2023 Trends, Events, and Developments (TEDs) in the Payer World—Focusing on Trends in Hospital Care Models, Access, and Finances

Happy Summer! I am Cynthia Miller, MD, MPH, FACP, Vice President—Access Experience Team, editor of All Access Newsletter. This edition will focus on the current and emerging hospital trends occurring that are impacting hospital finances, access to care, and payer reimbursement.  Our expert ex-payers will provide insights into these trends and developments and how they foresee them impacting the health care system, especially patients, health systems, and the pharmaceutical industry.

Hospital at Home Care Models
Janet Serluco–VP, Oncology Lead, Access Experience Team – Access Experience Team
Janet discusses the growing hospital at home (H@H) care movement that ramped up during COVID.  She reflects on how hospitals will adjust to this new trend and its financial sustainability, as well as how it fits into the value-based care landscape. Finally, she presents opportunities for pharmaceutical companies to engage in this new care delivery model.

Potential Expansion of CMS’s Site-neutrality Payment Policy and Its Impact
Kris Kang–Senior Advisor, Access Experience Team
Kris discusses CMS’s new site-neutrality payment policy, which is a major focus for AHIP.  While this may be a win for payers, there are considerable risks for hospital systems, and it may have long term impacts on consolidation trends. Impacts on specialty pharmacy and site of care strategies will change how pharmaceutical companies need to convey their value story.

Transitions of Care/Home Health: New Models in Value-based Care
Sejal Jonas–Senior Advisor, Access Experience Team
Sejal describes novel approaches to the long-standing problem of health care system fragmentation and transitions of care. New partnerships and disruptors like CVS and Signify Health, Good Rx, and Amazon are attempting to solve for fragmentation as it can lead to poor medication adherence and outcomes. Pharmaceutical companies can also be a leader in this space. Sejal provides recommendations on how manufacturers can support payers and improve the transition planning process.

The Future of Rural Health Care in the US
Barbara Henry–Senior Director, Access Experience Team
Barbara dives deeper into rural hospital closures and the growing rural health care crisis. She discusses new payer policy approaches as well as efforts in the virtual care and digital tool space. She concludes her article with insightful suggestions for pharmaceutical companies to partner with payers in addressing this growing health care gap.

We believe you will find these hospital care TEDs and their impact on market access insightful as you navigate the payer landscape. As always, please feel free to drop me a note and let me know if you have a topic suggestion for the payer team to address, and we’ll do our best to cover it in a future edition.

Best Regards,

Cynthia Miller
MD, MPH, FACP
VP, Medical Director
Access Experience Team
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