This article was originally published in MedCity News on March 10, 2023 here.
Sometimes you have to look back to see forward. We can clearly identify the key patterns that affected the healthcare industry over the past 12 months. Several of the themes that dominated in 2022 provide hints as to where the sector might be headed in 2023 and beyond.
Summary:
- Medicare Advantage (MA) enrollment saw an 8.8% increase since 2021. To meet the rising demand, numerous MA plans expanded and the number of plans doubled since 2017. Despite some calls to curtail the program, MA received bipartisan support in the Senate, effectively snuffing out any curtailment efforts.
- Payviders, a payer-provider hybrid, began to proliferate in 2022. Favored by Wall Street, the “payvider” will continue to grow in 2023 since it is proving to be a cost-effective business model.
- Over the past few years, OIG has increased its funding for fraud, waste, and abuse. This year CMS doubled its audit budget. Hence, this year will see a tightening of the regulatory environment.
- The Inflation Reduction Act of 2022 benefited ACA plans, as subsidies were extended to 2025.
- In 2022, TEFCA, also known as the Trusted Exchange Framework and Common Agreement, created a baseline for interoperability across the nation. This year many software organizations are creating technologies that support interoperability.
- The COVID-19 public health emergency is set to expire in May and may not be extended for an additional three months. This will likely have several implications for the healthcare industry.
Even though it is already 2023, the major trends from 2022 are still having an influence and will continue to do so for the rest of the year. By reading this article you’ll have a head start on what to anticipate for the rest of the year. Use this information to have your most productive and prosperous year yet in 2023.
To read more, visit our article in MedCity News here.
Episource
Episource is a leading provider of risk adjustment services, software, and solutions for health plans and medical groups. As an integrated platform, Episource empowers commercial, Medicare, and Medicaid health plans with end-to-end risk adjustment solutions, including risk adjustment analytics, retrospective chart reviews, and encounter submissions.
Harshith Ramesh
Co-CEO
Harshith is primarily responsible for new product development and global operations. Prior to joining Episource, he was in the investment banking industry, focusing on M&A, restructuring, and capital markets assignments. He has worked for a range of global institutions, including Moelis & Co.; Bain & Co.; and Bear, Stearns & Co. Harshith earned his BA at Tulane University and his MBA from the Wharton School.
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