Industry Conference Trends in Review: First Half 2023

As we approach the second half of 2023, we’ve been reflecting on the trends we’ve seen at the industry’s largest conferences and comparing them to our conversations with analysts, vendors, and customers. There has been a lot to take in, but three trends in particular stand out as the most timely and prevalent for health plans and providers alike.

Below is our recap of the most significant trends in healthcare for the first half of 2023.

1. Intelligence (AI) is everywhere
   The release of ChatGPT has reignited conversations about AI’s role in the business of healthcare, as evidenced by the massive turnout at HIMSS23 pre-conference AI session that drew a crowd of over 700 attendees.According to Forbes, the AI market for healthcare is forecast to top $20 million in 2023. Whether out of fear of missing out, fear of sentient machines vying for world domination, an optimistic belief in the power of AI to help improve the world we live in, or simple curiosity, AI has captured the attention of healthcare stakeholders across the world. So, let’s explore a couple of ways AI is helping transform healthcare in 2023.
   • Natural Language Processing (NLP) for automated and faster workflows
     • NLP is a type of AI that’s able to process language in a human way. For example, ChatGPT is a chatbot that uses NLP to formulate intelligent responses by analyzing unstructured data as input. The healthcare industry is increasingly relying on NLP to automate and speed up workflows by taking unstructured data inputs in multiple formats (like PDFs) and compiling that data into an intuitive and accessible output that reduces time, cost, and errors often associated with manual administrative processes. Today, NLP is being used to help health plans and providers solve for risk adjustment challenges, assist in medical necessity reviews, and automate prior authorization by reviewing clinical guidelines and patient records to “create responses that fall within the insurer’s guidelines.”
   • Machine Learning (ML) for clinical predictions
     • ML refers to AI’s ability to absorb and apply new information in real time, which helps AI programs make better predictions that can aid in patient care, analysis, and decision support. ML is increasingly being used to “assist with predicting outcomes of clinical trials and potential side effects of new drugs…” It’s also being used to help with administrative or clerical work, like processing claims and even helping to accurately and preemptively predict approval or denial status of prior authorizations.
2. Mandates continue to drive the creation and adoption of modern technologies
   In a highly regulated industry like healthcare, organizations must be agile enough to adapt to regulatory changes—and move quickly enough to meet regulatory deadlines. One way healthcare companies are doing that is by implementing SaaS and cloud-based technological infrastructures so their tech can adapt in real time to changing legislation. Here are some of the forthcoming regulations we are keeping our eye on.
   • Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule CMS-0057-P
     • With the primary goal of improving patient access to their healthcare data to enable better care coordination, experience, and outcomes, the Interoperability and Patient Access mandate was a massive step for the industry, as it enables subsequent rulings leveraging the required FHIR® APIs to improve other processes in healthcare. Once health plans put an interoperable infrastructure in place, they’ d be able to leverage that investment to improve the prior authorization process. Among other requirements, the proposed Rule CMS-0057-P would require health plans to build and maintain a FHIR® API that would automate the prior authorization process for providers and drastically shorten the time for approval.
   • 2024 Medicare Advantage and Part D Rate Announcement
     • According to CMS, the primary intent of the final notice is “to advance health equity; drive comprehensive, person-centered care; and promote affordability and the sustainability of the Medicare program.” This will require health plans to create new configurations for their IT systems and reassess interventions like In-Home-Assessments (IHAs). Analysts are also warning that plans may experience a 3-5% reduction on payments. Providers may experience more penalties for inaccurate or incomplete coding swaying incremental value for health plans. As a result, health plans and providers will need to assess their existing tech infrastructure to ensure the most accurate and streamlined risk scoring and coding to optimize care, understand risk, and secure accurate payments.
3. Interoperability is facilitating much-needed collaboration across the entire healthcare ecosystem
   Today, there is little uniformity in data and workflows across healthcare systems. These disparities make it difficult to exchange data and glean the insights needed to reduce costs and improve member/patient experience and outcomes, and to effectively deliver value-based care. A fully interoperable healthcare system is required to meet mandates and is key to succeeding in value-based care and delivering a member/patient-centric healthcare system. Here are three reasons true interoperability must be realized to facilitate collaboration.
   • Create a positive member/patient experience
     • Consumers have come to expect a robust customer journey and a seamless digital experience when engaging with organizations in any industry—and healthcare is no exception. Unfortunately, there are thousands of systems in use across the healthcare spectrum, each with their own unique configuration; as a result, healthcare data does not seamlessly transfer across provider organizations or between health plans and providers. Research has shown that engaging in the four levels of interoperability directly correlates to the rate of patient information available at the point of care.
   • Reduce costs
     • The variance in design and configuration of EHRs and health plan systems makes it difficult for just one person—or even one team—to master all of them. This results in the need to employ multiple subject matter experts (SMEs), each with their own unique area of expertise, to cover the entire range of systems. Interoperability can significantly alleviate the burden of managing, securing, and administering multiple IT platforms. Additionally, interoperability can facilitate shared automated workflows to reduce time and money spent on manual administrative processes.
   • Enhance value-based care to improve outcomes
     • As we continue to move towards value-based care models, robust data collection and the ability to transfer that data easily and securely where it is most needed will play a crucial role in minimizing risk and improving outcomes—both of which are critical to succeeding in value-based care.

Our healthcare system is complex, with multiple competing trends and priorities at any given moment. In our view, maintaining a strategic focus on these three trends will be essential to achieving all your organization’s objectives.

If you are interested in having a conversation about how Edifecs is helping unify and move healthcare forward for the betterment of all, contact us.