lose Medicaid coverage following redetermination. By improving member engagement to reach the most under-resourced members, we can begin to end inequities and improve outcomes for the most vulnerable.
- Emad Rizk, MD, president and CEO of Cotiviti

This year, all eyes have been on pending health policy and legislative updates, such as the imminent public health emergency (PHE) expiration as well as Medicaid expansion in certain states Heading into 2023, I believe this will continue to be a major focus as we are inching toward an unprecedented time of Medicaid redetermination, further complicated in states with arcane lookback rules. For this reason, I think it is paramount to locate, reach, and educate the Medicaid community in different ways.

To combat the impending administrative tsunami of redetermination (an estimated 15 million people are at risk of losing Medicaid coverage once the PHE expires), we must employ a strategic combination of multichannel and digital communications to reach this population, many of whose members are less likely to have a permanent address and/or landline. This will ensure gaps in coverage stay to a minimum and people are aware of their coverage status and empowered to make the right care choices.
- Venkatgiri Vandali, president of Healthcare and Lifesciences, Firstsource

As we look ahead to 2023 and the increased adoption of FHIR APIs, healthcare delivery organizations should focus on easing the collection and exchange of data to better inform patient engagement efforts and to avoid burdening clinicians. A transparent and comprehensive understanding of every health record will only become a reality when patient engagement initiatives (like digital front door) and analytics-driven innovation rely on a core set of foundational data management capabilities.

To achieve value from these initiatives, it’s paramount to move beyond transacting or moving data from one system to another to making sense of that data. For example, reliable person identity data achieved through an enterprise master person index (EMPI) is crucial for current events such as the upcoming PHE expiration and Medicaid expansion in states like South Dakota. An EMPI reduces risk inherent in aggregating records between public health agencies and their healthcare delivery organization trading partners. Being able to normalize code sets not only improves outcomes but alleviates billing headaches down the road.
- Drew Ivan, Chief Strategy Officer at Lyniate

No matter how you slice and dice intel from healthcare analysts, one message comes through loud and clear: providers need more and better digital tools to automate workflow processes. They look to compensate for labor shortages, tight margins and care backlogs – not to mention escalating patient demand to make healthcare more consumer-friendly. 2022 Gartner research, in fact, noted that digital technology initiatives and workforce optimization are the top two priorities for healthcare leaders through 2024 (“Top Tech Trend: Total Experience for Healthcare Providers”).

Technology solutions that will top their shopping list are likely to include next-generation “digital front doors” to help patients find information, connect with the right provider in the right care setting, schedule appointments and procedures, and prepare for those encounters. In short, patients are looking for a “Google-esque” experience so interactions with the healthcare system are easier. While patient-initiated interactions (like self-scheduling) will benefit from digitization, automation of provider-initiated outreach will be important, too. Call centers and clinical staff are stretched to the breaking point. Digital outreach solutions that integrate with existing systems of records like EMRs and CRMs help streamline activities such as preventive service reminders, care instructions and post-procedure status checks. Plus, best-of-breed solutions are built with conversational AI and natural language understanding to ensure interactions remain personal, a well-established hallmark of healthcare.
- Patty Riskind, CEO, Orbita

Here in the US and likely everywhere, the SARS-CoV-2 pandemic has exposed deep foundational cracks in our healthcare infrastructure. As three years of deferred care comes to a crashing crest, hospitals across the country are overflowing, understaffed, and staring down the barrel of a winter with white caps of influenza and RSV already breaking on battered medical shores.

While we face unprecedented challenges, we also have unprecedented resources at our disposal. Never before have tools such as artificial intelligence and machine learning, backed by computational power unrivaled in human history, been a part of our arsenal. Our potential as a species to re-write the rules of infection prevention, public health and healthcare response is incredible and only time will tell if we can rise to the challenge.
- Paritosh Prasad, MD, director of Global Health at VisualDx

This year brought significant codified changes to the Medicare Advantage Star Ratings program as part of CMS’s effort to reduce overspending and ballooning bonus payments – and the healthcare industry is seeing how this makes historically high Star Ratings more difficult to achieve. Smaller plans looking to grow their memberships will find it increasingly difficult to innovate and offer competitive benefits without the help of bonus payments, and plans that receive three stars or less for more than two years also stand to have their contract and expansion applications denied by CMS beginning in 2023. Now is a critical time for plans to prioritize interoperability and real-time electronic prior authorization resources that affect Consumer Assessment of Healthcare Providers and Systems (CAHPs) ratings. Looking ahead, we are likely to see more plans adopt technology that ensures people receive the care they need and get the benefits they expect.
- Cynthia Henry, Manager, Medicare Advantage Solutions, ZeOmega