Three Healthcare Trends to Watch in 2023

In the past decade, we have seen remarkable changes in our healthcare system. The aftermath of COVID-19 and financial downturns paired with rapid technological advancements has redefined everyone’s experience - whether patient or practitioner. No one can deny the world is drastically different since ten years ago, particularly within healthcare. 

With the ever-evolving healthcare industry, here are three trends we anticipate will reshape how we experience healthcare in 2023.

The Need for Value-Based Administration

In recent years, the concept of value-based care (VBC) has gained traction as healthcare providers and payers strive to improve patient outcomes while managing U.S. healthcare spending. A staggering 94% of health system executives anticipate that value-based contracts will only continue growing in upcoming years.

In order for VBC to be truly successful, all stakeholders must believe that the contract terms are fair. It may be challenging to find contract structures that meet the expectations of all network participants. In addition, network participants must have easy ways to share and validate data. Participants must also meet changing and complex regulatory requirements when engaging in value-based care. The role of value-based administration (VBA) is to help participants actualize value-based contracts.

The current claims and clinical workflow-based technology investments that exist in the payer and provider space lack the capability to administer value-based arrangements on a large scale. It is impossible for them to manage complex care networks with various stakeholders while also meeting requirements of quickly changing payment models. The only feasible solution here is to extend these essential legacy systems.

VBA allows for important data collection and sharing, enabling the creation of hierarchical partner models that are specifically designed to maximize value. By utilizing digitization-based approaches, VBA can provide businesses with the tools necessary to execute successful and rewarding programs.

VBA also offers whole-person care by unifying medical and nonmedical services to enhance patient outcomes while minimizing healthcare costs. When applied effectively, VBA encompasses all aspects of the care process - data capture, sharing, payment systems - across any setting (site-based, virtual, home or community). Moreover it can be scaled up easily for larger operations.

Capitation Gains Popularity

As healthcare costs continue to rise, capitation is becoming an increasingly popular option for healthcare providers. Capitation is a payment model in which a provider receives a flat fee per patient over a certain time period, regardless of the number or type of services provided. The goal of this method of reimbursement is to allow providers to better manage costs while still providing quality care. The fixed-fee structure should be designed to encourage preventive care that can help reduce long-term medical expenses. 

Additionally, by removing the financial burden of billing and collecting associated with service-based reimbursement models, providers are able to focus more resources on providing quality care rather than the administrative burden of fee-for-service models. Ultimately, this makes it easier for them to provide more personalized and comprehensive treatment plans that can improve patient outcomes and satisfaction. For these reasons, capitation is proving to be an effective and efficient way for healthcare providers to manage costs and deliver quality care.

Moving forward, look for capitation to quickly become a more popular payment model for healthcare providers as the demand for more affordable healthcare increases.

Continued Investment in AI

In 2023, the market forecast of artificial intelligence (AI) and machine learning (ML) tools in healthcare is projected to reach a staggering $20 million. In addition, various AI-aligned technologies such as computer vision, natural language processing, and pattern recognition algorithms are already gaining traction within the healthcare sector due to their effectiveness. With continued evidence of successful use of these technologies in 2023 they will become more common than ever before.

 It’s no secret, AI is reshaping the world of medicine, with applications such as drug discovery where AI can anticipate results in clinical trials and identify potential side effects. Additionally, AI has been used to detect various neurological illnesses like Parkinson's Disease or Alzheimer’s Disease through the analysis of medical images by computer vision algorithms. It truly is amazing how far this technology has come - its potential for life-saving use cases are endless.

Natural Language Processing is currently being used by companies like ForeSee Medical to help discover diseases that may not have been diagnosed by primary care physicians. Improvement in comprehensively documenting patient disease burden is keyed to higher quality care and improved outcomes.

Apart from its main use in clinical work, AI and ML can be utilized to automate tedious tasks such as processing insurance claims or managing medical record keeping. It is also used to mine data collected from patient wearables or virtual hospital settings that could provide earlier detection of certain diseases - a trend which will continue over the coming year. With these varied applications in mind, we have good reason to believe that artificial intelligence and machine learning are here to stay in healthcare.

Final Thoughts

Looking forward, 2023 will be a pivotal year for healthcare. The need for value-based administration is being seen as an essential component in achieving a successful transition towards value-based care models. Additionally, capitation is expected to become increasingly popular as a payment model and investment in AI/ML focused technology is on the rise. These three trends are likely to lead to improved health outcomes, better patient experience and cost savings in the long run. As the healthcare landscape continues to evolve, providers should keep an eye on these developments in 2023 to stay ahead of the curve and best serve their patients.

For healthcare organizations looking to succeed in the transformation to value-based care delivery models, including the Medicare Advantage Program, ForeSee Medical is a specialized software platform for accurate Medicare risk adjustment. Through artificial intelligence like proprietary medical algorithms and natural language processing, ForeSee Medical optimizes HCC coding, empowering providers to positively influence health outcomes.

Blog by: The ForeSee Medical Team