Skip to main content

Greenville Business Magazine

Health Care Trends For 2021

By Liv Osby

The health care landscape is always changing but the coronavirus pandemic has accelerated that trajectory and led to some developments that are likely here to stay.

From technology and vaccines to public health funding and disparities, experts say the innovations and actions growing out of the pandemic will be felt for years to come.

A more rapid increase in technological innovation, as illustrated by the development of the Pfizer and Moderna mRNA vaccines, is among the biggest changes, said Dr. David Blumenthal, president of The Commonwealth Fund, a nonpartisan, nonprofit think tank that works to improve health care access and quality.

“This pandemic has exemplified the way that innovation in biomedicine can help the average person,” he told Greenville Business Magazine.

“The mRNA technology … will be the target of lots of investment from the private sector,” he said. “It has wide potential application not only for vaccines, but development of medicines.”

And that is likely to spur substantial increases in the National Institutes of Health budget as Congress recognizes what science is able to do, he said.

Others, like Windsor Sherrill, professor of public health sciences and associate vice president for health research at Clemson University, say the growth in telehealth that occurred during the pandemic will be permanent.

“For 30 years we’ve been wringing our hands to figure out how to get health systems, patients and insurers to adopt telehealth,” she said. “Then along comes Covid and there has been just a paradigm shift.”

About a quarter of all outpatient encounters were done via telehealth during the pandemic, she said, as Medicare funded more of those services and private insurance followed.

“I believe now that reimbursement is beginning to embrace telehealth, we will see it as part of our system forever,” she said. “And that has implications for access to care. You can’t put providers in every rural community.”

Former U.S. Surgeon General Dr. Regina Benjamin agrees.

“A single mom … can’t take off a whole afternoon to go to the doctor for her blood pressure, but she … can find a quiet place for a telehealth visit,” she said. “Access is improved, there’s better contact with the physician, and the outcome can be better.

“Telehealth is here to stay.”

Psychiatric care is one area where telehealth exploded during the pandemic, said Dr. Nabil Natafgi, assistant professor and associate director for the Master of Health Care Administration program at the University of South Carolina Arnold School of Public Health in Columbia.

And he expects it will continue because a lot of questions about payment and quality of care have now been answered.

“There’s more appreciation that telemedicine could work,” he said. “Based on what many (insurers) say, it seems this is going to stay. A lot of patients are liking it.”

“My 82-year-old dad never would have voluntarily had a televisit with anyone. Now he’s Mr. Telehealth,” said Dr. Christine Carr, a senior clinical advisor to the South Carolina Hospital Association and professor of emergency medicine and public health at the Medical University of South Carolina.

“And everything we can do to continue that will be good,” she added, “including for reimbursement to keep up with the changes.”

An increase in health care wearables and devices that patients can use at home to monitor their health is also driving telehealth, she said.

Lior Rennert, assistant professor of public health sciences at Clemson University and an infectious disease epidemiologist and biostatistician, says the shift to telehealth will also reduce administrative costs and save time.

For example, he said, a patient has to get to the doctor 15 minutes early to fill out paperwork at every visit.

“Every time I go to the doctor’s office, I have to fill out the same form, over and over, and I think, ‘Isn’t there a record of this somewhere?’ ” he said. “You don’t necessarily need someone to fill out a bunch of forms when they can do it online.”

But Blumenthal said that while telemedicine was vastly underused before the pandemic, many people want to see their providers in person, and there are functions that must be done in person as well. So he thinks predictions of its future growth are overstated, adding that in-person physician visits are close to what they were before the pandemic.

Rennert says we’ll see a greater integration of data reporting as a result of digital health expansion that could benefit society.

“We set up infrastructure for health systems to start reporting to central data systems (as a result of Covid),” he said. “And after Covid, I’m hoping that leads to outcome reporting for a variety of diseases.”

That will enable a greater reach to underserved communities allowing for the identification of at-risk areas and needed resources, he said.

The use of data analytics during the pandemic also accelerated the move toward value-based care as opposed to fee-for-service in terms of reimbursement and health, Sherrill said.

“We’ve been pushing toward this for the last 20 years, but Covid pushed it harder,” she said. “If we’re getting more comfortable with our algorithms to drive health care decisions, those are considered valuable tools for population health management. And we can do a better job of preventive care.”

General Benjamin says the move toward value-based care will not only improve health, but is more cost effective as well.

Sherrill said she’s feeling optimistic about the future of health care.

“If we can have technology totally change how we buy groceries or book a vacation, it has to have positive changes in health care,” she said. “And using IT in ways that benefit health is a good trend.”

While some advocates expect the pandemic will likely lead to increased funding for public health, Dr. Georges Benjamin, executive director of the American Public Health Association, says it’s too soon to tell if that will happen.

Historically, he said, government takes a short-term approach – throwing money at a public health emergency too late and when things return to normal, funding is cut again.

“Once we get control, will we revert to the old patterns of underinvestment in health, or make strategic investments to build a first-class system … so the next health threat to the community can be rapidly identified and we can address the problem?” he asked. “We don’t know the answer.”

The nation hasn’t made major investments for so long that the public health system has suffered, he said, pointing out that earlier in the pandemic, the nation’s surveillance system was incapable of identifying the coronavirus variants.

“We keep trying to do public health on the cheap,” he said. “But we have to spend and rebuild the public health system - the sooner the better.”

Rennert said that funding typically only follows emergencies. But the U.S. Centers for Disease Control and Prevention is awarding $2 billion to all 50 states to improve public health in underserved communities, especially related to Covid, but also in planning for future pandemics, he said.

For instance, he said, South Carolina has a fleet of mobile units that were first used for testing and subsequently for vaccination that can be repurposed for other urgent health issues later on.

Blumenthal said the government made a historic investment in public health through the American Rescue Plan, providing hundreds of millions for training public health professionals and for public health infrastructure that will be “game-changing” for many states.

“That was inconceivable before the pandemic, and will be one of (its) most lasting legacies,” he said. “One only hopes they will put it to good use for hiring, modernization, upgrading of state labs, and for testing for infectious diseases - all the things states are supposed to do, but often fail to do because of lack of investment. The needs are great.”

The federal infrastructure legislation also would provide more funding for public health technology, which is essential to knowing things like who’s getting sick, where the ventilators are and how much PPE is in stock, he said.

Alwyn Cassil, a principal at Policy Translation, an independent Maryland-based health care consulting firm, says there will be great interest going forward in looking at issues of inequity and racial and ethnic disparities in health care, which have been highlighted by the pandemic.

“Using the medical system to address social determinants of health is the most expensive way you can deal with the problems of lack of transportation, housing, food insecurity,” she said.

Georges Benjamin agrees, saying much of what needs to be done involves policy changes as opposed to funding.

“Our society is much more aware of the broad societal inequities that manifest themselves in the health system, and the Biden Administration has tried to build equity in everything they’re doing,” he said. “I believe that will be a centerpiece in everything they do, from housing to climate change to health issues. It requires treating people equitably.”

Equity is also an issue when it comes to health insurance. And many Americans lost coverage during the pandemic when they lost their jobs as industries closed temporarily or shuttered permanently – an impact felt disproportionately among low-income workers and minorities.

“It was already a problem in our country and now it’s worse,” said Sherrill. “We’ve got a lot of catching up to do.”

She said she anticipates the Biden Administration will shore up the Affordable Care Act to allow more to be insured.

The APHA’s Benjamin also expects there will be an expansion of coverage in the ACA, and hopes states will consider expanding Medicaid as well.

Carr hopes there will be expanded coverage because a substantial portion of patients she sees in the ER are uninsured.

“It breaks my heart to have a 29-year-old manager at McDonald’s come in with an ankle sprain and there’s nothing I can do about their $3,000 bill because they have no insurance,” she said.

Cassil said there is also perennial interest in lowering health care costs.

While the nation spent less on health care over the past year because it didn’t use as much, that trend will revert to pre-pandemic levels in the next year as the virus recedes, Blumenthal said. And that could translate into higher prices and less competition.

“We will see a return to normal rates of use,” he said. “And we may actually see higher prices for the reason that there will be fewer providers of care because some have been damaged economically and some of them will close or merge with others, so there will be less competition and more consolidation in health care markets, which is not good for consumers.”

Health systems, which were operating with a 2 percent profit margin before the pandemic, saw a “huge loss of revenue” as they stopped elective procedures for months, Sherrill said. As a result, half of all hospitals had negative margins in 2020, she said.

Federal Covid relief packages provided significant aid to health care systems for their lost revenues, she said. And while they may get back to the same level of revenue in the next year, it will be difficult to make up the losses, she added.