Troy’s Interoperability Predictions for 2023

Last year, I made four healthcare predictions for 2022. Finally I can share how they turned out!

Our VP Marketing asked me to look ahead at the big interoperability questions for 2023:

What surprises you about how 2022 shook out? What did you think would happen, but didn’t? What happened that you didn’t expect?

What surprised me about 2022 was how slow the industry has adopted FHIR. I think that at the company level, priorities are set for revenue generation and sustainability given the new market conditions, which results in a lack of urgency around learning, building and deploying FHIR-based tooling and infrastructure. While FHIR offers long term value in its capabilities, it does not present short term ROI, particularly if the ecosystem as a whole is not doing it at the same pace (which is why we’re offering relational database products built off of FHIR).

What’s an emerging trend you find really interesting that we’ll see more of this new year? 

I think we will see more organizations make the jump from Value-Based Care back to Fee For Service, eventually coming back to Value-Based Care again. Fee For Service is, by definition, lower risk to operate. Organizations get paid quickly for services rendered and the overhead costs to operate are much lower - less reporting, data collection, validation, etc. Some organizations will flip back to Fee-For-Service to survive the down market, eventually pushing back into the high-risk, high-reward segment of Value-Based Care when they get the numbers back on track.

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What can we expect to see from the regulatory landscape in 2023?

TEFCA will launch its first cohort of QHINs. However, it will be a slow start. The value of a network is in its reach, and kickstarting something as large as TEFCA will take incredible effort and intent to get it to critical mass. 

While there aren’t many sticks for those who avoid TEFCA, there are some small carrots for participants. Still, I don’t expect the government incentives are going to be the main driver here. Instead, I think over the next 5+ years it will become a massive competitive disadvantage not to be connected to TEFCA.

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What new challenges do you think will VBC organizations face this year? 

CMS is already coming down hard on organizations submitting sloppy reimbursement requests and I believe this trend will continue.  Some of the biggest MA plans and at-risk provider groups have received OIG responses demanding over $200 million back for poorly-administered Risk Adjustment and performance-related revenue. VBC orgs will need to be much better in their operations around accurately capturing data that relates to conditions and closing gaps of care.

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What new challenges do you think EHR/EMR organizations will face this year? 

EMRs are facing an interesting decision: how to approach TEFCA. There is a complex web of regulatory risk, customer pain points, competitive positioning, costly development work and IP protection that will factor into different EMR decisions. Epic has already made a public commitment to become a QHIN, which makes a lot of sense given their current capabilities as it relates to Carequality participation, Care Everywhere, and how ‘in the spotlight’ they are when it comes to regulation and patient rights.

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What do you expect to be the biggest debate of this year? 

In 2023 we will 100% see Individual Access becoming a live Purpose of Use across the national networks and frameworks. The pressure from TEFCA and Anti-Information Blocking in combination are opening this up as a reality. As these rules trickle down to the private sector, tons of debate over how to actually do this in a safe and secure way has already started behind the scenes. The good news is that the technology exists to make this happen and it’s really just about the finesse of thoughtful design, policy and practicality. 

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What does good look like for a health tech company navigating this next year. And what would GREAT look like? (What are table stakes vs. what’s going to really push the innovation envelope?)

2023 will be the year of sustainability. We’ll continue to see big layoffs, hiring freezes and reposturing towards longevity instead of growth at all costs.  

“Good” will be making it through the economic downturn. “Great” will be figuring out how to actually accelerate through it in a low cost, low burn way. Thoughtful, creative, healthy margin  solutions that hit low hanging fruit and possess difficult to copy ROI due to the quality of the product will supersede organizations operating behind-the-scenes mechanical turks or hidden service layer orgs.  

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Who are you most excited to see succeed this new year? 

I think the new Cost Transparency regulations have just barely opened up the innovative solutions that will come to market in the next year. Companies like Turquoise Health have built clearly valuable solutions leveraging this new rule and the information transparency is eye opening.  

Cost in the healthcare industry is borderline nonsensical. Step one to solving this critical issue in US healthcare is establishing a baseline. From there we can actually start to leverage this information to make decisions based on value vs…really no method at all. I really hope to see this class of solution start to be used by all healthcare decisionmakers during care planning.

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Where will Particle Health fit into all of this? 

There has been an explosion of API-based healthcare tools over the last five-ish years. Independently, each of these solutions solves a handful of difficult challenges. In combination, they start to make magic happen… a classic 1 + 1 = 5 situation.  

Particle plays a major role in the ecosystem of APIs that are maturing across the healthcare landscape. One of our major goals is to continue partnering with other API solutions, making it even easier, faster and more valuable to leverage multiple data sources.  

Today we offer medical records, pharmacy data, as well as ADT notifications. In 2023 we plan to partner, integrate and flow more insights through our API to our customers key decision-making points, enabling better data, better care and better outcomes across every corner of the US healthcare system.