Many facets of healthcare remain in a state of flux at the close of 2022, as care practices that started during the pandemic found their way into the mainstream, and enthusiasm for new data sources and interoperability outpaced the realities of implementation.

Verinovum’s SWAT (Strategic Workforce and Tactics) team has been closely following these trends and has made predictions about how nine of them might play out in 2023.

1. Payers will start to feel the pain of ad hoc implementation of FHIR servers

Many payers, forced to comply with federal requirements of Fast Healthcare Interoperability Resources (FHIR) server implementation, had little time to strategize data feeds and server utilization. This requirement, aimed at streamlining data availability for payers and patients, increased the quantity of available data to the detriment of clinical data quality, creating a lag in the utility of this data for advanced applications.

2. Vendors will be subject to more data quality scrutiny

The fall from grace of IBM Watson and Google Health artificial intelligence healthcare solutions may have occurred in 2021, but the reasons behind these failures remain unaddressed. Little attention has been given to the faulty data foundations underpinning advanced health IT applications like risk modeling, care intervention, and machine learning. Gaps in quality and mistrust of data will continue to plague this space until data quality is formally addressed, causing more turnover and shelving of valuable workflow tools.

3. The NCQA Data Aggregator Validation program will initially gain steam, but then stall until the realities of data access and actionability are addressed

The thesis for the National Committee for Quality Assurance’s Data Aggregator Validation certification was noble and brilliant – leverage technology to supplant a labor-intensive NCQA HEDIS^®1 auditing process. The challenge, however, is that the new requirements essentially migrate human labor from the provider to the vendors processing and curating the data, thereby mitigating cost savings. The current program is a step in the right direction but will struggle until technology is generally accepted as a means to parse, normalize, enrich, and score data assets. NCQA has committed to review its processes and investigate ways to automate the data-quality process. We’re excited to see where this goes.

4. Social Determinants of Health (SDoH) data analysis will gain traction

Once again, SDoH generated a lot of buzz over the past year. But much of the data required to make SDoH meaningful for a patient population is either not standardized or tracked, or it’s tracked by tools without standard export/interoperability frameworks. NCQA’s push for race and ethnicity data for value-based contracts on behalf of payers has moved this conversation to the forefront and provided financial incentives. This prediction hinges on whether EHR vendors will step up and support United States Core Data for Interoperability (USCDI)/FHIR data standards for the creation, storage, and transport of more robust social determinant data.

5. Clinical Data Integration (CDI) programs will be pushed to publish their data quality practices

Gartner has long pushed CDIs as necessary technology to support next-generation payers and providers. Historically, CDI solutions have been synonymous with data aggregators, but 2023 will allow for a formal divergence of the two solutions and place far greater importance on data quality practices and appropriate lineage/audit requirements of advanced data curation and enrichment. CDIs without these data quality efforts will fall to the wayside.

6. Healthcare organizations will be challenged with managing even more data

The flow of data shows no signs of slowing in 2023, as more data types are incorporated from a growing number of sources. This data has limited value, however, without a method to ingest, organize, standardize, and normalize it into actionable information that impacts providers and patients. The onus will be on healthcare organizations to make the most of the data deluge. These organizations, already working with limited resources, will flounder.

7. Value-based care will become more popular

As health systems are struggling financially and payers face rising healthcare costs, they will be looking into various programs, such as value-based care (VBC), to offset costs. Medicare saved $1.6 billion in 2021 through its Shared Savings Program, which works with accountable care organizations. In addition, Medicare has a goal for 2030 whereby all beneficiaries to be treated by a VBC provider.

8. Care delivery numbers will see a decline

About 40% of consumers declined care in the past year because of a high-cost estimate, and the fear of surprise bills prevented others from seeking care. One-fifth of those who did opt for care spent more than they could afford. When consumers forgo healthcare to save money, preventive care suffers, which exacerbates chronic conditions and results in ever more expensive treatment options. The vicious circle continues.

9. Patient use of patient portals will decline

On Nov. 17, the Cleveland Clinic began charging for MyChart messages requiring a “provider’s medical expertise,” joining a handful of other health systems that charge for certain electronic messages. The rise of virtual appointments during the COVID pandemic has blurred the line between message and “e-visit,” and consumers will be reluctant to pay for a service that was once free.

Conclusion

These predictions highlight the need to address the issues of data quality, curation, and utility that are paramount for healthcare’s evolution in 2023. At Verinovum, we aim to remedy the pervasive problem of poor-quality clinical data with our Data Curation as a ServiceSM approach, so that clean, high-quality clinical data can inform reporting and actionable insights. Learn more at www.verinovum.com.

¹HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).