19 Jan Five Top Challenges Facing Healthcare in 2022

We blinked and 2021 has somehow transitioned into 2022. With any new year, we all face the challenges that often come with it, and the healthcare industry is no exception. New regulations, increased demands, and accelerated use of technology have left the door open on a few challenges from 2021 and opened the door to some new ones for 2022. Throughout the upcoming year, here are five top challenges facing the healthcare industry and how HealthTrio can help health plans overcome them:

Cybersecurity and Data Protection

Data breaches and issues with cybersecurity have been widespread since healthcare became more reliant on technology. Hosting information online leads to vulnerabilities that can cause severe damage and unwanted cost if proper precautions to protect sensitive data are not in place. According to a recent report by IBM and Ponemon Institute, a data breach in 2021 cost $4.24 million – not a small price to pay to recover from such an intrusive attack.¹ When outlining the steps to take for tighter data protection, it is important to look beyond your internal operating procedures. If you are using any other organizations or vendors for some of your services, include them in your action plan. About 60% of data breaches happen because of third party vendors.² When making a purchasing decision, evaluate your vendors based on their commitment and policies to protect your member’s data. Ask questions during the vetting process to ensure their infrastructure and technology will keep your sensitive information safe.

Interoperability & Connecting Disparate Systems

Each payer, provider, healthcare system, and third-party vendor stores and maintains different data sets in multiple, disparate, systems and databases. The now live CMS Interoperability and Patient Access Final Rule (CMS-9115-f) as of July 1, 2021, created a challenge by regulating the data standards and mandating the availability of the data using standard APIs. The framework of an entirely new ecosystem was made law.

The challenge in 2022 is going to be making the ecosystem a reality and having cost-effective data exchange among healthcare stakeholders. Many payers have not yet implemented the changes needed. For the payers that have, the unanswered question of whether they are fully compliant remains. Additionally, the market is awaiting new regulations and clarifications in the areas of payer-to-payer data exchange and prior authorization that will also be built on the new FHIR framework.

Meeting and maintaining the Interoperability requirements is expensive. With the right partner and proper planning and coordination, this challenge can be overcome. As the first and only portal solution with full API integration into the market-leading claims systems, HealthTrio’s dedication to interoperability leads to better outcomes and lower costs. Payers looking to offset the high costs of meeting the regulatory requirements by standing up and maintaining the FHIR standard infrastructure and APIs can contact HealthTrio here.

Consumerism & Price Transparency

Findings in a 2019 survey released by Sage Growth Partners found that 69% of national healthcare leaders note consumerism as a top priority, and they do so for good reason.³ Federal rules, like the price transparency mandate from CMS (CMS-9915-F), have been put in place that make it mandatory for health insurance companies to share their pricing publicly. These requirements pave the way for healthcare consumers to gain transparency into the options they have available to them, allowing for more educated healthcare purchasing decisions.

The CMS mandate outlines that “personalized out-of-pocket cost information, and the underlying negotiated rates, for all covered health care items and services must be made accessible to the health plan’s participants, beneficiaries and enrollees through an internet-based self-service tool and in paper form upon request.” As mentioned on their website, “an initial list of 500 shoppable services as determined by the Departments will be required to be available via the internet based self-service tool for plan years that begin on or after January 1, 2023. The remainder of all items and services will be required for these self-service tools for plan years that begin on or after January 1, 2024.”⁴

As this deadline quickly approaches, health plans need to determine, within the next couple of months, their best path forward. This path should include giving their consumers the tools they need through their member portal to be smart and proactive about their healthcare decisions. If your health plan is still determining how to best prepare for the January 1, 2023 deadline, we can help. One of HealthTrio’s team members can provide insight into the requirements and how our consumerism and cost transparency solutions solve these.

Big Data Utilization

Health plans are collecting vast amounts of data on their members, providers, and more. Once they have this data, the question becomes ‘what should they be doing with it?’ One answer: providing a member-centric user experience through personalization. Many plans have not fully tapped into capabilities brought forth through data analytics. Knowing information about your members through the data you collect allows you to provide them with a more targeted user experience through educational content and tailored health recommendations. Imagine logging into your member portal and seeing information pop up to educate you about a recent diagnosis. HealthTrio’s personalization engine makes this possible.

Improved Health Outcomes & Better Patient Experiences

When the focus is placed on improving patient experiences and their overall well-being, the opportunity for better outcomes rises. Each of the four challenges previously mentioned, combined with the need for better collaboration between providers, members, and care management teams inside the health plan, factor into our overall ability to impact health outcomes. When each provider only has their narrow view into a patient’s profile, collaboration between all the member’s providers and care team is near impossible. HealthTrio’s Shared Health Records and Shared Care Plans features open the door for this high level of integration among all key stakeholders on the care team, keeping the team working together towards the overall goal of better outcomes.

Follow our blog throughout the year as we take a deeper dive into each of these challenges and uncover how HealthTrio’s solutions help to overcome them. Eager to learn more now? Contact us for an introductory call to HealthTrio and to schedule a demo of our platform.