ASC and other specialized ambulatory care centers help reduce overall medical costs by moving specialized services to locations with that sole purpose. This frees up space and staff in larger medical institutions and, at the same time, provides more patient-centered care at the ASC. The quality of care also improves, as specialists can work in an environment focused on their area of expertise. ASCs also require quality reports and measures, almost twice as much as ambulatory surgeries in similar hospital settings.
The variability in growth in different areas of health care persists and, in some cases, has become more pronounced. For example, government lines of business continue to represent the fastest growing areas for payers. Out-of-hospital care services are the fastest-growing businesses for providers, given the continuous shift to the non-acute environment. Meanwhile, the evolution of value-based care and payments for related risks, as well as the digitalization of the value chain, are transforming value creation in traditional health subsectors, not within them.
HST has had extensive overall growth, but software, platforms, and data and analytics have performed especially well, with a CAGR of 10 percent and 17 percent, respectively. Changes in the business model of payers and providers account for much of that growth. In addition to the overall growth of specialties, the pharmacy benefit managers (PBM) segment is under pressure from greater transparency in reimbursements and differential network pricing by payers and sponsors. The demand from employers to contain and predict costs has led to a wave of new and innovative pricing models.
Specialized actors (such as specialty drug managers, therapy management, benefit optimizers, and pharmacy benefit managers) are now taking on some PBM functions. Faced with these trends and commercialization, PBMs have created group purchasing organizations (for example, Ascent Health Services, Zinc Health Services and Emisar Pharma Services) to better negotiate with drug manufacturers. They continue to invest to improve the experience of employers and employees and are redoubling their efforts to better manage medical benefits (specialized drugs). The increase in drug spending, including the increase in specialty drugs, has increasingly focused attention on the role of pharmacy in coordinating patient care.
Of particular interest is the use of pharmacists and patient services to promote greater adherence to medication regimens and provide medication related counseling. Both payers and PBMs and dispensers are focused on reducing the total cost of care and improving patient outcomes and experience. The continuous and rapid expansion of value-based models of care is leading to a realignment across the healthcare value chain. The realignment seeks models that can offer better affordability, quality, better access and experience of care, but that also offer the promise of obtaining higher economic returns.
Payers, for example, are innovating in their Medicare Advantage business to go beyond offering just the health plan and becoming owners and orchestrating models of care, including doctors' offices, virtual care, home care and pharmacy, as well as care management, medication compliance and other enablement services. These models are increasingly based on clinical services based on data and analysis, such as coordinating care and improving member participation. This approach can offer superior care to members and, at the same time, expand the source of benefits available to payers by two or three times (graphic). To access these capabilities, payers are making acquisitions, minority investments and partnerships with private equity firms.
The COVID-19 pandemic has had a profound effect on the health sector, from changing benefit funds to increasing innovation and creating new business models. Payers, providers, HST actors and pharmaceutical service companies are faced with important decisions about the type of companies they want to be in the coming years. Although the pandemic continues, now is the time to make strategic decisions and, potentially, big stakes. Acquisitions and the creation of new businesses will increasingly be key factors of success.
.
