It’s the start of a new year. It feels like the start of a new era in many ways, particularly in healthcare. This is partly because of two significant acts of legislation published in 2021 that will impact insurers in 2022 and beyond.
Health Insurer Trends
Here are four trends health insurers need to be aware of and pay attention to as we head into the new year.
Trend #1: Transparency and consumer protection regulations
Consumer protection regulations continue to roll out in the tech space, causing changes within the insurance industry. For example, the No Surprises Act requires insurers to share cost data information with consumers earlier in the treatment cycle. At the same time, insurers in 2022 will need to start publishing their negotiated rates as part of the Transparency in Coverage rule.
The result of the combined effects of the No Surprises Act and Transparency in Coverage rule is that insurers and healthcare providers will soon get to a point where they are accurately quoting services well in advance of patients undergoing a procedure.
Trend #2: A shift to value-based care
The Center for Medicare and Medicaid Services (CMS) closely examined the various value-based care model programs in their arsenal over the past year. Then, it paired them down to focus on what’s working and what can be eliminated.
As CMS continues to push forward with its efforts to provide value-based care to patients across the country, many commercial insurers and large provider groups will also start to prioritize keeping populations healthy rather than focusing solely on earning revenue from procedures.
Trend #3: Climbing drug costs
In 2022, we expect to see drug costs continue to climb. Currently, specialty drug spending is higher than the combined costs of traditional and generic drugs. In 2020, out-of-pocket costs for consumers skyrocketed to $77 billion, representing a $1 billion increase from the previous year.
The costs of new genetically-tailored specialty drugs will continue to soar in 2022, leading insurers and the US government to seek out innovative ways to lower costs. Congress has tried (unsuccessfully, so far) to give Medicare the power to negotiate prices. As a result, insurers have turned to specialty pharmacy solution providers and teamed up to create wholesale arrangements with manufacturers. The need for collaboration and innovation will continue to increase as pharma manufacturers continue to make specialty drugs.
Trend #4: COVID-19 remains a wild card on the market
We’re not done with COVID-19 yet. In 2022, the virus and its variants will continue to ripple through the market, causing uncertainty and shifting healthcare costs. For example, healthcare costs plummeted in 2020 as people stopped having elective procedures. However, by 2021, prices had returned to near 2019 levels for many procedures. At this time, it is uncertain whether that will continue in 2022 or whether new variants (such as the Omicron variant) will cause more ripple effects on the healthcare market.
One thing we do know for sure is that telehealth is here to stay. It was already an option before the pandemic. Now that doctors and patients have become accustomed to virtual visits, telemedicine will become a mainstream form of healthcare rather than a novelty.
Nothing is certain going into 2022 in the healthcare industry. However, these trends are certainly worth paying attention to if you’re an insurer.
HealthLink Dimensions has several options to help health insurers navigate the uncertainty of the new year. Our HealthLink Insurer options include the provider database HealthLink Directory and HealthLink Insight, which allows insurers to evaluate network adequacy and provides a single source to compare healthcare transparency pricing.