The Case for Change

We know that we cannot meet our commitment to become a lifetime, trusted health partner without taking a step back and listening to what is happening in the market. To that end, there are several trends, including affordability for consumers, and rising costs and burnout for care providers, which all emphasize why a change is needed.

First, affordability has increasingly become a pronounced issue for consumers and care providers in today's environment. In the first year of the COVID-19 pandemic, the National Health Expenditure increased by 9.7%, reaching $4.1 trillion in 2020.1 Nearly half of adults say it is difficult to afford out-of-pocket medical costs, with 24% saying they have delayed care or gone without care due to cost.2 That's all Americans, not just ones who have lower incomes. As such, many patients are delaying care, which can lead to worse prognoses, worse outcomes, and higher cost interventions.

We know that our care provider partners have also been hit by increased costs. In particular, costs have been trending higher due to the labor shortages or shifts in who is providing care. For hospitals, labor expenses have increased 19% between 2019 and 2021.3 Labor constitutes the largest share of hospital costs, and the pandemic exacerbated shortages in many frontline care positions, leading to not only dependence on staffing agencies to fill vacancies but also an increase in pay to retain employed workers. This is particularly important when resources like traveling nurses saw an increase of 213% in hourly wages in the height of the pandemic.4

Hospital labor expenses increased 19%

Additionally, burnout is top of mind for many; nearly 63% of surveyed physicians reported at least one symptom of burnout at the end of 2021, an increase from 44% in 2017.5 Though much of this increase can be attributed to the long duration of the pandemic, many physicians have seen an increase in patient panel size, fatigue from electronic health record demands, and gaps in care coordination for patients, often which they attempt to fill themselves.

~63% of surveyed physicians reported burnout

Forward Together

In response to these market forces, payers and nontraditional players continue to test out new models and approaches to healthcare delivery. Though the diversity of strategies is broad — players are investing in home care, virtual care, retail care, and care provider ownership — they are all attempting to make healthcare more affordable and the care provider experience more tenable. Innovative care models are by no means new, but the increased pressures described here highlight the imperative to find the right path forward.

As that path ahead takes shape, care providers and consumers have come to expect improved experiences with all their partners, including payers. Elevance Health remains dedicated to partnering with care providers to build models of healthcare delivery that not only address the current climate but also position care providers well into the future. For example, to help ease some of the concerns care providers face, we are simplifying the authorization process for care providers and our consumers through the increased access to electronic medical records (EMR) across the country. This reduces administrative burden for care providers and ensures our consumers receive timely, appropriate care.

We are also changing the healthcare landscape by addressing industry needs, including bringing together data sets and artificial intelligence, and integrating technology systems used across a patient's care journey. This helps increase affordability, quality, access, experience, and health equity.

1 Centers for Medicare & Medicaid Services, NHE Fact Sheet (Modified August 12, 2022): cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet. 2 Kaiser Family Foundation, Americans' Challenges with Health Care Costs (July 14, 2022): kff.org. 3 KaufmanHall, The Financial Effects of Hospital Workforce Dislocation: A Special Workforce Edition of the National Hospital Flash Report (May 11, 2022): kaufmanhall.com. 4 American Hospital Association, Massive Growth in Expenses and Rising Inflation Fuel Continued Financial Challenges for America's Hospitals and Health Systems (April 2022): aha.org. 5 Mayo Clinic Proceedings, Changes in Burnout and Satisfaction With Work-Life Integration in Physicians During the First 2 Years of the COVID-19 Pandemic (September 13, 2022): mayoclinicproceedings.org.