2021 Payer Strategies Build on Telehealth, Gene Therapy Lessons

In 2021, payers will expand upon lessons learned about telehealth and gene therapy in 2020 as they implement their strategies in the new year.

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Now that telehealth utilization has become more widespread, payers will work toward integrating virtual care and telehealth.

Over the course of the pandemic, payers had the opportunity to use telehealth and virtual care in a variety of contexts. As a result, the healthcare system has more data on what uses are best suited to telehealth.

For example, the data reinforced the fact that telehealth and virtual care are excellent modes of care for behavioral and mental health needs. One payer saw over 1 million telehealth claims between February and May 2020 and 50 percent of those telehealth visits were related to mental healthcare.

However, beyond behavioral and mental healthcare utilization, diagnostic work and some primary care services have also emerged as areas that can benefit from telehealth utilization. Virtual care’s role in chronic disease management and specialty care is expanding, according to some payer experts.

Payers will also need to grapple with how to approach gene therapy coverage in 2021. Throughout the pandemic, the healthcare industry and the public at large have been clinging to the hope of a gene therapy that would cure the coronavirus. As a result, the pandemic underscored the demand and the impact of these types of treatments.

In 2021, payers will now want to return to creating innovative, new payment models for expensive gene therapy treatments. CVS Health and Aetna reported that care coordination is key to lowering costs around gene therapies.

Payers can also implement value-based care contracts in which pharmaceutical companies can be held accountable for drug therapies that do not meet certain quality metrics.

One of the biggest takeaways from 2020, however, is that the future is unpredictable and that at times historical data cannot prepare healthcare organizations for coming events.

As a result, experts are predicting that real-time data collection will become more essential to forecasting the future in healthcare.

A little less than 75 percent of health executives told PricewaterhouseCoopers that they planned to increase investments in predictive technology in 2021.

Working off of recent data can help organizations both on a macro scale and a micro scale as payers work to identify widespread potential crises more quickly and to prevent health crises in individual members’ lives, PricewaterhouseCoopers pointed out.

Additionally, collaboration with other healthcare industry stakeholders can help inform payers’ efforts to observe trends and respond quickly.

Healthcare Strategies explored these and other trends in its recent special episode on 2021 expectations across the healthcare industry.