In an uncertain and changing healthcare landscape, shaped by the pandemic and a new administration, here are six hopeful trends that will characterize the next 12 months.
Heightened attention to health equity
The Covid-19 pandemic has placed a spotlight on our nation’s pre-existing health disparities, and this is an area President Biden is committed to addressing. Look no further than the President’s second-in-command to see the increased attention this issue will receive. Vice President Kamala Harris, who, when accepting her nomination as Biden’s running mate, made clear that COVID-19 is “not an equal opportunity offender. Black, Latino, and indigenous people are suffering and dying disproportionately.” Harris has paid special attention throughout her career to address racial disparities in maternal health, frequently noting that black women are three times more likely than white women to die of pregnancy complications.
And with California Attorney General Xavier Becerra tapped to lead the Department of Health and Human Services, it’s expected his team will seek to ensure that Black and Latino Americans have equal access to health services and more inclusive insurance policies (look to Medicaid waivers as a method to expand coverage for the underserved). The Biden administration will likely focus on collecting more detailed and specific data to better understand, uncover, and act on health disparities.
Beyond appointing the most diverse cabinet in our nation’s history, the President also established the White House Health Equity Task Force, to be led by Dr. Marcella Nunez-Smith, founder of the Equity Research Innovation Center at the Yale School of Medicine.
Through prioritizing equal access to COVID-19 testing and PPE, increasing the percentage of physicians and nurses of color to reflect the communities they are serving, and strategizing detailed plans on equitable vaccine distribution, we will see much greater attention to health equity, diversity, and inclusion.
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Greater focus on mental and behavioral health
The pandemic has laid bare the mental health crisis our nation has long been facing—and the woefully inadequate resources we have devoted to it. A combination of provider shortages, inadequate insurance coverage, and social stigma has exacerbated the dire situation. Demand has skyrocketed and far outstripped existing infrastructure and supply. We have witnessed an explosion in behavioral health services provided by telemedicine companies like Teladoc
In an encouraging response, the private sector more broadly is increasingly investing in new behavioral health solutions. Large flows of capital are being redirected to innovative, modern models of delivering mental health services. Venture capital investing in mental and behavioral health in 2020 far surpassed 2019 and quadrupled since 2015. Expect to see even more rapid expansion in venture and mid-market investing in both virtual and bricks-and-mortar service entities in the coming year.
This is also an area where President Biden has shown genuine commitment in the past. As Vice President, he helped lead the Obama Administration’s initiatives to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, designated mental health treatment as essential in the Affordable Care Act (ACA), and hosted the National Conference on Mental Health at the White House. His campaign’s health platform included plans to publish a strategy to address the high rates of suicide among veterans in his first 200 days in office, to double the number of school therapists and psychologists, and to invest in school mental health programs.
Increased bipartisanship in healthcare
Don’t laugh. There actually are areas of bipartisan interest where the current Congress, even with a narrowly divided Senate, can find common ground. These include surprise billing, drug pricing, transparency in prices, and telehealth. Members on both sides have indicated an interest in strengthening domestic biomedical manufacturing and supply chains as well as the antiquated Strategic National Stockpile. The bipartisan “Global Health Security and Diplomacy Act” introduced in May of last year suggests where there may be agreement on a revised, coordinated approach to global health security—something President Biden will be more receptive to than his predecessor.
Expanded adoption of telemedicine and virtual care
While growing explosively during the pandemic, telemedicine has been steadily building its base for decades. While I was in the Senate two decades ago, I worked to build programs establishing T1 lines to Native Americans reservations to provide critical, real-time care to remote regions otherwise without access. As a boy in the 1960s, I witnessed my dad reading from our home in the middle of the night emergency EKGs sent over the analog telephone lines from remote, rural Tennessee clinics.
With rapidly advancing virtual care-enabling technologies, with a cultural shift by providers and consumers to trust and use the technology, and with solid bipartisan support, telehealth will continue to expand. Virtual care and telehealth boomed during the pandemic, with private insurance claims for telehealth increasing an astounding 4,347 percent nationally from March 2019 to March 2020. Over the coming year telehealth will be permanently embedded in care delivery, with providers planning and financially budgeting for a larger percentage of virtual care, an estimated 10 – 30% of total patient visits post-COVID-19.
Innovative technologies will continue to move care toward the home. Such person-friendly and affordable devices include Kardia, a medical-grade EKG developed by AliveCor that detects atrial and ventricular arrhythmias and shares them with a physician within 30 seconds, and One Drop’s kit to measure blood sugar levels. TytoCare’s at-home kit combines a number of portable health monitoring devices that share data with providers instantaneously. Frost & Sullivan conservatively predicts that by 2025 telehealth will be seven times its current size, with a compounding annual growth rate of 38.2% over the next 4 years.
Government played a huge role in this fast-paced revolution toward virtual care. Emergency regulatory measures speeded access and enhanced reimbursement for telehealth services, rapidly accelerating physician adoption and removing traditional bottlenecks in administrative decision-making. For many of these gains to be made permanent, Congress, with support of the Biden Administration, must act.
Reentering WHO and the Global Health World Stage
President Biden reentered the World Health Organization (WHO) on his first day in office, reversing the previous administration’s hasty and what most believe ill-advised withdrawal.
Biden also directed the U.S. to support the WHO-launched Access to COVID-19 Tools (ACT) Accelerator and join the multilateral COVID-19 Vaccine Global Access (COVAX) Facility, an organization tied with WHO, teaming with 171 other countries to develop and distribute vaccines equitably around the world.
This quick reinstatement of US support is highly symbolic of America’s intention to reenter the global stage on a broader front. However, it will take time and renewed commitment on multiple fronts before the United States will re-earn its former preeminence as a credible and trusted partner in global health. In 2021, expect to see the United States continue to find ways to rebuild public health relationships with our allies.
Reenergizing the Affordable Care Act
The Affordable Care Act is here to stay. The administration and Congress will act to strengthen it at every turn, initially focusing on buttressing the Exchanges with enrollment incentives and increased subsidies.
On his first day in office, Biden made increasing ACA subsidies a major platform of his $1.9 trillion COVID-19 relief plan. And in his first week, he signed an executive order opening a Special Enrollment Period for Americans to sign up for health coverage on the ACA exchanges, running from February 15 through May 15. Already, more than 200,000 Americans signed up on HealthCare.gov during the first two weeks. The order also directs federal agencies “to reconsider rules and other policies that limit Americans’ access to health care” including demonstrations and waivers “that may reduce coverage or undermine the programs, including work requirements.”
President Biden will continue to use executive orders to undo changes the previous administration made to weaken the law. These include such issues as reinstating the 90% cuts in community outreach, restoring the 84% cut in grants to those assisting with ACA enrollment in their communities, and reestablishing the longer ACA sign-up period shortened by the Trump administration. It is likely that the administration moves to limit enrollment in short-term, limited coverage insurance plans, some of which skirt preexisting conditions.
As the Biden Administration works with Congress to shore up the ACA, the third branch of government, the U.S. Supreme Court, still has the ability to upend their plans. The Court heard oral arguments in November challenging the constitutionality of the law, with a Texas-led coalition arguing it should fall since the mandate that it rests on was essentially eliminated when Congress zeroed out the tax penalty in 2017. On February 10, the Biden Administration told the Court in a letter that the Department of Justice had reconsidered its position and now finds the mandate to be constitutional, a move that’s largely symbolic. The Court’s decision is expected by July. And while the law in its entirety is not expected to be struck down, President Biden does have the advantage of a Democratic Congress that can address changes to the ACA via reconciliation if necessitated by the Court’s ruling.
The next 12 months are brimming with realistic opportunities to more honestly and directly advance equitable access to healthcare, especially for vulnerable populations, and to firmly root virtual health and telemedicine in every aspect of delivery. And opportunities to move services closer to home, to address racial disparities and inequities in care delivery, to assimilate social determinants into all care models, and to more aggressively improve mental and behavioral health. As our nation continues to face enormous challenges amid a ruthless and smoldering pandemic, we see burgeoning hope and opportunity for a more promising health and well-being future.
Acknowledgment: Cate Merriman Frist contributed to this article with research and editorial assistance.