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eightexpertpredictions for

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Table of Contents1. Social Determinants of Health

2. mHealth

3. Data and Analytics

4. Opioid Epidemic

5. Behavioral and Physical Health Integration

6. Artificial Intelligence

7. Shift from Volume to Value of Care

8. Crisis Management

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As we begin 2018, and reflect on 2017, it is easy to

acknowledge the upheaval of the current healthcare

landscape. With mergers of enormous proportions

and regulations and reform in a constant state of flux

it can be difficult to see the forest through the trees.

However, experts from across our organization

have weighed in with their insights on trends in

the healthcare industry to look out for this year.

Along with a shifting focus to Social Determinants

of Health, advancements in technology, increased

integrations, and more, there is plenty to be excited

about in 2018.

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Social Determinants of HealthGLORIA WILDER, MD, MPHVICE PRESIDENT, INNOVATION AND PREVENTIVE HEALTH, CENTENE CORPORATION

Health is not the absence of disease. Many of us know this World Health Organization quote, but what does it mean to our operations as a health care organization? Research proves unequivocally that non-medical factors play a substantially larger role than medical factors in health outcomes. These Social Determinants of Health (SDoH) factors include housing, food insecurity, transportation, employment, social violence, financial health, and other environmental stressors. As one of our own members asked her care support representative, how can she be expected to get to the doctor when she has to deal with multiple trips to Section 8 to get an apartment?

The healthcare industry must begin to listen to and understand the individual’s unique life barriers and how these barriers impact both individual and population health

outcomes. 21st Century healthcare will be focused on shifting from output payment systems (claims paid for the interaction) to outcome systems (claims paid for the impact of the interaction-Did it matter?). With this shift comes the requirement that health plans and health systems support solutions that reduce barriers to the SDoH and support community wide, place matters interventions that lift all boats.

This shift is not simply for goodwill. By concentrating on environmental and social stressors, expected outcomes could include reductions in unnecessary healthcare expenditures, reduction in statewide expenditures in housing, criminal justice, social services, and morbidity/mortality rates. The ultimate goal of impacting the SDoH is improvements in life expectancy and quality of life for all.

Healthcare, 10%

Genetics, 30%

Individual Behavior, 40%

Social and Environmental Factors, 20%

Health and Wellbeing

Adapted from: Schroeder, SA. (2007). We Can Do Better – Improving the Health of the American People, NEJM. 357:1221-8

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The World Health Organization (WHO) defines mHealth as a

component of eHealth, the cost-effective and secure use of

information and communication technologies for health and

health-related fields. mHealth is further classified as involved

in the provision of health services and information via mobile

technologies such as mobile phones, tablet computers, and

Personal Digital Assistants (PDAs).

mHealthJEREMY CORBETT, MDCHIEF HEALTH OFFICER, ENVOLVE PEOPLECARE

As health outcomes such as quality scores and member satisfaction surveys become the measure of how well a healthcare product functions, the need to reach the right individuals via their preferred channel is critical for success. Innovative programs must overcome regulatory hurdles to take advantage of modern technology to broaden the reach of services. With upwards of twenty percent of the US population living in rural areas, often geographically isolated from medical professionals, mHealth offers an opportunity to further the reach of healthcare and interventions in ways previously unavailable.

By incorporating mHealth technologies into the care coordination process, both members and providers will benefit from increased health outcomes. Furthermore, as these modalities progress from cellular-enabled glucometers and blood pressure cuffs to digital voice-powered personal assistant integrations and more, the industry is poised for disruption in how traditional care is delivered. Improved quality outcomes and customized healthcare is right in front of us like never before.

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Data and AnalyticsRACHEL BLAISING, RN, CCMSENIOR DIRECTOR, PORTFOLIO MANAGEMENT, CARE COORDINATION, ENVOLVE PEOPLECARE

As more and more health data is captured across the healthcare industry, the opportunity exists to consolidate and analyze data in a drive to achieve better health outcomes. By combining multiple data sources, not only from claims and utilization but now also including wearable devices, Internet of Things (IoT) devices, and patient-sourced insights, a comprehensive view of individuals and populations can be drawn. Segmentation models can further help isolate diagnoses, treatments, outcomes, and more.

The next step in interpreting the vast amounts of data is the development of predictive modeling. How can real-time data be used to predict health incidents before they occur and help patients navigate care? Algorithms are being developed to combat substance use disorders, irregular heartbeats, seizures, and more. Socioeconomic factors, such as the Social Determinants of Health, can even help influence these models as well for barriers such as transportation availability to appointments. The use of big data analytics across the industry should help improve patient outcomes, while reducing costs for providers, and protecting member privacy rights.

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Opioid EpidemicSOSUNMOLU SHOYINKA, MD, FAPAMEDICAL DIRECTOR, ENVOLVE PEOPLECARE

On average, 115 Americans die every day due to opioid overdoses.1 These numbers have risen significantly over the past few years, with opioid involved deaths rising five-fold from 1999 to 2016.1 Although the epidemic is recognized across the healthcare industry, finding solutions has been challenging. Reasons for this include the nature of addiction, its complex interaction with pain and other mental illnesses, socioeconomic determinants, and lack of (or difficulty getting into) treatment for those battling addiction.

However, there is hope. Cutting edge analytics, population health methods, technology, innovative funding mechanisms, and new evidence-based treatments offer new tools for attacking this epidemic head on. By segmenting populations into known categories of substance use disorder behavior along with predictive models that track migration risk between segments, we can begin to proactively target at-risk members. More effective coordination among healthcare partners, providers, and government agencies should begin to help putting a stop to this serious crisis.

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1. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly

Rep. ePub: 16 December 2016. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1.

2. https://www.cdc.gov/drugoverdose/data/overdose.html

Each day, more than

PEOPLE1,000

are treated inemergencydepartments fornot using prescriptionopioids as directed.2

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Behavioral and Physical Health IntegrationJAY BUTTERMAN, DOBEHAVIORAL HEALTH CHIEF MEDICAL OFFICER, ENVOLVE

For far too long the healthcare industry has approached behavioral and physical health as two separate and distinct areas of a person’s wellbeing. Approximately one-in-five Medicaid enrollees has a diagnosed mental health condition or substance use disorder.1 Additionally, more than half of the Medicaid-enrollees in the top five percent of expenditures who were diagnosed with asthma or diabetes, were also diagnosed with a behavioral health condition.1

There is a growing body of research demonstrating statistically significant relationships between physical health (such as heart attacks, strokes, diabetes, thyroid disease, and auto-inflammatory disorders) and behavioral health conditions.2 For example, research has linked the physical sensation of pain to the mental health status of an individual.3 Initially, researchers suggested that the connection between physical and mental health was due

to lifestyle factors or stress. Over time, several common physical findings have been noted such as the same type of inflammatory response (there are many different types) that seem to connect the physical and mental health disorders.4 Studies also show that treatment of mental health conditions can positively impact the physical health of an individual well beyond the impact of better self-care.

This lack of integrated and coordinated care between physical and behavioral health specialists impacts health and drives unnecessary costs. By unifying the approach to whole health, the industry can help increase member engagement and satisfaction, as well as overall health outcomes. These integrations should include providers, navigators, community resources, and other system-level assimilations of care.

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1. June 2015 Medicaid and CHIP Payment and Access Commission’s Report to Congress 2. Musselman DL1, Evans DL, Nemeroff CB., The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment, Arch Gen Psychiatry. 1998 Jul;55(7):580-92.3. Katon, W.J. (2003). Clinical and health services relationships between major depression, depressive symptoms, and general medical illnesses. Biological Psychiatry. 54(3). 216-226.4.Almond, M. (2013). Depression and inflammation: Examining the link. Current Psychiatry. 12(6) 24-32.5. Source for graphic: https://www.nami.org/NAMI/media/NAMI-Media/Infographics/GeneralMHFacts.pdf

Fact: 43.8 million adults experience mental illness in a given year.

1 in 5 adults in America experience a mental illness.

Nearly 1 in 25 (10 million) adults in America live with a serious mental illness.

One-half of all chronic mental illness begins by the age of 14; three-quarters by the age of 24.

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Artificial IntelligenceAMY TROOP, MBASENIOR VICE PRESIDENT, ENVOLVE INNOVATION LAB

The dystopian depictions of Artificial Intelligence (AI) in films, novels, and popular culture are fiction. In reality AI is already changing our daily lives in vastly positive ways, improving our health, safety, and productivity.

AI is a broad field—spanning from Natural Language Processing and computer vision to machine learning and neuromorphic computing—that is enabling capabilities like virtual personal assistants (Alexa, Siri), service robots, and autonomous vehicles. Though the field that has been in existence for decades, the recent rise in innovation has been driven by advancements in computing power and hardware technology—with major tech players (Google, Amazon, Microsoft, IBM) offering platforms that accelerate development.

The healthcare domain is thought to be one of AI’s biggest beneficiaries—with plenty of live applications to validate this belief, including clinical decision support, machine learning to predict patients at risk, and conversational chatbots designed for triage, condition management, therapeutics, and administrative tasks. Look for AI technology to continue to drive advancements in 2018.

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Millennials Gen X Baby Boomers

Note: individuals who use voice-enabled digital assistants at least once a month on any device; millennials are individuals born between 1981-2000, Gen X are individuals born between 1965-1980 and baby boomers are individuals born between 1945-1964. Source: eMarketer, April 2017

23.3

2016 2017 2018 2019

13.415.6

8.6 9.7

29.9

16.7

9.9

35.8

17.2

10.1

39.3

US Voice-Enabled Digital Assistant Users, by Generation, 2016-2019millions

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VALUE

VOL

UME

Shift from Volume to Value of CareDAN CAVECHIEF EXECUTIVE OFFICER, ENVOLVE PEOPLECARE

We all know where the managed care industry comes from – its beginnings in indemnity insurance and benefits administration, to the emergence of provider networks, contracting, and utilization management and ultimately a shift to begin to focus on consumers of care and their health behavior. These transitions have resulted in marked improvements in the overall cost and quality of care, but there remains much room for improvement. While there may not be a “one size fits all” remedy, it is time for all industry players to move out of our comfort zones.

The current healthcare market remains highly-influenced by fee-for-service care delivery models that encourage an over-supply of care, while providing insufficient incentive for improving health outcomes. As we better understand the linkage between life and health, the

role of social determinants of health, and other societal and environmental factors, we are inextricably driven to a different paradigm – one that focuses on broader community outcomes. This began as “value-based contracting” where care providers experienced financial incentives related to care quality measures. The next generation of this paradigm represents a fundamental shift, from the volume of care to the value of care – where value is broadly defined to be not only the health of the individual, but rather, the health of the community at large.

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Crisis ManagementLESLIE ADKINS, SPHR, LMSW, LCDC CLINICAL MANAGER, MANAGEMENT CONSULTATION TEAM, ENVOLVE PEOPLECARE

Last year was an incredibly challenging year for natural disasters in the United States between hurricanes, wildfires, floods, and more. The physical damage of these disasters is most evident. The harm goes much deeper, however with long-term financial impact, emotional stress and trauma, and relocation and employment challenges. The healthcare industry plays an obvious role with these disasters aiding with both physical and behavioral health.

With the growing cost and impact of these disasters, look for the healthcare industry to play a larger role in preparedness and recovery efforts for both individuals and healthcare infrastructure. Services like Employee Assistance Programs once limited to employer markets will be an easy shift into other health arenas to help with crisis management, support, and planning.

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Graphic sourced from: PwC Health Research Institute analysis of data from the National Oceanic Atmospheric Administration

0 50 100 150 200

Cost (In billions)

2013

2014

2015

2016

2017

Wildfires

Drought

Hurricanes

Severe weather

Flooding

Tornadoes

Winter storms

$22.1

$18.3

$23.1

$37.8$195.2

Disasters cost the US between $18 billion and $200 billion each of the last five years

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©2017 Envolve, Inc. All rights reserved. For internal use only. Do not distribute. May 201713

About Envolve PeopleCareEnvolve PeopleCare focuses on individual health management through education and empowerment. Through behavioral health, nurse triage, telehealth, and health, wellness, and disease guidance programs, we help transform lives.

Envolve™ is a family of health solutions, working together to make healthcare simpler, more effective, and more accessible for everyone. As an agent for change in healthcare, we’re committed to transforming the health of the community, one person at a time.

Envolve represents one, integrated company with three main focus areas: Pharmacy Solutions, PeopleCare, and Benefit Options.

www.EnvolvePeopleCare.com

Acaria® Specialty Drug Solutions

Online Drug Management Tools

Analytics and Clinical Consulting

Home Delivery Services

Digital Health

Behavioral Health

Health and Life Coaching

Nurse Advice Line

Care Gap Closure Services

Foster Care Management

Employee Assistance Program

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