Anticipating the Future: A Glimpse into 2024's Healthcare Landscape

The coming year holds promises and pitfalls that will shape the way we approach health and wellness. In this article, we present a series of predictions spanning the realms of innovation, provider engagement, CMS guidance, and the ever-present influence of politics on healthcare policies.

1. Innovation Unleashed: Specialization of MA Plans

In 2024, the landscape of Medicare Advantage (MA) plans is set to undergo a radical shift. The larger national players are embracing specialization, expanding Special Needs Plans (SNP) offerings, and introducing or expanding affinity MA plans tailored to various demographic groups. This strategic move aims to attract consumers by offering differentiated services catering to specific ethnic, gender, and veteran status groups. Beyond altering plan designs, this evolution aligns the financial and prioritization aspects of these plans with the goal of closing health achievement and access gaps among diverse populations. For both consumers and insurers, this shift is seen as a win-win, fostering a more inclusive and responsive healthcare ecosystem.

2. AI's Year of Proving ROI

If 2023 was marked by the buzz surrounding Artificial Intelligence (AI), 2024 is the year of reckoning. Organizations, eager to avoid being labeled as late adopters, face the challenge of delivering tangible value through multiple successful ROI use cases by year-end. However, amid this push for AI integration, the industry is grappling with fundamental questions about its application, especially in driving clinical and care management decision-making. Expectations are leaning toward more focused AI models, narrowing their range of use cases to provide greater clinical certainty. This shift may slow down overall development but emphasizes the efficient deployment of AI models across the expansive technical infrastructures of insurers.

3. Provider Engagement in Crisis

As staffing shortages worsen and clinicians opt for early retirement, provider engagement is predicted to reach crisis levels. The rise of clinician unions becomes a formidable force, inspired by the success of actions like the Kaiser Permanente strike. Healthcare organizations ignoring the well-being and satisfaction of their staff risk not only losing profit margins but also market share. The voice of underpaid and underappreciated clinicians is poised to become a central theme in the healthcare narrative.

4. Provider Consolidation Dynamics

Provider consolidation, a trend that has been reshaping the healthcare landscape, is expected to witness a shift. While consolidation slows in primary care, it accelerates in specialty care and the acute space. The industry recognizes that the next frontier in value-based care delivery involves roll-up and consolidation in specialty care. This shift is likely to impact the dynamics of healthcare delivery and bring about changes in how specialized services are offered and accessed.

5. CMS Guidance: Health Equity in Focus

In response to the growing emphasis on health equity, CMS is anticipated to embed Health Equity principles further into the fabric of Medicare Advantage (MA) and Dual Special Needs Plans (DSNP) benefit structures. As part of an election-year strategy, CMS is expected to release additional guidance and standardization measures for health equity. This move aims to address disparities in healthcare access and outcomes, making it a pivotal year for policies that prioritize inclusivity and fairness.

6. HCC Coding Evolution

With the roll out of version 28 of the HCC coding model in 2024, health plans, provider groups, and care management organizations face a crucial juncture. Successful adaptation to this new coding model becomes imperative for meaningful medical cost management and utilization reduction. Organizations that previously thrived as coding-centric organizations will face challenges, signaling a shift towards a more collaborative and integrated approach to healthcare management.

7. Election Year Dynamics: CMS Rate Increases

In the backdrop of 2024 being an election year, the perennial cycle of political inertia is anticipated. However, for Medicare Advantage, the expectation is for CMS and the administration to ensure rate increases are steady. This stability aims to ensure benefits for seniors remain largely unchanged during the Annual Enrollment Period (AEP) season.