In this week’s episode of Tuning In to the C-Suite podcast, MHE Associate Editor Briana Contreras spoke with Ash Shehata, KPMG’s national sector leader for healthcare & life sciences. The two chatted about a recent paper by KPMG titled “From payor to healthcare partner,” which highlights how the pandemic drove changes for plans to adopt a patient-centric model and it gives a look into the six healthcare trends to watch for in 2021.
Below is a brief Q&A from the interview. The text has been edited for clarity.
Q: What are the six healthcare trends to watch for and what should payers do to prepare for them? That's a bit loaded question. But
A: Trend number one is kind of the move towards the consumer, right? What does that mean? Well, it means that, in general, everything in our life is moving towards consumer-valued behaviors. Examples are buying groceries, going to your favorite pizzeria or your local grocery shop. All of those things have moved towards the digital format. I think the first question is, what are those kind of back office things that need to be modernized? Is it my call center? Is it my web infrastructure? Is it a variety of infrastructures that are basically serving consumers? Are they as good as they need to be? Are they as good as they can be? And are they integrating the healthcare delivery?
I think now there's a kind of a really renewed emphasis on wellness. We've talked about new trends like mental health, and looking at new trends around factoring in people's different work environments, and being able to bring care to them, not necessarily driving care to the traditional organization. So I wanted to cover a few of those trends in this consumerism topic, because it really is an important one. It's one that I think can transform the industry and more importantly, is going to transform the value that payor brings to the equation.
I think the second one is when we start to look at some of the newer trends like telemedicine and others, we look at how to make them permanent because a lot of times these capabilities are really embedded in a variety of places in the organization. Sometimes providers have them, sometimes they have them. I think it's about building and weaving these capabilities throughout the entire continuum of care. So to me, that's a very important part of the process. When you start to think about the impacts that could happen, a health plan is not going to be about provisioning sick care anymore, it's going to be provisioning the continuity of care and working with providers differently. Many health plans are entering into all kinds of relationships with providers. Now, some of them are acquiring provider systems, some are partnering, but the idea is how to begin to both put that into kind of a new continuum of care, that makes it much more accessible and transparent.
The third area we'll call it is modernization. In order for these great things to happen, modernization needs to happen. Claim systems need to be modernized. The platforms that we communicate with our payers need to be with our members and need to be modernized. The platforms that we connect to providers need to be modernized. All of those things that we've been kind of getting around to, all of that now is needing kind of urgent attention.
The next focuses on health equity. I think health equity fits perfectly into the "S" part of ESG, and focusing on our societal impact. I think as health plans come out of the pandemic and help sustain our providers, being able to focus on reinvesting in those communities and making an impact, sustainability is going to be a top priority.
Next is looking at some of these new relationships. Think about all of these capabilities that health plans have: now they have PBMs, they have retail capabilities, we're seeing a lot of crossover relationships between retailers, PBMs and grocery chains. It's really being able to kind of rationalize those relationships in a way that's going to start to bring value. It isn't just the payer anymore. It's the payer, the provider, the retailer, the community, and building new business relationships.
Lastly, I think I'm really, really excited about even bringing in new relationships with the tech industry. So to me, the tech industry itself is really fascinating. You look at all the things we can learn as we move to the modern cloud, as we enable capabilities that we've never been able to enable before, as we build new relationships and partnerships. Tech could be the next transformative partner in the health insurance industry. So hopefully, I've tried to enumerate many of them without kind of getting into the stealing the luster of the of the written piece. But I think those are the really big caravans.
Q: What does the reevaluation of telehealth look like in a post-pandemic world?
A: Telehealth was one of those things that came upon the scene. So quickly, you saw the data and the charts - the meteoric rise of the use of telehealth. Clearly, there's been a lot of activity, a lot of acquisition, and certainly a lot of innovation. I think the real question is going to be, where's it going to sell? That's the real kind of operative question. Is it going to be continuing this meteoric rise?
I think in order to answer that question, we have to be able to address how does it become a part of the process everyday. So it can't be one of those things that a provider does in their busy day. So ironically, being able to connect the telehealth visit with the entire patient care record, and building that into the EHR, building continuity around it, making it a truly a patient choice, that they can engage these systems, and it can be connected to everything they do. That is really where the future is. That's going to take back to my earlier point about technology, it's going to take some additional technology be able to do that, right, it's gonna be taking additional talent and make it sustainable, and completely transparent to the user and the provider.
If you were to really ask providers, they kind of have a mixed opinion on that. Some of them think it's the best thing and then maybe they've transitioned much of their practice, the majority of the providers that have to live in this mixed world have a difficult time doing both. I think payers have a very unique opportunity to help harmonize that. To make it much more tactical, make it much more approachable and make it much more consumer friendly, while being able to modernize it at the point of care. Ultimately, you're probably going to see multiple telehealth solutions, you're going to see provider based one payer based ones retail based ones. You might even see some that are very specialty around for example, behavioral health. So I think the kind of the sky's the limit, but I think building that architecture for telehealth, probably one of the more important things to do.