Lindsay R. Resnick, MHA

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Futurists and pundits are advising healthcare companies to look forward and not backward in a post-COVID-19 world. However, the coronavirus pandemic was an interrupter, a sudden force unsettling the healthcare landscape early in 2020. Healthcare trends shaping strategic plans and tactical implementation efforts were moving full-speed ahead. And then, boom… everything came to a screeching halt, agendas were put on hold, and budgets were frozen or suspended indefinitely.

While there’s consensus COVID-19 has changed the business of healthcare forever, it’s important not to dismiss the trends that were influencing investments and used to deploy resources designed to shape the future of healthcare. Reevaluating and reactivating these initiatives intended to improve the way healthcare is delivered, financed and accessed by consumers is critical to accelerate a return to normalcy.

It will take time for the trends that were driving healthcare’s transformation and innovation to get back on track. There’s no question the coronavirus pandemic will require a rethinking of priorities and reorientation of strategies as underlying market dynamics of a recovery, and eventually, a "new normal" evolve.

Following are 10 trends that cut across the healthcare ecosystem prior to COVID-19 and will undoubtedly reemerge and restart going forward albeit at a different velocity and voraciousness.

 Families are in crisis, wrestling with an array of financial burdens to a degree few ever experienced before - unemployment, financial market downturn, business closures, and strained household budgets. People are being stressed-tested to the max. In the short-term, uncertainty about the COVID-19 shutdown timeline is driving high levels of anxiety. Add to the mix healthcare costs, already outpacing wages, with high deductible health plans and climbing out-of-pocket expenses, consumers are facing extraordinary financial burdens. They are delaying care, skipping prescriptions, and ignoring chronic conditions.

As we push consumers to take more personal responsibility for financial healthcare decisions the onus is on healthcare brands to support their customers make value-based, clinically effective choices.

 We know that socioeconomic inequalities in income, housing, jobs, nutrition, and education are forces that can have twice the impact on an individual’s health than biology, DNA, and clinical care. COVID-19 has highlighted these health disparities in terms of who gets tested, hospitalized, and treated. It has been particularly glaring in African American communities. Going into 2020, initiatives addressing Social Determinants of Health (SDoH) were gaining significant traction among payers and providers (e.g., safe housing, food markets and delivery, job training, medical transportation). Addressing SDoH is critical for improving health outcomes and reducing health disparities.

Investing in epidemiological, data-driven methodologies that support SDoH programs focused on under-served populations will improve quality of life and over time, life expectancy.

Historically, consumers don’t trust the healthcare industry. When asked: will they do the right thing by my health - most healthcare brands come up short. That said, COVID-19 has moved the trustability needle. Healthcare workers - doctors, nurses, front-line staff, first responders -had people cheering in the streets. Health insurance companies were praised for broadening benefits such as telehealth, and waiving co-pays and deductibles. Even the pharmaceutical industry, where pricing horror stories have drawn the ire of consumers and regulators alike, is being viewed as heroes as they amend redirect agendas to dedicate resources to coronavirus testing methods and vaccine development.

To build trust and gain respect, healthcare companies must deliver relevant, simple narratives tied to a brand purpose. Communications need to be adaptable to the pace and scope of marketplace change, and exude honesty and sincerity about how, why, and what you are doing.

 Going into 2020 there were approximately 29 million uninsured Americans, slowly trending upward. With massive layoffs and loss of employer-based health care coverage (more than 20 million filing unemployment) it’s estimated that another seven to 15 million people may join the ranks of the uninsured. Expect uncompensated care and bad debt to spike as providers attempt to manage uninsured patients as well as those "underinsured" unable to meet out-of-pocket obligations. Given threats to the aimed at hastening the demise of Affordable Care Act’s and pre-existing condition protections, it may be the perfect storm for continued growth of uninsured citizens that could last for years.

Medicaid enrollment will increase, individual insurance markets will expand, and debate will intensify around single-payer healthcare, Obamacare and Public Option proposals. Reforming the healthcare system will be a major focus of the 2020 election (#VOTE).

 There’s nothing like a contagion to shine a light on the importance of putting patient data into actionable profiles so care providers can improve clinical interventions and financial outcomes for different patient risk segments. Population health takes a community orientation to coordinating medical needs across the population and across the care continuum. The result improves experiences and quality, lowers cost, and can be measured by health outcomes. Primary care is at the center of population health, through medical home models and value-based payment schemes. Recent growth of primary care retail clinics and networks (e.g., hospital branded, Walmart, CVS, Iora Health, OneMedical) are important driver of population health.

Population health is focused on the health of ordinary people. Today, COVID-19 proved there are glaring gaps in the country’s public health system. Going forward we need a scalable, data-driven approach to improve community healthcare structures built around coordinated, patient-centered care management.

 Americans are scarred. Quarantine, lockdown, shelter-at-home, social distancing, and "six feet of separation" of knowing a friend or family coronavirus fatality has taken its toll on the nation. People are overwhelmed as their lives have been turned upside-down for months and changing daily. Patients and health plan members have always ranked customer service as the most important factor influencing loyalty, and healthcare brands have consistently fallen short when it comes to delivering frictionless, customer friendly experiences. Consumers want interactions on their terms throughout their healthcare journey and are setting expectations around their favorite customer experience outside the healthcare sector. Healthcare companies need to keep pace.

Handle with care! Your customers are feeling very vulnerable and need help. They need to feel included and respected. And, they need a reliable, empathetic healthcare partner. Now more than ever superior CX wins.

The psychological impact of a pandemic and it’s associated "life disruptors" – social distancing, school and business shut downs, prolonged isolation, healthcare worker burnout - are far-reaching and will take a toll on many Americans. It crisscrosses generations with depression and anxiety, loneliness and grieving, alcohol, drug and domestic abuse, and panic and psychoses. Additionally, it impacts customers, business partners and stakeholders (not to mention family and friends). Mental health services improve emotional, psychological, and social well-being but most importantly, these programs save lives. Awareness and support of effective mental and behavioral health resources is essential in the current and future COVID-19 environment.

What’s it going to take to turn mental illness into mental wellness: identify and pay attention to warning signs, break down barriers to open access to behavioral health professional interventions, and work to remove social stigmas around mental health disorders.

 The shift from hospital-based services and physician offices to in-home care, DIY, retail clinics, and digital health (telemedicine and virtual care) was a rapidly advancing trend earlier this year. It has matured three years in the last three months…and there’s no going back. The promotion and subsequent consumer uptake of telemedicine resulting from the onslaught of COVID-19 is a prime example. Another trend sprouting out of the pandemic is the new, more prominent roles for nurse practitioners and physician assistants. Healthcare consumers are telling the market they are ready to embrace new sites of care, experiment with innovative health solutions, and take ownership of their health through digital touchpoints.

Healthcare brands need to adapt and work across the point-of-care continuum to remove barriers to care, create convenience-driven experiences, and inspire patients to face personal health challenges and stay motivated to proactively deal with their health.

 Going into 2020 it was clear that whether Gen Z, Millennial, Gen X or Boomer, they don’t want to engage with the healthcare system the way it is currently structured. COVID19 has brought its own new dynamics. Gen Z is being relabeled Gen V with COVID19 a life defining event for them, disrupting entry into adulthood, altering earning potential and eroding trust in institutions…it’s this generation’s 9/11. Millennials are also anxious, less about coronavirus as a health crisis but rather its financial, job prospect, and cost of living implications. For Boomers, not only are they a vulnerable at-risk group (and suffering from ‘boomer remover’ memes), it has brought a new twist to their work, retirement, and financial planning.

One size doesn’t fit all. Use actionable data-driven individual insights to have a cross-generational view of customer preferences, expectations, attitudes and behaviors.

 Health and medical technology companies were seeing record levels of funding and valuations. Through creative collaboration, either acquisitions or partnership, healthcare markets were being moved in new directions: Best Buy/Great Call, Google/Ascension, Apple/Johnson & Johnson, and Amazon/Pillpack. And, healthcare’s innovation index was in overdrive using artificial intelligence, wearables, robotics, genomics and internet of things to advance connected health communities reshaping consumer experiences. While COVID19 has slowed, in some instances stalled, the momentum of innovation, it won’t stop it.

Successful companies don’t sit still in disrupted markets. Startups and established companies need to keep pushing the limits to retool and improve the healthcare value chain: contain costs, reduce expenditures, improve quality, and increase efficiency.

Healthcare companies are facing their own challenges: revenue and growth shortfalls, work-from-home disruption, stakeholder pressures, and shifting customer needs and demands. Picking up where you left off pre-COVID-19 takes enterprise agility. It means strategic pivoting and business nimbleness. This crisis is an opportunity for healthcare brands to act, not sit still in a ‘wait & see’ mode. Consumers need help traversing healthcare’s treacherous terrain as they move from initial shock to recovery to a "new normal" in a COVID-19 world order.

Uncertainty and volatility will reign for the foreseeable future. Preparing for a post-COVID-19 future is a complex calculation based on four values:

Align with customer needs, for recovery and ‘new normal’ phases.

Position around brand purpose recognizing COVID impact and inspiring action.

Activate messaging born from your brand setting you apart in the market.

Deliver tangible value in the short-term that’s transportable to the future.

Brands that are human centric, show empathy and take noticeable action on behalf their customers will do well in earning goodwill, appreciation and loyalty. Customers admire companies that take action on their behalf to alleviate the impact of crises, protect and improve the value they receive, and bring back a sense of normalcy.

Lindsay R. Resnick, MHA is executive vice president at Wunderman Thompson Health. 

Articles

The coronavirus pandemic has been a seismic disturbance however in a post-COVID-19 environment transformational healthcare trends will be back with a vengeance.

Trends Relevant in Healthcare Before COVID-19 Will Remain So After

As we hit the halfway mark of 2019, it's worthwhile to step back as take a look at what’s trending, what’s getting attention, and most importantly, what’s impacting your business in the healthcare landscape. There are big policy issues to resolve, practical product and operating decisions to be made, and increased pressure from customers making new, market-altering demands. The following healthcare trends provide context as you anticipate change and manage through obstacles and opportunities ahead.

1. The “Medicare for All” debate will rage on

Is healthcare a right, an individual responsibility, or both? Current proposals falling under the moniker of Medicare for All can be slotted into four categories:

Single payer.  Replace private health insurance markets with a government run system.

Public option. Create a new public health insurance plan available to individuals.

Medicare/Medicaid buy-in. Expand access to current federal and state insurance coverages.

Public/private partnership. Structure a program for individuals similar to Medicare Advantage.

At the heart of all these approaches (and their viability) is cost-how will it be paid for? Cost has been the death knell for most healthcare proposals in the past, and with 

predictions that the current Medicare program is expected to go bankrupt

 in seven years, cost will remain the biggest obstacle going forward. Add to the mix that paying hospitals Medicare rates would bankrupt that sector and support from private insurers and pharmaceutical companies is non-existent, and the stars would have to line-up for Medicare for All to become reality. Progressives would have to win the presidency with a Medicare for All as a key agenda item and Democrats have to hold the House and take the Senate with a large majority to pass a bill. And even then, there are no guarantees.

Medicare for All: Four Things Health Executives Should Know

: No need to panic. Stake out a position that promotes and protects your interests and jump into the debate in preparation for the 2020 election-remember, 40% of 2018 midterm voters said healthcare was the top issue facing the U.S.

2. Uninsured Americans on an upward trajectory

The number of Americans without health insurance has increased by 7 million since 2016. Congressional Budget Office (CBO) projects that under current ACA rules (i.e., no further interference from the Trump Administration) 32 million Americans will be uninsured by 2020.

Should the President and Department of Justice’s unwavering efforts be successful in having ACA completely struck down, the total uninsured population in the U.S. would quickly top 50 million. Closing insurance marketplaces and exchanges, ending Medicaid expansion, and eliminating protections for Americans with pre-existing conditions would be significant contributors. Demolishing Obamacare also threatens ACO survival, HIV and opioid program funding, and Medicare Part D out-of-pocket costs.

What’s the endgame? On the eve of the final ACA enrollment deadline this past December, a U.S. District Court judge ruled the ACA unconstitutional. An appeal to the Fifth Circuit Court will resume the ACA challenge (beginning July 2019) and ultimately, it’s likely the next ruling will go to the U.S. Supreme Court for final resolution-stay tuned.

Contingency planning would be smart as the individual and small group insurance markets would be severely impacted if ACA goes away, and uncompensated care and provider bad debt would skyrocket as all those insurance ID cards disappear.

Vertical integration, consolidation of companies that own different parts of value chain, is reshaping the business of healthcare. On top of the dominance of large multi-hospital systems and national mega-health insurers, we’re seeing retail behemoths aggressively stake their claim across verticals in the health care market-from big box store clinics to 

 to aging-at-home to digital commerce. It’s a true ‘blurring of the lines’ in healthcare delivery. The lure of two organizations combining resources in a joint venture, alliance, or partnership is too good to pass up in a turbulent marketplace like healthcare.

The result is collaboration never before thought possible-some are competitors playing defense, others are seeking scalability, and still others simply want to take advantage of a perfect storm of an industry in transformation. Alas, these associations don’t come easy. Balancing financial, operational, and customer needs between multiple parties takes extraordinary discipline, common vision, and mutual trust.

Given the integrators, disruptors and disintermediators reshaping traditional healthcare markets, can you really go at it alone? Cross-industry teamwork brings access to new markets, delivers cost-critical efficiencies, and enhances customer experiences.

4. Healthcare consumerism is a ‘crawl, walk, run’ journey

Whether GenY, millennial, or boomer, they don’t want to engage with the healthcare system the way it is currently structured. They are demanding virtual health, telemedicine, community clinics, wearables, and active aging. And, they want relationships with companies they can trust to make healthcare simple: be there when I need you, communicate with me honestly, deliver an experience that respects me as a person, and do the right thing for my health.

As more and more financial responsibility shifts to the consumer (i.e., the patient is the payer), you have their attention: give me the most for my money for what’s most meaningful and important to me. But, healthcare purchases-from insurance to prescription drugs to routine check-ups-aren’t easy, given health literacy disparities, variations in sites-of-care, and in general, bureaucracy extraordinaire. Getting to the point of being a savvy healthcare shopper able to make confident, value-based choices takes time and experience. In healthcare, the path to self-reliance is long and full of impediments.

Seven Tactics to Create a Lifetime Healthcare Consumer

 Help your customers! As consumers are forced to take more personal responsibility for healthcare decisions they need help making personalized, value-based choices. Why? Because ultimately, engaged healthcare consumers drive better care, better experiences, better outcomes, and better value.

5. Healthcare technology is an unseen power tool

Healthcare’s future isn’t about wearables, virtual care, and artificial intelligence-it’s about experiences, services, and convenience, all powered by subtle, behind-the-scenes technologies that the customer barely sees. Healthcare innovators are using technology to deliver value to their customers that improves experiences and health outcomes. They are leveraging technology to enhance the healthcare value chain by containing costs, introducing infrastructure efficiencies, increasing individual productivity, promoting self-management, and extending life expectancy.

Take the wearable sector, where one in six consumers own and use one. They started out as a wellness tool, a fitness tracker. Now they have shifted to real-time monitoring of a wide range of patient vital signs with promises of becoming an auto-integrated part of the electronic health record, all unseen by the patient. Tomorrow’s health and medical technology solutions will be invisible in our everyday life, removing barriers, creating convenience and inspiring healthcare action. It’s the new normal.

 The less intrusive the better. Connected healthcare consumers are ready to embrace innovation and willing to be engaged through digital health touchpoints. There’s unprecedented opportunity for health brands to emerge as trusted, go-to resources that are there to help consumers take responsibility for their health.

6. A year from now you may wish you started today

As competitors realign, market rules change, and customer demographics shift, successful healthcare companies don’t sit still, they take a critical look at business plans, operating models, customer experiences, and growth strategies. To do this, context is critical: what’s getting attention in the marketplace that may (or may not) have influence on your future. Here’s a few additional health trends to add to your watch list:

. Physician shortage or not, primary care is at the center of modern care delivery through large organized networks, medical home care models, proliferation of retail clinics, value-based payment, and in-home care delivery.

. An individual’s economic situation and social determinants (nutrition and food, education and literacy, work and home, guns, and addictions) have twice the impact on their health than biology, DNA, and clinical care.

. Cannabis, both medical and legal recreational, is estimated to emerge as a $166 billion industry segment and will become a part of America’s healthcare fabric (medical claims, treatment protocol, workplace rules).

. Changing peoples’ behavior to deal with and improve their health-breaking health inertia-means motivating them to action through personalized emotional drivers and gut-level appeals such as fear, joy, self-esteem, and hope.

. Crisscrossing generations-depression, anxiety, addiction, psychoses, dementia-means identifying and paying attention to warning signs and removing the stigma for getting timely, professional support will help turn mental illness to mental wellness.

 Empowered healthcare consumers are using their newfound influence to choose, challenge, and change the conversation with preferred brands. Healthcare is a complex domain with many issues pushing and pulling its multiple stakeholders-make sure you’re prepared

Lindsay Resnick is executive vice president of Wunderman Thompson Health. He can be reached at 

From disruptive technology to regulatory ‘known-unknowns’ to the plight of today’s healthcare consumer, 2019 is shaping up to be a year of extraordinary transformation.

Lindsay R. Resnick, MHA

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