Better healthcare forecasting for 2021 and beyond

The work of building forecasting systems to prevent organizations across the healthcare industry from flying blind in the next crisis will begin in earnest in 2021. In its "Top Health Industry Issues 2021" report, PwC’s Health Research Institute (HRI) found that 74% of health executives surveyed said their organizations would invest more in predictive modeling this year. The pandemic showed us that healthcare players can no longer rely on retrospective data to plan for the future, but need a prospective model fueled with a steady stream of data in as close to real time as possible.

This effort will help healthcare organizations not just to prepare for the next public health emergency, but also to quickly identify and respond to shifts in the insurance market, the economy, utilization and consumer behavior in order to survive and even thrive. For example, better forecasting on the economy could enable providers to predict and plan for changes in patient demand for elective procedures and payers for swings in Medicaid managed care enrollment.

All healthcare is local and the pandemic proved this point as it ebbed and flowed in different parts of the country at different times. The experience shows that establishing a national forecasting system will not be enough and that the various players in regional healthcare systems need to be able to predict changes that will affect their communities. HRI found that 73% of healthcare executives surveyed were starting to collaborate or had plans to collaborate with other care providers and payers as a result of the pandemic.

Of course, one glaring problem is that no one organization has all the data needed to fuel the forecasting engine. Community partnerships will need to be established so that the necessary data can be collected, analyzed and shared. Hospitals and academic medical centers, business councils, community leaders, government, and local employers all have a role to play, and different expertise and community insights to offer. New digital-focused entrants or health information exchanges could provide the platforms needed to unite the data from the various sources and run the simulations that would generate forecasts on an ongoing basis. The federal interoperability rules, finalized in March 2020, and a general push toward more health information exchanges should ease the flow of data needed to enable these collaborations to succeed.

Conveners of these initiatives will vary across regions. An academic medical center might convene a consortium to develop a regional forecasting system with data contributions coming from the area’s hospitals, pharmacies, payers, suppliers, government, businesses and community groups. Using the results, all healthcare players, including life sciences companies, could make data-driven decisions to improve their business operations and generate better health outcomes.

A critical task for the year ahead is determining the types of data that need to be gathered to build useful, actionable forecasts. The data points can’t be limited to healthcare information pulled from provider and payer sources; they have to include social determinants of health factors like air quality, education and employment levels, and access to transportation and healthy food. Combined, this data can paint a better picture of patients’ lives and their preferences to drive better engagement and more effective interventions, ultimately creating healthier communities.

Hospitals need to take control of their own destinies by anticipating instead of reacting to demand. Using customer relationship management technology for targeted and proactive outreach not only can help manage fluctuating volumes but may also reduce overall cost by improving health and preventing expensive acute, episodic care.