2021 Healthcare Trends: What Leaders Need to Know from COVID-19 to New Administration Policies

After a turbulent, COVID-19 dominated 2020, healthcare leaders, policymakers, and the U.S. public are eager to know what 2021 holds. Pressing concerns include persisting and emerging pandemic challenges, the long-term effects of COVID-19, future emergency preparedness, and how the Biden administration will impact healthcare—notably, the future of theAffordable Care Act(ACA).

2021年的医疗保健趋势主要分为三类:医疗保健政策、护理提供和技术。行业可以通过了解这些类别中需要关注的关键领域，以及哪些事件和活动可能影响医疗保健生态系统，为未来做好准备。

2021 Healthcare Trends in Policy: What to Expect Under the Biden Administration

With President Joe Biden’s inauguration on January 20, the healthcare industry will be watching for the new administration’s priorities around the ACA and its COVID-19 plan, as well as who will be on the administration’s healthcare team and on which policies it focuses.

The Affordable Care Act

While ACA repeal was a constant threat under the last administration, the Act looks more secure following recent developments. The ACA’s future likely hinges on the constitutionality of the individual mandate and potential severability under theCalifornia versus Texas美国最高法院目前正在考虑此案。

The California versus Texas case came to the Supreme Court from a federal appeals court. If the Supreme Court affirms the appeals court ruling, the case will go back to the federal district court to decide on the issue of severability of the individual mandate from the rest of the ACA. At the November 2020oral argument, it looked like the Supreme Court, including one or more of the new justices, was inclined to honor the doctrine of severability, making it less likely the ACA will face complete repeal. Additionally, the new slim Democratic majority in the Senate (thanks to the Georgiarunoff) makes it likely that Congress would fix the constitutional problem by reinstating the mandate with a nominal penalty.

《平价医疗法案》还包括许多受欢迎的、以患者为中心的项目，这使得它不太可能被废除。其中包括对已有疾病的个人的保护，对26岁以下儿童的父母医疗保险，以及通过交易所获得更多健康保险的机会。Popular on the healthcare-industry side arevalue-based care(VBC) and theMedicare Shared Savings Program. These programs and are likely to continue, regardless of the ACA’s future, because they enjoy bipartisan support.

The Biden administration may also take steps to strengthen aspects of the ACA, such as making more resources available for demonstration projects, and raising tax credits and subsidies to purchase insurance on the exchanges. These actions may be attainable within the framework of the existing law and wouldn’t require new legislation.

The Biden Healthcare Team

The Biden administration has made a number of appointments and nominations to fill healthcare positions, with notable roles including the following:

• 泽维尔·贝塞拉(Xavier Becerra)，卫生与公共服务部部长(加州司法部长，前美国众议院议员)。
• Jeffrey Zients, COVID-19 Coordinator (previously led Healthcare.gov turnaround).
• Vivek Murthy，卫生局局长(曾在奥巴马政府中担任卫生局局长)。
• Carole Johnson Chair, National Pandemic Testing Board (New Jersey Human Services Department commissioner and former Obama administration official).
• Cyrus Shahpar, COVID-19 Data Director (CDC official, and FEMA official in Obama administration).
• 美国国家过敏症和传染病研究所所长安东尼·福奇(现任美国国家过敏症和传染病研究所所长)将继续担任拜登的首席医疗顾问。
• Sonya Bernstein，高级政策顾问(HHS官员)。
• David Kessler, Chief Scientific Advisor to Operation Warp Speed (former FDA Commissioner).
• Rochelle Walensky, Director of the CDC (Chief of Infectious Diseases at Massachusetts General Hospital and Professor at Harvard Medical School).
• General Gustave Perna, Operation Warp Speed COO (to continue to control vaccine distribution logistics).
• Marcella Nunez-Smith, COVID-19 Equity Task Force Chair (a new role) (Professor at the Yale School of Medicine and the Founding Director of Yale’s Equity Research and Innovation Center).
• Osaremen Okolo, Policy Advisor (Senior Health Policy Advisor to U.S. Representative Jan Schakowsky of Illinois).
• 美国卫生与公众服务部副部长安德里亚·帕姆(Andrea Palm)说。

这些任命和提名表明，高度重视COVID-19的恢复以及疫苗的分发和协调。例如，福奇仍然是国家过敏和传染病研究所的所长，现在有一名COVID-19数据主任(Shahpar)，这表明本届政府将强调数据和报告。这些任命还表明，拜登政府重视卫生公平和医疗差距，特别是努涅斯-史密斯担任COVID-19公平特别工作组首任主席。

民主党在参议院的控制也将影响医疗保健。例如，华盛顿州参议员帕蒂·默里(Patty Murray)将担任参议院卫生、教育、劳工和养老金委员会主席。她主张联邦政府对COVID-19采取更有力的应对措施。俄勒冈州参议员罗恩·怀登(Ron Wyden)领导财政委员会，并推动药价改革和药价谈判。

Biden Administration Priorities

2019冠状病毒病是拜登政府的首要任务，在可预见的未来可能也会如此。Vaccine distribution will dominate the first six months of 2021, with federal effort focused on the expansion of testing, contact tracing, and better public health reporting from states and localities up to the CDC and other federal agencies

数据收集和扩大数据使用对拜登政府正在进行的COVID-19应对至关重要。政府建议为各州和地方政府的公共卫生响应基础设施(包括登记、报告、监测和仪表盘)提供资金。奥巴马政府还计划扩大确保患者数据安全的平台的可用性，并扩大数据使用权，使研究和监测能够使用和披露数据。世界杯厄瓜多尔vs塞内加尔波胆预测这些行动将加快对有效临床干预措施和治疗途径的研究，扩大患者监测，并帮助公共卫生报告和跟踪疫苗分发。

The new administration will also likely push to expand healthcare program funding, including ACA programs and value-based care, and expansion of coverage. The Senate may use the budget reconciliation process to push through a COVID-19 relief package and some healthcare-related policies. Budget reconciliation requires only a majority vote, as contrasted to a supermajority vote for regular legislation. However, budget reconciliation can only happen a couple of times per year, generally speaking, when the budget is up for approval, and is limited to budget-related items.

2010年，预算调整推动通过了ACA的一些条款。虽然《平价医疗法案》的一些扩张、增加补贴和税收抵免可以通过预算调整实现，但这一过程不适用于与联邦预算无关的更大的健康政策问题。These bigger picture items include issues such as a public option, Medicare for all, and lowering the Medicare eligibility age to 60.

The following policy priorities, if the administration adopts them, would also help the nation better prepare for future emergencies at the health system, local, state, and national levels:

• A national patient matching strategy, such as implementing a national patient identifier, will be critical in public health emergencies to enable healthcare organizations to link patients across providers and health information exchanges and surveillance and contact tracing efforts.
• 持续支持整个医疗保健行业的互操作性和对信息封锁实践的强制执行也将加强应急准备。
• 为国家流行病/大流行信息网络的发展提供资金，该网络将包括全面改革CDC的数据汇总和报告系统，并在ehr中强制执行医疗保健数据词汇标准。

The Biden Administration COVID-19 Plan

The Biden administration has released itsNational Strategy for the COVID-19 Response and Pandemic Preparedness这是一项1.9万亿美元的计划，国会截至2021年2月初一直在辩论。Although Congress will likely approve a reduced COVID-19 relief package, some notable features of the proposal include the following:

• 一项全国疫苗接种计划，包括向各州、地方、部落和地区提供200亿美元，在全国各地建立社区疫苗中心和流动疫苗接种单位。
• Enhanced testing and contact tracing, including $50 billion to expand testing, including in-home and instant tests, and funding the hiring of 100,000 public health workers to assist in vaccine distribution and build public health capacity.
• Equitable distribution of tests, treatments, and vaccines, including addressing disparities in the equitable distribution of vaccines and supplies and expanded services and vaccine availability for underserved populations.
• Domestic production of personal protective equipment (PPE), including fully utilizing theDefense Production Actto increase the production of masks, face shields, and other PPE, a $30 billion investment in theDisaster Relief Fund以及100亿美元用于扩大生产能力。
• 支持部落政府应对COVID-19，包括投资200亿美元，提供个人防护装备、清洁水、电力、教育互联网、远程医疗等。
• Public health surveillance, including expanded surveillance of new strains of COVID-19 and monitoring effectiveness of new treatments and therapies.
• Support for first responders and essential workers, including $350 billion in emergency funding to state, local, and territorial governments to ensure support of frontline workers (e.g., in healthcare, education, and vital services).
• Preserve and expand healthcare coverage, including subsidizing COBRA continuation through the end of September 2021 and expanding and increasing thePremium Tax Credit.

2021 Healthcare Trends in Delivery

与医疗政策一样，2019冠状病毒病将继续推动2021年的医护服务。大流行将影响医疗保健的发展，病毒的影响和代价将在很长一段时间内影响医护服务。关键的关切领域包括COVID-19如何继续影响卫生系统、临床医生、提供者、患者、VBC项目和医疗服务提供变化，以应对未来的大流行。

The Toll of COVID-19

As of early February 2021, theWashington Postreported that COVID-19 deaths had reached over 2 million worldwide. This number included more than444,00 deaths全球有超过1亿的病例。

In Figure 1, below, fromCenter for Disease Control (CDC), the bottom line shows the expected deaths in the United States for any given year. As of January 23, 2021, the actual observed numbers of deaths were well above the threshold for excess deaths.

The above numbers represent a tremendous burden on COVID-19 victims and their loved ones and theU.S. healthcare workforce—with both physical and mental impacts. Those working in high-risk departments (e.g., emergency departments (EDs) and ICUs) with infected patients, sometimes with suboptimal PPE access, have felt the most significant impact and experienced the highest mortality. This loss will impact the industry indefinitely. To fill in frontline gaps, many organization team members who usually focus on process improvements in care settings are doing frontline work. This matter reflects the financial impact and the shortage of staff due to COVID-19.

The CDC has responded to the pandemic’s toll withProject Firstline, an initiative for communities and health frontline workers to promote infection prevention and infection control. TheHealth Research and Education Trust,American Medical Association, and theAmerican Nurses Associationco-sponsor the initiative, which provides practical tools and resources to implement infection control protocols in every patient interaction.

COVID-19-Driven Changes to Care Delivery

COVID-19患者的涌入推动了医疗服务体系的巨大变革。According to the Kaufmann Hall National Hospital Flash Report, many individuals are avoiding routine and elective interactions with healthcare, with consequences including a drop in weekly screening for breast cancer, colon cancer, and cervical cancer of between 86 and 94 percent, according to theKaufmann Hall National Hospital Flash Report: December 2020. Foregoing screenings and other preventive care will have a long-term impact on healthcare, as early detection and intervention will decrease.

Kaufmann Hall’s findings also showed discharges volumes were down in terms of elective discharges, as were operating room minutes, elective procedures and ED visits in general, and revenues were dramatically down at 14 percent per adjusted discharge. Outpatient revenue (a source of loss for elective work) was down 6 percent compared to an inpatient revenue drop of 1 percent.

As healthcare consumers have made fewer routine and elective visits, organizations have felt a financial impact, hitting ambulatory and hospital settings. Operating margins have fallen dramatically, with a5 percent到2020年底，全国范围内的利润率下降。TheCARES Actprovider relief has given some support to the healthcare delivery system, but 2020 margins still declined nearly 2% compared to 2019. (Figure 2,Kaufman Hall National Flash Report: December 2020).

A Light at the End of the Tunnel but More Challenges to Come: The COVID-19 Vaccine

In 2021, on the other side of COVID-19’s tolls, is a light at the end of the tunnel: the COVID-19 vaccine. By the last week of January, the United States averaged around1.5 millionvaccinations a day.

Despite encouraging vaccination numbers, distribution is meeting challenges. According to theKaiser Family Foundation, some Americans are hesitant to receive the vaccine, a preference that appears to correspond to political orientation, ethnicity, age, and urban or rural setting (Figure 3,Kaiser Family Foundation).

As of December 2020, people in their 50s and older, urban residents, those with a household member with a health condition, Democrats, and Hispanic adults appeared more likely to get the vaccine, and women were more likely than men. Interestingly, healthcare workers were a little cautious, with 29 percent hesitancy.

One of the best chances for more comprehensive COVID-19 vaccination among U.S. populations is for primary care physicians to become a recognized information source about the vaccine. According to aKaiser Family Foundation poll, 85 percent of patients regard their healthcare provider as the most trusted source of information about the vaccine.

2021 Healthcare Trends in Technology

作为COVID-19在整个医疗保健领域的深远影响的延伸，大流行也影响了医疗保健技术，加速了一些变革，并显著展示了该行业的灵活程度。医疗保健数据分析、人工智能和远程医疗能力已大规模扩展，以支持大流行的应对和恢复，这一趋势可能会继续推动医疗保健技术。

Data and Analytics Are Increasingly Central to Health System Operations

2019冠状病毒病使利用数据和先进分析成为许多卫生系统的核心需求。为了满足实时数据或接近实时数据的需求，这些能力的扩展已经非常显著。

例如，医院管理人员每小时查看COVID-19仪表板，并使用数据更新其商业智能报告工具。此前，最有用的人工智能应用(AI)和机器学习(ML)可能是预测收入周期趋势，而在更复杂的用途上的尝试，比如用AI读取图像，则停滞不前。现在，COVID-19迫使创新将先进的分析技术带到疾病应对的前沿，使用预测模型跟踪病毒，并估计COVID-19对症状严重的患者的风险，从而实现更有效的治疗。

Health systems are rapidly expanding their support for a digital workforce, including the chief information officer (CIO) role. The CIO is playing a larger role in an organization’s strategy, risk management, and cybersecurity. The EHR has expanded and will likely continue to evolve with digital and voice assistance and natural language processing. With such clinical IT developments, including augmented reliable and wearable technology so that patients can make decisions in real-time with real data, the digital workforce and CIO roles stand to continue to grow.

Telehealth Is Here to Stay

COVID-19带来了对远程医疗的迫切需求，以便在诊所或办公室以外为患者提供护理，并抵消因门诊就诊减少而造成的经济损失。According to aMcKinsey study, the number of patients using telehealth increased from 11 to 46 percent in 2020, with growth likely to continue. McKinsey predicts telehealth could account for 20 percent, or $250 billion, of U.S. healthcare spending in the near future.

虽然向扩大远程医疗的过渡正在进行中(包括围绕可访问性和报销的政策变化)，但医疗保健技术仍需要适应持续的转变。卫生系统需要与现有技术平台和战略进行更大的整合，以解决网络安全和隐私问题。世界杯厄瓜多尔vs塞内加尔波胆预测通过这种方式，远程医疗是另一个将增加对数字劳动力和医疗保健cio需求的领域。

Through Loss and Recovery, a Silver Lining

医疗保健行业开始了被COVID-19彻底改变的2021年，仍在努力恢复和寻找方向。尽管医疗保健领导人和专业人员正在从2020年的重大损失中恢复，但随着大流行的继续和复苏的开始，他们将继续面临挑战。新一届联邦政府将借鉴大流行期间迄今为止吸取的教训、现有数据和行业专家，以加快疫苗分发，使国家恢复正常。由于大流行病的应对和复苏，护理提供模式和技术的变化已经加快，并将继续加快。也许一线希望是，医疗保健行业、患者和提供者将继续受益于这些护理服务和技术的积极发展。

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

1. The 2021 Healthcare Financial Forecast: What to Expect, How to Prepare
2. Healthcare Trends During COVID-19: Top Five Areas to Watch
3. Value-Based Purchasing 2020: A 10-Year Progress Report
4. Telehealth: A Top Organizational Performance Solution During COVID-19 and Beyond
5. 2021 Changes to the Quality Payment Program: Must-Know Guidelines for ACOs