Provider Priorities for 2022: Putting Out Pandemic Fires While Also Acting Strategically

There will be little rest for weary health care providers in 2022.

With the emergence of the omicron variant and surging COVID-19 cases, hospitalizations and deaths, providers must stay on top of the ongoing public health crisis. As the pandemic enters its third year, the terrible strains and stresses on hospitals, physicians and other providers are mounting, including employee burnout, sicker non-COVID patients, and workforce shortages.

Yet it’s not possible to prosper in the long-term while operating in crisis mode indefinitely. The pandemic has highlighted some serious shortcomings in traditional care delivery and payments as well as showcased the industry’s capacity to quickly innovate. In 2022, health care providers need to balance short-term crisis management with decisive and bold strategic planning and execution.

1. Hospitals and physicians need to expedite their move to full risk.

The pandemic has only increased pressure to adopt value-based care and payments. The Centers for Medicare & Medicaid Services have pledged to move every Medicare beneficiary and most Medicaid beneficiaries to programs that are accountable for quality and total cost of care by 2030. CMS also is prioritizing social determinants of health, health equity and access, all of which will improve under population health management. As non-COVID patient volume has seesawed, capitated physicians have had steady revenue and fared much better than those dependent on fee-for-service payments.

In the new year, providers will need to think more like payers and beyond their current footprint when it comes to risk contracting. Hospitals must decide if they are efficient enough to put inpatient operations into risk arrangements or if they will focus primarily on their physician network. Similarly, physicians will need to move more strongly into population health management and preventative care, beyond simply assuring members receive annual physicals, for example.

In all cases, providers need to determine what part of the care continuum they want to directly control and whether to build, buy or outsource to obtain the infrastructure for managing total cost of care and population health. The necessary infrastructure includes data analytics and tools, utilization management, care management and network management.

2. Providers must address macroeconomic trends.

It’s not just personal protective equipment and other health care-specific shortages. Rising inflation is joining with persistent supply chain disruptions, driving up costs and impacting the timely availability of a wide range of goods. With these economic forces expected to continue well into 2022, if not 2023, providers need to reassess and adjust everything from pricing to purchasing.

Providers also are on the front lines of the Great Resignation and competition for talent. The pandemic is badly exacerbating pre-COVID health care workforce shortages, but providers cannot afford to focus solely on filling immediate openings. Value-based care requires new skills, knowledge and behaviors. Attracting and keeping clinicians and allied health professionals for all roles, plus non-clinical employees, demands new approaches to recruitment, retention, training and career development.

Adventist Health, for one, is not letting COVID-19 force it off-track from the long-term workforce development plan that it launched shortly before the pandemic hit. To learn more, see Adventist Health is Building Its Future Workforce Now.

3. Government spending on health care is poised to benefit providers and patients.

Providers and their patients stand to benefit from the $1 trillion Infrastructure Investment and Jobs Law, including plans to extend rural broadband which would support broader telehealth. The larger and still pending Build Back Better Act could deliver a much bigger financial positive for providers, including increasing Medicaid coverage to millions more and making Children’s Health Insurance Program (CHIP) permanent.

Providers need to prepare to take advantage of these federal investments. They can help underwrite the shift to new, more accessible and more affordable care models, such as telehealth, and expand care to include SDOH. Providers should collaborate with health plans, community-based organizations and other partners to build out contracts, provider networks, and technology-enabled tools, training, infrastructure and data sharing.

4. Think like a disrupter, then carpe diem in 2022.

With its complex regulatory environment, reinventing the U.S. health system is no easy feat. It proved too much for Haven, the Amazon-Berkshire-JPMorgan venture that disbanded in early 2021. But that isn’t stopping aspiring deep-pocketed disrupters from Google to Walmart, and given enough time and effort, they will likely succeed.

For traditional providers, then sticking to the tried-and-true, no matter how profitable at the moment, is filled with peril: Think Sears, Blockbuster, Kodak, Toys ‘R Us.

Health systems, hospitals, and medical groups have no time to lose in leveraging their strengths and expertise to lead the change. They need to capitalize on their understanding of the health system, laws and regulations, and competition to successfully innovate—building out provider networks, aligning with the right partners, putting the necessary infrastructure in place, incenting and training clinicians and other employees to change behaviors, protocols and processes.

It takes thinking like a disrupter. If new health care entrants are striving to move more care to lower-acuity settings, traditional providers need to make that leap first—or risk being forced when they aren’t ready or simply cut out altogether.

5. M&A will continue apace, with some caveats.

Some non-traditional players will continue to purchase their way into health care while payers buy more providers and providers acquire other providers. Still, the Biden Administration has signaled greater scrutiny for some mergers and acquisitions, such as UnitedHealth’s proposed purchase of Change Healthcare. And rising prices for providers could deter some buyers.

Providers need to assess whether buying other providers is the best strategy for achieving their goals. Clinically integrated networks that share data and financial risk, for one, might be a better alternative to pricy M&A.

In 2022, the persistent pandemic and its ripple effects will continue to dominate the daily lives of providers, whether that’s treating COVID patients, scrambling to fill open positions or caring for non-COVID patients who often are sicker because they postponed medical attention. But providers must also bring discipline and purpose to setting up their organizations for longer-term success. For both challenges and opportunities in the new year, the answer will most often lie with accelerating the shift to valued-based care and payments, including building the essential experience and infrastructure to succeed.

To help you assess and pursue 2022 priorities, please contact info@copehealthsolutions.com.