Healthcare is one of the largest and most complex sectors in the U.S. economy. While backed by a strong system of research and development, many barriers exist that place enormous strain on the healthcare industry’s infrastructure, workforce, and supply chain.
The COVID-19 pandemic remains one of the most grueling challenges in healthcare. In addition to treating patients ill with coronavirus, physicians are now experiencing a stream of sick patients who delayed care during the pandemic. Coupled with the nation’s mental health crisis, the new year is expected to be filled with uncertainties.
The media has been abuzz with news of healthcare reform, and with recent changes in both employer-sponsored and government-run health insurance, it is important to stay informed. Take a comprehensive look at the state of the healthcare industry trends during this period of transformation and what new possibilities await us in 2022.
Healthcare Industry Trends
Modern healthcare has been shaped by a new administration and the pandemic. In recent months, new trends have provided insight as to what changes to expect in the upcoming year. One of the biggest trends relates to the availability of telemedicine. In response to the COVID-19 pandemic, many employers and private insurers have increased telemedicine coverage to allow more patients to get the care that they need.
Employees are also gaining more mental health benefits. The pandemic has had a strong effect on the mental health of many Americans. Many marketplace and employer-sponsored plans have now been enhanced to include mental health and substance abuse coverage as essential health benefits.
There has also been a rapid shift towards care delivery within the home. An increasing senior population, along with a high number of COVID-19-related hospitalizations, has resulted in larger demand for at-home healthcare benefits. The need for alternative care delivery models for at-risk or older individuals is believed to help reduce the spread of the virus and alleviate pressure on hospital staff.
Healthcare trends have also focused on better benefits for caregivers. Approximately one in six Americans are caregivers, according to the Family Caregiver Alliance. With a rising demand for caregivers, many employers are making the essential move to provide support through increased mental health benefits and caregiving assistance programs.
COVID Mandates, Vaccines, and Boosters
New COVID-19 mandates and recommendations offer benefits, but also pose certain challenges in the healthcare sector. On November 4, the Biden administration ordered certain healthcare workers, federal contractors and businesses with more than 100 employees to show proof of their full COVID-19 vaccination status or undergo weekly COVID testing. This vaccine mandate has a deadline of January 4, 2022, although is currently facing some opposition.
The Biden administration has also instructed the Centers for Medicare and Medicaid Services (CMS) to create a rule that requires employees in healthcare settings that receive either Medicare or Medicaid reimbursements to develop and implement COVID-19 vaccination and testing protocols.
While receiving COVID-19 booster shots has not yet been enforced by the federal government, it is still highly recommended. Approximately 23 percent of all fully vaccinated adults in the U.S. have received a COVID-19 booster shot, according to the latest KFF COVID-19 Vaccine Monitor report. There has also been discussion about whether the definition of “fully vaccinated” will ultimately evolve to require boosters. However, for now, boosters are optional.
Health Insurance Enrollees’ Top Concerns For Healthcare Industry Trends
Over the last decade, the U.S. has taken countless measures to improve healthcare and the overall patient experience. However, a survey published by Public Agenda revealed that just 7 percent of Americans are satisfied with the current U.S. healthcare system. Problems range from poor quality of care and lack of transparency to high costs of services and difficulty finding a qualified physician. Shortages and inefficiencies in the healthcare industry have also made it more difficult to keep pace as demand increases.
Health insurance enrollees remain concerned about many aspects of their plans and benefits. Some of the most common problems identified include the following:
Surprise Medical Bills
Surprise medical bills are a common problem in the U.S. According to the Kaiser Family Foundation, there are millions of unexpected medical bills each year that affect both the uninsured and fully insured. If a health plan does not cover out-of-network care, the insurance company could completely deny coverage. Alternatively, the patient may be responsible for paying the difference between what is charged and what the insurance covers, a practice referred to as balance billing.
A patient may receive a surprise medical bill if their treatment was not covered by their health insurance plan. This occurs commonly in emergency situations, such as when an ambulance takes a person to an out-of-network hospital where their care is not fully covered. Surprise bills can also arise for services that are not always fully covered, such as an ambulance, emergency surgery, or life flight.
Fortunately, changes are being made to the way that surprise medical bills are handled. In July 2021, the Biden administration issued a rule to protect consumers from surprise medical bills by restricting excess out-of-pocket costs to consumers from surprise billing and balance billing. The interim final rule also bans surprise billing for emergency services and high out-of-network cost-sharing for both emergency and nonemergency services.
There are also other things that people can do to prevent having to pay surprise medical bills. First, contact the number on the bill to ensure that it was not an error. Second, patients should request a copy of their medical records from their provider with itemized charges to ensure that all information is accurate. Records should include procedures, medications, surgeries, consultations, and billing codes.
Prescription Drug Costs
People in the U.S. are paying more for prescription drugs now than ever before. A growing number of patients are paying deductibles and coinsurance based on the list price of prescription drugs. There are several possible reasons for rising out-of-pocket drug costs, but the most obvious is that drug manufacturers are unregulated. This means that they are free to set any price that they feel is appropriate for prescription drugs.
According to a recent survey published by eHealth, 74 percent of general population respondents stated that they feel the federal government should be responsible for directly negotiating with pharmaceutical companies to decrease the cost of prescription drugs. Just 12 percent said that they would not support the federal government getting involved with drug cost negotiations, while 14 percent remain uncertain.
There has been a lot of discussion surrounding prescription drug costs and what can be done to rein in the high costs of these medications. The amount that insurance plans are charging members for drugs has a significant impact on whether patients are able to afford the drugs they need.
Public Option Health Insurance
Public option health insurance refers to a coverage program that is run by the federal government or state and made available alongside existing private health insurance plans. The Affordable Care Act (ACA) legislation originally included a nationwide public option, but it was ultimately eliminated from the final bill due to opposition from Republicans and some moderate Democrats.
There has been much debate as to whether people would support the establishment of a “public option” health insurance plan that competes with private insurers. A survey published by eHealth showed that 54 percent of general population respondents would indeed support the establishment of a public option health plan, while 20 percent would not support it and 27 percent remain unsure.
A public option health insurance is an emerging solution that would create dependable, affordable, and high-quality health insurance. It would be a government-regulated plan that is privately run and made available to small businesses, nonprofit organizations, and individuals.
Some states have already begun to offer public option health insurance. Colorado, Washington, and Nevada all have public options; however, none of them are true public options as they were originally meant to be since they are not set up or run by the government.
How Working With A Benefits Consultant Can Help
It can be challenging to navigate the complex healthcare sector without guidance from an experienced industry professional. Working with a reputable benefits consultant can help individuals gain a better understanding of their health coverage options and what benefits and services are available to them.
The primary role of a benefits consultant is to advise clients in matters relating to employee benefits, including health insurance coverage. Benefits consultants perform some duties that are similar to insurance agents or brokers; however, consultants have a deeper knowledge of group insurance options and employee benefits.
Benefits consultants can provide expert advice on the marketplace, including the strengths and weaknesses of different insurers. They are also knowledgeable about the latest legislative changes in the health industry and can keep clients up-to-date when changes occur that may affect their coverage. Benefits consultants can offer year-round support, answer questions, address concerns, and help manage expectations surrounding service and cost.
The U.S. has one of the most complex healthcare systems in the world, and as a result, changes tend to be slow. However, having a better understanding of the healthcare industry trends and what changes to expect in the upcoming year can help ensure that patients receive the medical services they need at a price they can afford.
Contact New City Insurance To Get Help With Your Health Insurance
New City Insurance is an experienced employee benefits consulting firm that specializes in benefits consulting, tech services, insurance, and compliance. We have worked with countless businesses to keep employees motivated through the delivery of competitive benefits. For more information or to speak with a benefits consultant about your health insurance, contact New City Insurance today.