2024 Healthcare forecast: Expert strategies to succeed this year

As we venture into 2024, healthcare is primed for significant advancements in technology, analytics, and patient care – but not without its challenges.

The regulatory landscape continues to evolve, forcing organizations to ensure they are accurately following new guidelines and complying with reporting requirements. Mergers and acquisitions throughout the industry are ongoing, challenging outdated processes and driving system consolidation. The potential of artificial intelligence (AI) is only growing, though many questions remain on how to best apply this technology in clinical, operational, and administrative settings.

Now is the time for health plans, providers, pharmacies, and life sciences organizations to harness the full power of data and connectivity to improve healthcare outcomes and economics.

This blog shares expert insights on how to tackle the year’s biggest challenges and seize the opportunities of the moment.

Advancing health plan’s digital transformations

Heading into 2024, health plans are facing more pressure to transform outdated processes with digital-first methods.

In quality reporting, there are emerging requirements around the use of electronic clinical quality measures (eCQMs) and digital quality measures (dQMs), which use a standard electronic format, FHIR®, and electronically extracted data to measure the quality of care provided. Use of these measures requires understanding, developing, and managing the requirements around electronic data capture, transformation, and digital measure reporting. Health plans that are still at the beginning stages of their digital transition will need to focus on building the right systems – and the right connectivity – to ensure they don’t fall behind and are ready to account for eCQMs.

For Medicare Advantage (MA) plans, new regulations around risk adjustment data validation (RADV) mean health plans will continue to experience heightened government scrutiny via RADV audits conducted by the Centers for Medicaid & Medicare Services (CMS). To ensure risk score accuracy and minimize audit risk, health plans need analytics capable of identifying potential undocumented risk adjustable diagnoses as well as potential risk adjustment audit risk diagnoses.

For Mike Jones, President and General Manager for Inovalon’s Payer business unit, digital transformation presents a unique opportunity for health plans to get the most out of robust EHR connections. “With the right approach to interoperability and secure connections, health plans can transform their data capture to meet new digital quality measure reporting requirements, while also enhancing reporting for risk adjustment, value-based care, and more.”

Inovalon is here to help health plans leverage cloud-based, scalable, and cost-effective solutions, all connected under the Converged solution suite. Our Payer Cloud software enables digital transformation, while helping health plans improve resource allocation in areas such as patient outreach and minimizing audit risk.

Navigating provider consolidations and new care settings

Although M&A activity in healthcare hit a three-year low in 2023, a resurgence could happen in 2024, influenced in part by shrinking valuations and increasing frequency of divestures. Meanwhile, the ripple effects of pre-2023 acquisitions are still being felt by providers across care settings.

Healthcare leaders are challenged to consolidate siloed systems, a lengthy process of choosing the right vendors to support more needs and larger teams. On the patient care front, new care delivery settings are emerging. Hospital at home is making a resurgence, and being tested in rural communities to improve quality and access to care. Providers are racing to capture this market, and to do so with the right systems in place to properly deliver and bill for these services.

“Providers need more robust tools than ever before,” shares Julie Lambert, President and General Manager for Inovalon’s Provider business unit. “To succeed in 2024, providers must have end-to-end solutions that can scale with their business’s growth and be easily implemented in any care setting, particularly as the lines between care settings continue to blur.”

With our revenue cycle management and workforce management solutions, Inovalon supports providers across all settings and sizes. Our Provider Cloud software can meet current business needs and grow with your business, while streamlining claims management and staff scheduling.

Overcoming inefficiencies in pharmacy care to better serve patients

The role of pharmacists and the specialty pharmacy landscape will continue to evolve in 2024. Pharmacists are increasingly challenged to improve patient education and medication adherence, adhere to new industry standards on claims submission and ePrescriptions, prepare for drug pricing requirements, and keep their operations running smoothly. Meanwhile, as the rate of acquisitions and partnerships in the pharmacy space grows, newly joined organizations must reassess their processes and solutions.

Across all specialty pharmacies, interoperability and better data sharing are no longer an option. Pharmacies must invest in these tools now to gain efficiency, better manage costs, and get the most out of their data and labor to best serve patients.

For Ernie Shopes, President and General Manager for Inovalon’s Pharmacy business unit, the value of applying data and automation to enhance pharmacy operations is clear. “Establishing the right foundation for data-driven workflows will allow pharmacists to be fast and flexible in their response to industry challenges in the new year. The right solutions now mean being the first to react later, while maintaining organizational standards in care, compliance, and cost management.”

Inovalon is ready to help specialty pharmacies adjust to the shifting landscape and achieve key objectives in 2024. Our Pharmacy Cloud helps streamline operations and improve clinical performance with real-time data exchange and automated processing.

Adopting AI, factoring for SDOH, and prioritizing data governance

For life sciences organizations, data is the key to unlocking powerful insights to improve care delivery, healthcare costs, health equity, and more. With the exponential growth of AI in 2023, researchers and analysts are tasked with appropriately harnessing the combined power of massive amounts of data, applied to the right models.

As John Chinnici, President and General Manager for Inovalon’s Insights business unit, states, “The challenge with AI is thinking not just about how people consume data, but also how models and algorithms consume data.”

Regarding health equity, he adds, “80% of health outcomes are influenced by social determinants of health. When leveraging data and AI, healthcare organizations must be mindful to account for inherent biases and ensure their data is representative of the populations they aim to serve.”

In any use case for healthcare analytics, data governance is the foundation on which data-driven healthcare advancements are built; powerful insights hinge on data security, privacy, consent, and rights management.

With the industry’s largest primary source dataset, access to 100% Medicare Fee-for-Service data as a CMS Qualified Entity, and a team of research experts across a variety of HEOR, epidemiology, clinical, and commercial analytic disciplines, Inovalon is here to support you through our Data Cloud.

Achieve your 2024 goals with Inovalon

For 25 years, Inovalon has empowered data-driven healthcare across the continuum of care, supporting health plans, providers, specialty pharmacies, and life sciences in improving healthcare outcomes and economics.

This year is no different. No matter your organization’s space in the industry, your challenge, or your needs, we are here to help you harness the power of data to achieve your goals.

Discover how the Inovalon ONE® Platform can help you succeed this year.

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