Todd Shyrock

Health care leaders are anticipating a turbulent 2023, according to a 

. Staffing, inflation, shrinking margins, and supply chain issues are among the top concerns that will continue to challenge hospitals and health systems and have an outsized effect on overall strategy.

Here are the four factors Deloitte identified as being the most likely to impact health care next year.

, with 76% of health care leaders indicating they think it will have a significant impact on their strategy. Only 7% said it wasn’t likely to have any effect.

Rising cost-of-living expenses could cause some patients to delay routine care and screenings, similar to when the pandemic hit, resulting in worse health outcomes.

While most health system leaders surveyed by Deloitte indicated inflation would have a major impact on their strategy, less than half of health plan executives thought it would impact their near-term strategy. But the trickle-down effect of health care pricing will likely mean health plans could feel the effect after 2023 when health systems fell the brunt of the financial pain, according to the report.

With interest rates increasing, health care organizations may find it more difficult to modernize their technology and embrace 

Just 29% of health system respondents said accelerated digital transformation would likely have a major impact on their organization’s strategy in 2023, while 63% thought it would have a moderate effect. Among health plan executives, however, accelerated digital transformation is expected to have a “great impact” (43%) or a “moderate impact” (50%) in 2023.

Deloitte notes that the difference in responses may be that health system leaders want to digitally transform but may not know how to pay for it, or they are anxious to implement long-delayed projects. Health plans also tend to be ahead of health systems on the technology front.

Many health systems saw lower patient volumes and revenue during the pandemic and have yet to recover to pre-pandemic levels. With costs for supplies and labor rising, 2022 might end up being one of the worst financial years hospitals have experienced in decades.

Revenue continues to be squeezed by patients who are delaying care, and an increasing number of patients are shifting to ambulatory centers over hospitals for non-emergency procedures.

According to the report, median operating margins among hospitals and health systems were down 46% in September compared to the same month a year earlier. This margin compression might not be sustainable for many hospitals—particularly small and locally controlled organizations. As a result, some hospitals may get acquired while others might be forced to close their doors.

New payment models and alternative sites of care

Transitioning to new payment models, such as value-based care (VBC), was seen as the top priority among health plan executives Deloitte surveyed for 2023. Many health plans are likely to enter the new year in a strong financial position due to fewer health care claims in 2022. Hospitals and health systems, on the other hand, will be more focused on slowing losses in 2023. That could make it difficult for health plans to move their network providers into new payment models.

The report notes that consumers are looking for more convenience, which could give rise to alternative care sites that can offer a better customer experience. Alternative sites of care (defined as care outside the traditional doctor’s office) aren’t new, but they’re rising in prominence as the retail and digital worlds converge and the public sector recognizes the need to advance health equity and improve the consumer experience. At the same time, consumers are changing the way they want to access care and pushing the traditional health care visit and experience to be more in line with other encounters they have in daily life.

The expectation is that most health plans will see profitability in 2023, but hospitals and health systems are probably facing another challenging year as they try to balance financial pressures with the need to invest in the future while ensuring high-quality care.

This article was published by our sister publication Medical Economics.

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The health care industry will face myriad challenges in the coming year.

Four factors that will likely affect health care in 2023

Most patients who had a telehealth visit did not require an in-person follow-up appointment in that same specialty in the next three months, according to a 

Researchers examined more than 35 million 

 visits conducted between March 2020 and May 2022 to see how often in-person follow-ups were required. The highest rates were not surprisingly in specialties that have unavoidable needs for hands-on care, such as obstetrics, 

Specialties such as mental health and psychiatry had the largest volume of telehealth usage paired with some of the lowest rates of in-person follow-ups, with only 15% of patients needing to see the doctor in the office within three months of the initial telehealth visit.

Researchers say that for many specialties, telehealth visits are an efficient use of resources in most cases that are unlikely to require in-person follow-up care. In some cases, such as for genetics and nutrition, telehealth might even replace the need for in-person visits, according to the report. Genetics only required in-person follow-up 4% of the time, while nutrition visits required them 10% of the time.

Health care providers should continue to educate policymakers and administrators on how telehealth is an alternative method of seeing patients, and not a duplicative one, researchers say, adding that payers should extend telehealth visit coverage beyond the current waiver to support this method of care delivery and increased health care access.

Trend holds true across almost every specialty.

Telehealth patients rarely need an in-person follow-up

During the COVID-19 public health emergency, millions of people were enrolled in Medicaid thanks to a law that prevented state agencies from disenrolling people during the emergency.

 is set to expire in April 2023, and when it does, an estimated 18 million people will be in danger of losing their Medicaid coverage in the following 14 months because states will resume their normal eligibility requirements, according to the 

Of the 18 million, 3.2 million children will transition from Medicaid to the 

, though some enrollees may have to pay premiums for coverage they did not have to pay under Medicaid. An estimated 1 million people losing Medicaid coverage will enroll in nongroup coverage, mainly through the Marketplace coverage with government assistance. The report estimates that 9.5 million will be eligible for employer-sponsored insurance, but that not everyone will enroll. In total, 3.8 million of the 18 million losing Medicaid coverage are expected to be uninsured.

 to private coverage will pay more in premiums and out-of-pocket health costs, and may experience a temporary interruption in health coverage enrolling in alternate coverage. An estimated 19 states will see their uninsurance rates spike by more than 20%.

“State policy decisions during the transition following the PHE expiration will affect how many people lose coverage, how rapidly they lose coverage, and how many people will enroll in other coverage,” the report reads in part.

If the public health emergency expires, millions are set to lose health insurance.

 18 million people set to lose Medicaid coverage in April

Vaccine confidence has declined significantly since the start of the pandemic, according to a 

 from the University of Portsmouth. Researchers used anonymous surveys in the winters of 2019 and 2022 to examine attitudes toward vaccinations and that factors that might lead to hesitancy and refusal.

The results from more than 1,000 adults show the post-pandemic group was considerably less confident in vaccines than the pre-pandemic group. The results were published in the medical journal 

Researchers found that nearly one in four participants reported a fall in confidence since 2020, and this occurred regardless of age, gender, religion, education, and ethnicity.

 hesitancy is not a new phenomenon, COVID-19 vaccines have been met with particular hostility despite the overwhelming scientific evidence of their safety and effectiveness,” says 

, associate head of the School of Biological Sciences at the University of Portsmouth, in a statement. “This isn’t just among conspiracy theorists though, but also those who don’t consider themselves ‘anti-vaxxers’ and had supported other vaccination campaigns in the past.”

Participants were asked how much they agreed with statements including:

I think vaccines should be a compulsory practice

I believe if I get vaccinated it would benefit the wellbeing of others

Vaccines are a necessity for our health and wellbeing

In both surveys participants who held religious beliefs were significantly more vaccine-hesitant than atheist and agnostic ones, and individuals from Black and Asian backgrounds were more hesitant than those belonging to White ethnicities. However, gender showed no association with vaccine confidence.

While these overall trends remained largely similar between the two surveys, some noteworthy changes were observed in the post-pandemic survey, according to researchers. For example, the analysis revealed that while in 2019 middle-aged participants were considerably 

 about getting vaccinated than younger groups , this was not the case in the 2022 survey.

“This could be because COVID-19 infections notoriously lead to more severe outcomes in older patients,” said Siani. “Young people who are infected rarely experience severe symptoms that lead to hospitalization and death, so it’s possible that many have become complacent and don’t feel the need to get vaccinated. On the other hand, older people may have been more wary of the consequences of the infection, and more appreciative of the protection offered by the vaccine.”

While providing precious insight into how the pandemic affected the public perspectives on vaccinations, the study is not without limitations. The original survey was designed as a standalone piece of research, so a different group of people had to be sampled in 2022. This resulted in a cross-sectional study as opposed to a longitudinal one.

“However, the study is consistent with other observations suggesting that vaccine confidence may be yet another victim of the COVID-19 pandemic,” said Siani.

Confidence in vaccines is lower post-pandemic across all demographic groups.

Vaccine confidence declined considerably during pandemic

 Action Collaborative on Clinician Well-Being and Resilience launched a 

 this month aimed at driving collective action to restore the health and wellbeing of health care workers. The vision put forth by the NAM is that healthier health care workers equals better outcomes, lower costs, and improved care for patients.

The plan identifies seven priority areas for health workforce wellbeing:

• Create and sustain positive work and learning environments and culture. Transform health systems, and health education and training, by prioritizing and investing in efforts to optimize environments that prevent and reduce 

, foster professional well-being, and support quality care.

• Invest in measurement, assessment, strategies, and research. Expand the uptake of existing tools at the health system level and advance national research on decreasing health worker burnout and improving well-being.

 and reduce stigma. Provide support to health workers by eliminating barriers and reducing stigma associated with seeking services needed to address mental health challenges.

• Address compliance, regulatory, and policy barriers for daily work. Prevent and reduce the unnecessary burdens that stem from laws, regulations, policies, and standards placed on health workers.

• Engage effective technology tools. Optimize and expand the use of health information technologies that support health workers in providing high-quality patient care and serving population health, and minimize technologies that inhibit clinical decision-making or add to administrative burden.

• Institutionalize well-being as a long-term value. Ensure COVID-19 recovery efforts address the toll on health worker well-being now and in the future, and bolster the public health and health care systems for future emergencies.

• Recruit and retain a diverse and inclusive health workforce. Promote careers in the health professions and increase pathways and systems for a diverse, inclusive, and thriving workforce.

According to NAM, the plan is intended to be a starting point that will help coordinate actions across the field and provide a roadmap to develop a health system in which health is delivered “joyfully and with meaning,” by a committed team, in partnership with engaged patients and communities. It will take the collective efforts of many individuals, organizations, and coalitions of actors to reverse trends in health worker burnout.

There are 10 key elements for driving a successful national movement, and the NAM Clinician Well-Being Collaborative has been working on several of these elements since 2017. Here is an overview:

 In 2017, the NAM established the Clinician Well-Being Collaborative to raise the visibility of clinician anxiety, burnout, depression, and suicide, recognizing that clinician well-being is essential for safe, high-quality patient care. The Clinician Well-Being Collaborative’s work prior to and throughout the COVID-19 pandemic recognizes the challenges facing health workers as systemic, complex, and longstanding.

Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being

 in 2019. The Clinician Well-Being Collaborative is also a leader in identifying evidence-based strategies to improve clinician well-being at both the individual and systems levels. Products include an online knowledge hub, a series of NAM Perspectives papers, and a conceptual model that reflects the domains affecting clinician well-being.

 At the outset, the Clinician Well-Being Collaborative focused on fostering a community of diverse stakeholders across the health care system. More than 200 organizations have joined the Clinician Well-Being Collaborative’s network by making a visible commitment to tackle the issue of clinician burnout and support the work and priorities of the Clinician WellBeing Collaborative locally.

 Working groups of the Collaborative have identified evidence-based strategies to engage leadership, break the culture of silence, organize promising practices and metrics, address workload and workflow, and act on recommendations to improve clinician wellbeing. Recent focus areas include mobilizing national stakeholders, reviewing and applying lessons from COVID-19, and implementing evidence-based tools for clinician well-being.

 The NAM’s Taking Action Against Clinician Burnout report raised the far-reaching consequences of burnout at the personal, organizational, and societal level. The report estimates $4.6 billion in societal costs each year in the U.S. due to the U.S. clinical workforce reporting substantial symptoms of burnout. The Clinician Well-Being Collaborative launched a Resource Compendium for Health Care Worker Well-Being, featuring tools to calculate the organizational costs of burnout and other resources for health care leaders and workers to use across practice settings.

 The Clinician Well-Being Collaborative has more than 100 members across sectors who participate in working groups, including representatives from the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Centers for Medicare and Medicaid, and Veterans Health Administration. In 2021, the Office of the Surgeon General joined the Clinician Well-Being Collaborative, to lead alongside the NAM, Accreditation Council for Graduate Medical Education, and the Association of American Medical Colleges.

 The priorities, goals, and actions laid out in the National Plan are urgent, yet complex. The NAM has created a National Plan to focus on the immediate and long-term needs of the health workforce with the intention that the goals and actions will enable a sustained state of well-being. Every actor and sector should identify the most pressing priorities or promising opportunities and develop plans for near-, medium-, and long-term actions in accordance with available resources and in collaboration with other actors.

NAM is now focusing on the last three elements:

Communicate the Details of the National Plan Widely

Activate Change Makers to Spark Action Across the Nation

Seven priority areas established to strengthen the health care workforce

National plan aims to boost health care worker wellbeing

/Gallup poll found that nearly four in 10 Americans in the last six months have delayed or skipped health care treatments, trim regular household expenses, or borrow money, because of rising health care costs. Extrapolated across the entire population, that means 98 million adults are having to figure out how to afford health care.

While half of adults in households earning less than $48,000 per year report cutting spending, the effects also extend to more influential households. For those earning at least $180,000, 19% said they have pared back spending to pay for health care.

 under 50 are disproportionately being compelled to cut back on health care with 36% reporting they have done so, compared to 22% of men. having done so, compared with 22% of men.

Overall, 26% of adults report delaying or avoiding medical care or purchasing prescription drugs in the prior six months due to higher health care prices. This rises to 43% among adults in lower-income households (those making less than $24,000 annually).

For those cutting costs, health care is usually on the chopping block with other expensed. The report found:

Of those who cut back on utilities, 59% also cut back on medical care and medicine.

Of those who skipped a meal, 71% also cut back on medical care and medicine.

Of those who borrowed money, 60% also cut back on medical care and medicine.

Of those who drove less, 55% also cut back on medical care and medicine.

The effect of inflation exacerbates an already significant issue for millions of Americans struggling to pay for health care and medicine. Prior findings from the 2021 West Health-Gallup Healthcare Study showed that an estimated 18% of adults, or about 46 million people, 

could not afford needed care if they required it today

unable to pay for prescribed drugs in the prior three months

Health care inflation, which stood at 4.5% in June, is lagging overall 

, which spiked to 9.1% in June, a new 40-year high primarily because of rising prices for gas, food and rent. According to the report, inflation has not yet fully hit health care prices due to prenegotiated contracts with insurers and providers for 2022, but inflation is likely to impact prices later in the year -- something that consumers may not fully appreciate given the mere 3% that cite health care as the service expected to rise in price the most in the next six months.

Patients are either skipping care completely, cutting costs elsewhere, or borrowing money to pay for health care.