Editor's Note: Manatt Health has just released the 2023 update of our Health Care Imperatives for the 2020s series. Recognizing the myriad of challenges that emerged in 2022—from the impact of the Dobbs decision on abortion care access to the surging mental health crisis to the exploding labor and supply costs bringing massive losses to many hospitals—we chose Embracing Whole-Person Health as the unifying theme for this year's update. The executive summary is below. Click here to download a free copy of the full report—and watch your email for your invitation to our upcoming companion webinar program.
The new report is the latest release in Manatt's ongoing Health Care Imperatives series. In January 2021, Manatt Health described ten health care imperatives essential for improving our health care system and advancing health equity in the decade of the '20s. Our 2022 update, Navigating Through the Surges, recognized the extraordinary challenge of simultaneously improving the health care system while navigating the exigencies of the pandemic, and highlighted the problems presented by the erosion of trust, the epidemic of behavioral health disorders, persistent and widening disparities, and chronic workforce shortages and stresses. To view our companion overview webinars free on demand, click here to access our 2022 program and here to access our 2021 series.
2022 proved to be a challenging year. While enrollment in Medicaid reached an all-time high of 90 million, access to abortion care was sharply curtailed with Dobbs. Commitments to health equity met backlash from "anti-woke" advocates. Safety net facilities struggled with rising demand and declining payments, including loss of federal COVID-19 relief funding. The rapid spiral upward in labor and supply costs combined with compressed reimbursements resulted in massive losses for many hospitals. The worsening children and youth mental health crisis overwhelmed health services. Amidst this dark landscape, there were glimmers of light. Telehealth continued to demonstrate its potential with digitally enabled care models. Innovative solutions integrating health and social services were meaningfully launched in several states to meet the health-related social needs (HRSNs) of enrollees. Recognizing these important opportunities, we have chosen Embracing Whole-Person Health as the theme for our annual update, and we have added an 11th imperative: Innovating and Advancing Care at Home.
In addition, in this year's Leading for Change section, we highlight how an environmental, social and governance (ESG) framework can bridge the gap between health care organizations and their stakeholders in order to build a better, more equitable health care system. While public, private and not-for-profit health organizations have different drivers for adopting an ESG framework, they all serve communities that are increasingly aware of what responsible business looks like and have elevated expectations for the organizations with which they engage.
ESG provides a framework for organizations to integrate their sustainability (e.g., environmental performance); corporate social responsibility; community benefit investment; and diversity, equity and inclusion initiatives. We also believe it creates a framework for advancing whole-person health in the manner most suited to the organization's priorities.
As a unifying theme, Embracing Whole-Person Health establishes a "north star" for the alignment of needs across the health system. Our individual ability to live a healthy and productive life depends to a great extent on drivers of health, including housing, food, safety, education, help at home, transportation and coordination of care across the continuum. The concept of whole-person health recognizes the benefit of aligning services from wellness through primary care to acute and post-acute care. It also embraces the need to focus public and private resources on aligning downstream health care services with upstream social and community resources. This alignment benefits from health care coverage and the intensive coordination of primary care, hospital, behavioral health, pharmacy, retail, social and educational services to improve the health of individuals, families, communities and populations. States are implementing these coordinated solutions through their Medicaid agencies and managed care contracting practices. Retailers are integrating health care and pharmacy services with expansive digital platforms. Health plans are building out extensive primary care platforms and taking steps to integrate social care into health care delivery. Health tech companies are rapidly evolving and introducing capabilities that facilitate coordination of services. And health systems are expanding their ambulatory, digital and community benefit investments to achieve similar goals.
We added our 11th imperative recognizing that Innovating and Advancing Care at Home has long been a critical missing link in the alignment of the health care system around those who need it the most, particularly the aging and those suffering with chronic and debilitating conditions. Advances in technology, including telehealth, remote patient monitoring, smart sensors, AI and medication administration, along with payment models piloted during the pandemic, have made care provided in the home far more available to millions of people and a desirable alternative to institutional care. Medicare Advantage plans, in coordination with community-based organizations (CBOs) and health systems, are likely to be significant leaders in advancing care at home. Our newest imperative reinforces the need to modernize the legal, data-sharing and regulatory frameworks that govern home care and the reimbursement schemas that pay for it.
2023 Health Care Imperatives
1. Ensure Access to Coverage and Care. Improve access to needed services at every point in the health care system. Minimize coverage losses due to the end of the federal continuous coverage requirements.
2. Achieve Health Equity Through Collective and Sustained Actions. Work upstream to solve structural issues of social need while continuing to improve access to and quality of health care.
3. Stabilize the Safety Net and Rebuild Public Health Capacity. Deploy financing solutions that allow safety net facilities to remain open and enable them to stabilize their workforce, invest in outpatient services and access capital for needed investments.
4. Address Social Drivers to Improve Health for All Americans. Embrace whole-person-health strategies and engage enrollees in new ways to address their health-related social needs.
5. Help Our Children Reach Their Full Potential. Leverage policy and financing strategies to build partnerships between health care institutions, schools and community organizations to develop life skills, enhance mental health knowledge, provide early intervention and connect youth in need with more intensive services.
6. Innovate Long-Term Financing and Care Models to Promote Living Longer, Healthier Lives With Dignity. Expand and support the long-term care workforce and improve access to noninstitutional and home-centric care models for older adults and people with disabilities.
7. Innovate and Advance Care at Home. Modernize legal and regulatory frameworks that govern home care and the reimbursement schemas that pay for it to remove barriers to facilitate innovation.
8. Accelerate Digital Health. Tightly integrate technology and clinical models to drive improved experience and clinical outcomes, implement strategies to incorporate AI, and design payment policies to stimulate further adoption.
9. Advance Academic Medicine. Accelerate repositioning strategies: expand ambulatory and community locations, invest in population health and value-based payment strategies, integrate community health into academic programs, extend digital offerings, and become vastly more efficient.
10. Deliver Breakthrough Treatments Affordably. Engage with the Food and Drug Omnibus Reform Act (FDORA) to optimize new therapy review and launch.
11. Secure Health Data and Put It to Work. Execute a unified, cross-agency, comprehensive national framework to protect the vast amount of digital consumer health information held outside the traditional health care system. Ensure data strategies account for new federal and state data-sharing requirements.
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