The Rise of the ‘Payvider’ and Other Healthcare Trends to Watch

The rise of the “payvider” — joint ventures between payers and providers — is one of this year’s “Dirty Dozen” healthcare trends to watch, David Nash, MD, MBA, said at the virtual 2020 Population Health Colloquium.

“We’re going to see the Big 5 — Cigna, Aetna, Humana, Anthem, and all the rest — reaching out and connecting with provider groups in ways we could never have imagined,” Nash, founding dean emeritus of the College of Population Health at Thomas Jefferson University in Philadelphia, said Monday during this year’s colloquium. “This is especially true post-pandemic because of the exigencies in the marketplace, the layoffs, and the $10 billion loss on the provider side; it’s a really important trend.”

Other trends identified by Nash, a regular columnist for MedPage Today, included:

• “Another century, another pandemic.” Nash dedicated this year’s colloquium to the late Li Wenliang, “the young ophthalmologist who first brought the world’s attention to bear on the outbreak of a serious respiratory illness in Wuhan — a city of 11 million, larger than any city in the United States. We owe a great deal to the valor of Li Wenliang.” Li eventually caught COVID-19 — from a patient who had not been identified as infected — and died at the age of 33.
• The 10th anniversary of the Affordable Care Act. “All the research evidence shows that when you have access to care and appropriate coverage, your health improves,” said Nash, adding his concern that there are “forces at work in our society who want to bring an end to Obamacare.”
• Unacceptably high healthcare costs. A grim milestone has been reached, Nash said: “The average American family lucky enough to have health insurance — their premiums and out-of-pocket expenses exceed $20,000 a year, while the average American family income is at $60,000 a year. This is an untenable situation for the future.”
• The recognition of racial unrest in the country. This includes the Black Lives Matter movement and “all the other issues surrounding decades of inequality.” Nash said he was happy that his own institution “and many other organizations now have a person in the C-suite — the chief diversity officer — whose sole responsibility is to bring further recognition and education to the issues about diversity. Kudos to all of our colleagues in this role.”
• Further consolidation in the marketplace, including the growth of larger and larger integrated delivery systems, “not only at the national level … but even in our marketplace, even at Jefferson,” said Nash. “Unfortunately, at the moment, the research evidence about the growth of these large delivery systems is a little tough — research evidence does not support the fact that these organizations are delivering higher quality or are safer. We need to do some more work to demonstrate the value of the growth of consolidation in the marketplace.”
• The digital transformation of healthcare. “Telemedicine, telehealth, digital health — whatever term you like to use — clearly has had an amazing rise in popularity, especially for primary care doctors,” he said. “There has been growth in the for-profit telehealth industry, especially in the last 7 months … some have called this healthcare’s Amazon moment.”
• The rise of robots in healthcare. “I think robots are going to play an incredibly important role, especially as it relates to helping the elderly to reduce loneliness, and delivering goods and services like prescriptions to your front door, and an even more important role in the inpatient setting,” Nash said.
• Personalized medicine. There are “150-plus new CAR-T therapies pending,” said Nash, adding that people will soon be able to “take a buccal smear, get your genetic makeup, and make a prediction about your own health, even in the primary care doctor’s office — that’s an important trend.”
• The convergence of artificial intelligence, predictive analytics, machine learning, and population health intelligence. That will enable providers to “put data together to create information that is actionable,” he said.
• The growth of the “young old,” sometimes called the “yold.” “Maybe you were as surprised by the recent CMS [Centers for Medicare & Medicaid Services] numbers as I was, that since August, mortality for Medicare beneficiaries who got COVID exceeds 22%,” Nash said. “The young old, the old, and the very old — we are in a jam. Not only are we going to be a greater percentage of the population, but we’re suffering disproportionately from morbidity and mortality from COVID.”

And his final addition to the Dirty Dozen? The election. “One month from today, our republic is at risk,” he said. “I’m not going to make a political statement except to say, this is the most important election in my lifetime and yours and I’m urging you to do the right thing.”