Covid-19 substantially impacted the cardiovascular care landscape by driving up disease prevalence and comorbidities, compounding staff burn out, and exposing gaps in how we think about accessible, high-value CV care for all patients. However, the biggest changes for CV care are not behind us—we're only expecting things to get more complex.
Here are the four major cardiovascular trends to know across 2022 and beyond:
1. Workforce shortages were exacerbated by Covid, but several factors contribute and will continue to drive ongoing CV provider shortages
Throughout the pandemic, staff burnout has been on the minds of many across the industry, and CV is no exception. According to the American College of Cardiology, 55% of cardiologists feel more burnt out compared to the initial months of Covid-19, but supply concerns far predate the pandemic given the growing burdens of an older and sicker population.
As a result, providers will need to improve staff engagement and work-life balance, or otherwise lose staff to other employers of choice. For example, physicians working at ASCs can achieve higher pay, greater control over their schedule, and a more gratifying work life balance.
But your workforce isn't just shifting to other sites of care—they are also taking advantage of opportunities to move between clinical and non-clinical work. Opportunities in drug development or public health allow staff to explore additional interests and skills that benefit their professional and personal lives.
2. Out of hospital shift will become more important despite historically slow movement for CV
We have predicted the shift of CV procedures out of the hospital for a while now. This shift seemed to be at its critical point when PCI was added to the ASC-procedure list in 2020. Today, the future state of PCI in the freestanding space is still in flux.
But we are still seeing new in-kind drivers that are pushing shift in the CV space from all sides of the industry—purchasers are encouraging lower cost care in new ways, advancements in tech and innovation are enabling more CV procedures to be safely conducted out of the hospital, and progressive providers are shifting care to freestanding competitors.
However, care moving out of the hospital doesn't only mean that it is shifting to freestanding brick-and-mortar facilities anymore—home-based and virtual care are ripe for CV growth. Though accelerated by efforts to social distance during the pandemic, interest and funding to grow home-based and virtual capabilities has never been higher and show no sign of slowing down in the CV space.
Take Eko for example—a digital health system with remote patient monitoring and algorithms to help patients detect heart disease at home that garnered $30M. Or Recora, a virtual cardiac recovery telehealth company that has obtained $20M to scale nationally.
This shift saga will only become more complex as cross-industry forces and alternative care options continue to increase. Providers, and all stakeholders with a say in non-hospital care, run the risk of losing out on significant market share and cost savings if they do not think strategically about how they can respond to this mounting steerage and competition.
3. Patients are being steered to high-value care sites in more creative and direct ways
The pandemic has increased provider interest in risk-based payment models as organizations under fee-for-service (FFS) payment models particularly felt the negative financial impact of care avoidance. The Center for Medicare and Medicaid Innovation (CMMI) has outlined steps to achieve their mission on cost and quality through higher-valued care, but several other market influencers are already moving on steering care toward value.
Private plans are using value-based agreements to align incentives with providers and more aggressively direct patients. They are also using risk-based payment models and site-of-service reviews to steer care out of the hospital outpatient department. But beyond embracing risk-based payment models, plans are considering alternative ways to push on value. For example, some are incentivizing risk-bearing and FFS ambulatory sites to steer patients out of the hospital.
Additionally, plans, employers, and primary care disruptors are working concurrently to break historical referral patterns in favor of higher-value care sites. Purchasers (plans and employers) are directing patients to preferred providers through Center of Excellence network tiering narrow networks. For employers, their main priority is minimizing productivity losses, and improving both the employee and caregiver experience.
Primary care disruptors cannot rely on legacy referrals, so they stay competitive on high-value metrics such as total cost and complex care management—they look for specialty partners that prioritize the same things. This means that cardiovascular providers will need not only to think about total cost of care but also throughput, efficiency, and other stakeholder goals to prove their value proposition.
4. Health equity is a business imperative
CV inequities are systemic and were prevalent long before COVID-19 brought them into the limelight. However, what is new is acknowledgment that CV health equity is a business imperative.
Firstly, plans incorporate health equity metrics into their provider quality scorecards as health equity is an important piece of the value-based care puzzle. Additionally, boards are increasingly pressuring executives to measure the scope of the problem, especially as more and more research is conducted on the cost of cardiovascular disparities. In 2016 and 2017, heart disease cost $363B. This includes health care services, medicines, and mortality-related productivity losses.
Overall, CV programs can't afford to ignore these disparities anymore both from a mission-oriented and business-oriented perspective. Leaders must understand and respond to local social determinants of health and should proactively consider community-based and industry partnerships that are starting to drive change in several parts of the country.
Cardiovascular leaders across the healthcare ecosystem are needed to tackle these inflection points. Provider, plan, life science, digital health, and employer stakeholders should work to develop a synergy that links and elevates their capabilities.
This requires proactive and careful planning, and we're here to help! Review our 2022 Cardiovascular State of the Union (advisory.com) webinar to understand how these inflection points are playing out in real time and how you should be preparing NOW.