By Jay Sultan

As the healthcare industry bids farewell to 2020, we do so with a humbled heart and determined spirit. The pandemic has raised numerous patient care and system-wide challenges, and industry stakeholders have worked tirelessly to meet them. While managing COVID-19 has rightfully been this year’s predominant concern, other areas will also demand attention in 2021. New federal rules on interoperability and patient access to data will influence the way providers and patients interact with data, while concerns about privacy, security, and price transparency will continue to evolve. Furthermore, 2021 will bring a new outlook on operationalizing social determinants of health (SDOH) data, bringing a deeper understanding of its applications and effectiveness. Health disparities in the U.S. are staggering, and we have a real opportunity to close gaps in care with the appropriate and intelligent use of this key information.

Here’s a closer look at some predictions for the New Year and what they may mean for health systems, patients, and payers in a pandemic- and post-pandemic world.

Closing in on interoperability gaps
By the end of 2021, we’ll be surprised at how much progress we will have made on adoption of the CMS Interoperability and Patient Access final rule. While the implementation deadline was extended six months for hospitals amid the COVID-19 pandemic, all the requirements of the law—including the data blocking provision—remain the same.

Payers and providers alike will move forward with building more applications to manage patient and provider data. In addition to helping them comply with the CMS rule, this will allow them to build data infrastructure for multiple business uses. As a result of this change and the Patient Access API and Provider Directory API policies, we will see data finally begin to flow as patients gain access and control of their healthcare information.

We’ve never had a standardized way in healthcare to authentically and seamlessly move data. Both access and freedom will bring numerous benefits to the industry, easing data exchange friction among providers and enabling better experiences for patients. Health systems will gain the ability to effectively allocate resources and intervene on the right patients at the right time with the right treatments. With the legislative support, next year is when we finally will see this happen.

Building a solid foundation to operationalize SDOH
In 2021, we’ll see an effort to systematize the use of SDOH data and measure its effectiveness. While the majority of providers have shown interest in enhancing clinical data with SDOH data, investment to operationalize strategies simply has not yet materialized. Rather, this year, the industry experienced a gradual adoption of SDOH data with a select few champions acting on this vision rather than organizations establishing a foundation of appropriate training and IT support. Kudos to those who went above and beyond to work with the data and actively implement it into workflows, but healthcare requires a more sustainable model based on actual support.

With COVID-19 highlighting the adverse effects of various disparities on health outcomes, including socio-economic factors and access to care, organizations will finally invest in technology infrastructure and training to systematize the use of SDOH. Following that, the same tools will enable organizations to measure the effectiveness of specific interventions, a key component of an outcomes-driven strategy. This promise—and the demand for value-based care—will only fuel greater demand for SDOH data integration in 2021.

Balancing privacy and security
As we introduce new types of data and manage an increase in data access points on various devices and systems, privacy and security will be front and center in healthcare next year. The CMS Interoperability and Patient Access rule will further drive the need to share patient data and increase consumer appetite for owning and moving it. This year already brought a heightened awareness among patients regarding privacy of their data, as well as numerous cybersecurity breaches. Cybersecurity threats are on the rise, and will continue to grow in 2021.

While I want to be optimistic about healthcare’s ability to balance privacy and security, I don’t see the industry arriving at a tenable solution in the next 12 months. The existing patchwork of federal regulations, combined with emerging state-level efforts, will create an even more confusing regulatory environment that doesn’t jive with existing efforts. I also predict a high likelihood of an adverse event where a patient’s data is accessed or shared inappropriately. Should that happen, the issue of a national patient identifier (NPI) will be back on the docket in Congress, but conflicting interests will make it unlikely for real progress to materialize. The new administration will bring an increased activity and a new focus to these issues, particularly interoperability and access, but security weaknesses will prevail.

Getting to terms with transparent payment rates
As we dispense with the secrecy of rates via the Hospital Price Transparency rule on January 1, we can expect a close scrutiny of previously hidden rates by all in the industry. While some stakeholders, particularly in the hospital setting, fear that exposing discounted rates will drive up healthcare costs, I truly believe that the rule will spur a healthier market competition. Payers and providers will shift the rate negotiations to focus on the value each party brings to the table. Volume, care outcomes and other meaningful factors will become more important as stakeholders seek to determine the new market rules. A focus on tangible variables directly related to care will open up more options for all parties, leading to a healthier market.

The stars are aligned in 2021 for real progress in healthcare. As we stand shoulder to shoulder, supported by innovative technologies and informed by lessons learned during this difficult year, I’m confident we will make great strides toward meaningful, positive changes.

About the author: Jay Sultan is the vice president of strategy for healthcare at LexisNexis Risk Solutions.