Avalon Healthcare Solutions hosted a webinar covering updates to federal programs and the importance of member-centricity in the future of healthcare. The webinar content included:

Electronic Prior Authorization

Digital prior authorizations may be on the horizon. A new task force composed of industry veterans and federal stakeholders (HITAC) is championing fast-track prior authorization. The plan includes incentives for health systems to adopt EHR systems and certified health IT under certain conditions outlined. “This is a sea change in how prior authorization will take place; it will change from a slow process to an electronic federally mandated process,” says Julie Barnes, a federal policy expert.

Direct Access Testing

What is direct access testing and who performs or produces this testing? This type of testing began in the 1950s with urine glucose and ketone testing. These days, an entire menu of tests is available online for direct access by consumers, split into two high-level categories: at-home testing and self-testing. “COVID-19 brought home-based testing into focus for a greater population,” says Mike Snyder, EVP of Avalon Networks.

Direct-to-consumer tests are also growing in complexity and scope. One company is marketing a test that analyzes your hormone levels day-to-day to predict fertility. Ultimately, the global direct access testing market is projected to grow at a 26% compound annual growth rate over 10 years, proving it is a sector of the healthcare industry to watch.

The “Me” Generation: Navigating Patient Choice

Over the past years, there has been a seismic shift by health plans from volume to value-based care. As part of this change, member-centricity and personalized care have taken precedence. In addition, members have come to expect more from their healthcare experience, seeking to replicate the digital and product-based experiences they have come to appreciate in retail, banking, and transportation. “Now it is happening in healthcare,” Rahul Singal, MD says, referring to the rapidly evolving consumer-centric focus of health plans.

Health plans have:

•       Data volume, veracity, velocity, and value
•       Relatively large technology budgets
•       The control of financing

Opportunity for health plans to drive outcomes by:

•       Engaging consumers and provider stakeholders
•       Aligning financial incentives (including member)
•       Promoting quality by publishing metrics