Trilliant Health SVP of Market Strategy Sanjula Jain, Ph.D.

Digital Health

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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The Wire

• Viome Funding: Direct-to-consumer testing startup Viome Life Sciences closed a $67M Series C round (total funding now $170M) to launch a new line of at-home tests focused on the oral microbiome. Viome’s existing gut microbiome tests allow it to provide precision nutritional recommendations based on the results, and it recently received FDA Breakthrough Device Designation for its mRNA analysis test that can detect early biomarkers associated with oral and throat cancer with an impressive 95% specificity and 90% sensitivity.

• ED Wait Times Spike: New research in JAMA Network Open highlighted how hospital occupancy was associated with longer ED wait times during the pandemic. After analyzing Epic EHR data between January 2020 and December 2021, researchers found that ED wait times were over four hours in 90% of cases when hospital occupancy was greater than 85%, and that median wait times were longer than nine hours at the 5% of hospitals with the highest occupancy.

• Stanford Virtual Visit Track: Stanford Health Care’s emergency department seems like it’s faring better than most, according to a case study on its success with a Virtual Visit Track that lets remote physicians use telemedicine to care for on-site low-acuity patients in two EDs. In the first 11 months of the VVT, 2.2k patients received care, resulting in a 1.9 hour median ED length of stay (vs. 4.2 hrs for main ED), a 6.7% median 72 hour return visit rate (vs. 7.2% for main ED), and all 50 participating physicians ranking their ability to deliver remote care comparable to in-person care as “very good or excellent.”

• Headway Enters California: Headway is expanding its behavioral health services to California amid the state’s ongoing troubles with providing timely access to mental healthcare. The news follows the state’s implementation of CA SB221, which requires that patients have access to in-network mental health appointments within 10 days. Headway reports that its patients attend their first appointment less than 6 days after scheduling, compared to a national average of two to three weeks.

• Telehealth OUD Treatment: A Yale-led study found that 85% of physicians who have used telehealth to treat opioid use disorder support making pandemic regulatory flexibilities permanent to enable more virtual care. Among 1,141 survey respondents, 54% found virtual care to be more effective than they expected (vs. 16% less effective), and 77% are likely to continue using telehealth to treat OUD after the pandemic if regulations permit it.

• PurpleLab Partnership: Data analytics startup PurpleLab secured $40M in Series B funding and inked a partnership with Dstillery to help leverage real-world data for custom patient targeting solutions. PurpleLab’s HealthNexus platform organizes real-world data into provider-specific cost and quality scores, and integrating Dstillery’s condition-specific ICD-10 code data is intended to help hone patient targeting without relying on personal user information.

• Signify Expands In-Home Diagnostics: Signify Health is expanding the preventative services it offers to MA and Medicaid members during its home health evaluations less than two months after reaching an agreement to be acquired by CVS. The expansion adds spirometry testing for COPD to its existing service line of diagnostics for peripheral arterial disease, chronic kidney disease, colorectal cancer, and diabetes.

• Physician Recruitment Challenges: A report from the Association for Advancing Physician and Provider Recruitment highlights how physicians are becoming more difficult to replace as burnout pushes many to exit the industry. The AAPPR analyzed 23k physician hiring searches from last year, finding that 48% were to replace departing doctors (up from 32% in 2018), 33% of physicians cite burnout as the reason for leaving, and that healthcare organizations are increasingly relying on physician assistants and nurse practitioners because there are more candidates and credentialing is faster.

• BioIntelliSense Acquires AlertWatch: BioIntelliSense is acquiring AlertWatch, an FDA-approved clinical intelligence and triage system that integrates with BioIntelliSense’s BioButton wearables for scalable remote patient monitoring. The acquisition builds off BioIntelliSense’s recent partnership with Medtronic, and AlertWatch will now be distributed to US hospitals as a new offering in Medtronic’s HealthCast portfolio.

• EHR Use Improves Outcomes: A study of EHR data from 291 PCPs at Mass General Brigham found that increased EHR use is associated with improved outcomes for diabetes, hypertension, and breast cancer screenings. After adjusting for physician demographic and practice characteristics, the researchers found that each additional 15 minutes of daily time spent on EHR messaging was associated with a 2.3% increase in A1c level control, 1.7% better hypertension control, and 1.3% higher breast cancer screening rates.

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