In 2020, healthcare AI will move far beyond chatbots to earlier indications of chronic disease and lower costs.
Health Plans

2020 market forecast: 2019 trends materialize

November 13, 2019
In 2020, healthcare AI will move far beyond chatbots to earlier indications of chronic disease and lower costs.
Molly Gallaher Boddy

With another year already drawing near an end, Geneia is busily assessing how our tools and services will further support our payer, provider, health system and employer customers in 2020. So today on the blog, I’m sharing a few of the trends that we think will capture the market’s attention during the coming year. While some of the themes are familiar, having driven healthcare innovation for the last several years, these trends should be underlined for 2020 due to quickened pace of the market and growing customer expectations.

1Greater – and broader – need for value-based analytics

As Definitive Healthcare recently reported, value-based care is no longer a choice for a growing number of organizations as more mandates come into existence. 

  • In August, I wrote on the blog that increasing pressure from CMS means that hospitals and health systems are being pushed into value-based arrangements, their payer peers. Hospitals and health systems have specific analytics needs, and we expect that more targeted prescriptive reporting will help them drive better results in 2020.
  • In addition, providers—whether they are part of an ACO, standalone practice or health system—will increasingly be pushed to meet certain cost and quality standards as CMS zeroes in on the preventive power of primary care. Health Affairs reports that “the proportion of ACOs taking on any downside risk is generally increasing across all ACO types and sizes, with some important patterns emerging.”

It seems that physician-led ACOs are more willing to take on downside risk, but we anticipate that hospital-led ACOs will eventually do the same and need the help of population health vendors to succeed. Further, Health Affairs notes that “CMS is also planning a rapid expansion of other value-based options beyond ACOs,” which will open up a wider market for value-based care analytics as well as services in 2020.

2The new normal of “disruption”

We’ve written for some time now about non-traditional industry disruptors, but I’d propose that in 2020, “disruptions” will begin to be accepted as a kind of standard across our industry, much as they are in other verticals. For vendors and consumers, it seems to be a given that healthcare technology and outcomes must increasingly move at the pace of Amazon to maintain relevancy.

  • Increased pace and a digital approach to healthcare will be particularly important to leading the market in two specific areas this year: employer healthcare and Medicare Advantage. 
  • Amazon’s (and joint venture Haven’s) recent activity focuses on several key areas that can lower employer healthcare costs: telehealth and a virtual medical clinic offering, prescription delivery options, and a Centers of Excellence approach that prioritizes employee travel for low-cost, high-quality care. 
  • In the Medicare Advantage space, meanwhile, competition is fierce and does not allow for healthcare’s typically conservative approach to technology. To succeed here, plans must do everything possible to effectively control the cost of chronic conditions and expensive prescriptions. Walmart and other retail vendors have already recognized this huge market opportunity, with Walmart leveraging a combination of in-store and digital assets to provide partnerships with major Medicare Advantage plans, convenient healthcare services, access to affordable prescriptions and various healthcare supplies to seniors. Plans will find themselves increasingly collaborating with various technology and retail vendors to differentiate (or realistically, just keep pace) in Medicare Advantage. 
3The power of healthcare AI

Despite the healthcare industry’s historic lag when it comes to market-leading technology, we predict that 2020 will be the year we see healthcare AI move far beyond chatbots and physician transcription, instead increasingly translating into lower costs, better care, streamlined operations and earlier indications of chronic disease. While the industry still has unanswered questions around patient data usage, privacy and general integration or connectivity, our AI team is hard at work on disease identification models because buyers require better ways to reach the right members or patients at the right time, catching their shifting disease state or high-cost trend before it reaches unmanageable levels. 

To effectively practice population health, an eye to populations that will become sicker or higher-cost—rather than a focus only on those that are today—is quickly becoming the new standard. Better analytic insights are needed to achieve this; simply put, to quote a recent TIME article: “AI and Health Care Are Made for Each Other".

4Patient experience, continued

We said it at the beginning of 2019, but it’s worth repeating at the close of 2019. Pleasing the consumer—whether they be the member or the patient—will be one of the primary goals of healthcare technology vendors in 2020. Recent consolidation, partnerships and general market activity all support the idea that consumers must have more options when it comes to their care, as well as stronger alliances with their physicians and health plans.

The above trends represent only a few of the market forces we are responding to in 2020, but the continued march towards value-based care and growing focus on patient experience are helping shape Geneia’s innovations for clients and partners.

Stay tuned for our thoughts on themes at HIMSS20 as well as a trends progress report in mid-2020.