2024 Trends Shaping the Health Economy

Trilliant Health just released its 2024 Trends Shaping the Health Economy Report, delivering a unique perspective on the healthcare market through the lens of supply and demand.

The fourth edition of the report builds on the core findings from the previous three:

  • 2021: Healthcare is a negative-sum game.
  • 2022: Every part of the health economy will be impacted by reduced yield.
  • 2023: The victors in healthcare’s negative-sum game will be those who deliver value.

This year’s 164 page analysis is organized into eight sections, each examining a significant macro trend and supported by a wide collection of data-driven stories:

  • 1) The healthcare system is disproportionately expensive. Despite spending nearly 2X more on healthcare than peer countries, utilization has remained largely unchanged, while increasing 7% in peer countries since 2000. U.S. outcomes are also far worse. (Page 11 Chart)
  • 2) Health status continues to decline. We’re seeing higher volumes of early onset cancers in patients under age 45 for breast (+6.6%), colon (+10.0%), and kidney (+2.1%) between 2018 and 2023. (Page 22 Chart)
  • 3) Government regulation is failing to produce value. This one’s a mixed bag. Regulating cigarettes decreased usage by 30%, but mandated reporting of quality measures hasn’t yielded enough improvement to offset the cost of reporting. (Page 46 Chart)
  • 4) The value of tech advancements is uncertain. Since 2018, multiple AI CPT codes have been introduced, but utilization remains infrequent and concentrated among cardiac conditions such as coronary artery disease and ECG cardiac dysfunction. (Page 77 Chart)
  • 5) Supply constraints are correlated with inadequate yield. The decrease in practicing physicians from 2019 to 2023 resulted in a -0.9% workforce reduction. Notably, 31.3% of physicians changed practice location over that time period. (Page 89 Chart)
  • 6) Forced consumerism has fostered fragmentation. Over 14% of patients with commercial coverage go out-of-network for behavioral health services, versus just 2% for physical care. (Page 111 Chart)
  • 7) Lower-cost care settings can offer better value. New treatment paradigms often start in the hospital but shift to new settings over time (due to new tools, reimbursement reform). How long will that continue? (Page 125 Chart)
  • 8) Employers are better equipped to demand value. Employers have historically been relatively passive in managing healthcare costs., but new transparency requirements compel them to change that. (Page 148 Chart)

The Takeaway

Trilliant’s report showcases the fact that the inputs of the U.S. healthcare system, as measured by cost, exceed the outputs, as measured by the actual value received by Americans. As Trilliant’s Head of Research Sanjula Jain puts it, “every stakeholder can – and must – deliver more value to their customers.”

Trends Shaping the Health Economy: Behavioral Health

Trilliant Health published a new report that’s pretty close to required reading for anyone working in behavioral healthcare – Trends Shaping the Health Economy: Behavioral Health.

The report does a thorough job wrapping numbers around the biggest trend in the space: patient demand is outpacing the supply of providers.

  • Behavioral health volumes were 18.1% above pre-pandemic levels by Q2 2022, driven by a combination of stress-induced disorders and a 45X increase in telehealth utilization. Behavioral health visits accounted for 63.8% of total telehealth visits in Q2 2022.
  • Since 2019, the conditions that saw the sharpest rise in visit volumes were eating disorders (up 52.6%), anxiety (47.9%), substance-use disorders (27.4%), depression (24.4%), and bipolar disorder (12.2%).
  • Unlike many other areas of healthcare, behavioral health doesn’t appear to be a small group of high utilizers driving up volumes. In 2021, two-thirds of patients diagnosed with a mental health condition saw a provider five times or fewer.

Although telehealth was initially viewed as a way to expand access to therapy, the data paints a different picture of its actual impact. More prescriptions, treatments shifting away from behavioral health providers, and lackluster follow-up care.

  • The share of patients with a prescription for antidepressants increased 15% from 2017 to 2021, while patients ages 22-44 saw Adderall prescriptions spike 58.2%.
  • PCPs now prescribe the greatest share of behavioral health medications (42.3%), and NPs and PAs have also begun to account for a large share of prescribing volume (22%). Behavioral health providers account for just over a third of total prescribing volume.
  • Most patients initially diagnosed by their PCP with schizophrenia (70.2%) or bipolar disorder (62.8%) received subsequent treatment from a behavioral health provider, but the same was true for only 30.3% of ADHD patients.

The Takeaway

Trilliant’s data provides a strong foundation to start asking the right questions about the direction behavioral healthcare is heading.

  • Should high demand shift care settings for behavioral healthcare?
  • Should primary care be the first line of defense?
  • If PCPs are delivering this care, is more training needed to manage these conditions?
  • Is this the proper balance between therapy and medication?

While Trilliant’s report isn’t setting out to answer these questions, it’s a valuable tool for those that are.

2022 Trends Shaping the Health Economy

Trilliant Health just released its 2022 Trends Shaping the Health Economy Annual Report, providing a unique perspective on the healthcare market through the lens of supply and demand.

Even though these dynamics don’t play out in healthcare exactly how they would in an “ideal market,” the 147-page report does a good job turning the core principles into a framework for examining 13 different secular trends.   

Perhaps the biggest trend, at least on the demand side, is what looks to be a shrinking total addressable market. The share of Americans with commercial health coverage dropped 0.6 percentage points from 2020 to 2021.

  • On top of this, care forgone during the pandemic appears to be permanently lost rather than delayed. Pandemic-related care is driving the appearance of a rebound, but with COVID treatment and vaccination omitted, healthcare encounters are down 6.2%.
  • The widespread availability of virtual care options hasn’t saved the day either, with Trilliant’s data showing that half of telehealth users in 2021 only used the modality once.

At the same time as demand is contracting, a growing supply of new entrants like CVS, Walmart, and Amazon is making consumer loyalty harder to capture. 

  • Trilliant makes the case that these retailers are commoditizing low-acuity services, leveraging their scale and large customer bases to pressure established players. 
  • This is taking place against a backdrop of burnout among traditional providers, with 9.8% of physicians leaving the field between 2019 and 2022. When accounting for new physicians entering the industry, the U.S. saw a -2% reduction in the physician workforce during the same period.

The Takeaway

If the full report makes one thing clear, it’s that the health economy is quickly turning into a negative-sum game as the number of patients with commercial health coverage decreases and new entrants swarm the field. Even though Trilliant doesn’t set out to give a solution to this problem, its research is a solid tool to help each stakeholder make sure they’re at least asking the right questions.

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