2020. Something about the number suggests we’ll get greater clarity on the market. On how the bets we’ve made in the past couple of years on technology and new services will pan out. On what the regulatory environment (or at least legislative environment) will be.

And as we start the year, here are 6 questions for which we’re hoping to see answers:

1. Will primary care practices succeed in value based care where many health system partnerships could not?

Nearly every day this year I opened my email to see a new partnership announced between plans and primary care providers. Whether it was with a disruptor group (BCBRI and Oak Street), primary care enablement company (BCBSNC and Aledade), or direct employment (United and OptumCare), health plans are shifting strategy. A few years ago, we wrote about the promise of health system-led ACOs and how greater coordination across the continuum would lower costs. Instead, we find many (though not all) of those partnerships stalled and replaced by a focus on the PCP as the navigator between and away from health systems.

2. With all the new entrants in MA, will market share shift away from larger plans?

Almost every plan I speak to is thinking about expanding or entering the Medicare Advantage market. Inspired by favorable rates, greater control over benefits, and a path to profitability, plans are dipping their whole feet in the water. Although the MA space may seem like a hotbed for expansion and profit, there’s already a couple giant players in the MA space who don’t seem keen on surrendering their foothold in the MA market. In 2019, United and Humana accounted for 44% of all enrollment – up from 42% in 2018. It remains to be seen if these newer entrants can overcome the incumbency and brand advantage the nationals possess.

3. Can digital tools take on what physicians won’t – namely enhanced outcomes?

By our last (and probably now outdated) count there were 638 new wellness companies in 2019. While some are a stretch to make a medical case (looking at you turmeric-infused butter), digital tools are being taken more seriously than in the past. After a two-and-a-half-year digital health IPO drought, 2019 saw digital health companies explode onto the scene with five IPOs to date. Livongo’s successful IPO further cemented the value organizations place on partnering with digital tools, particularly those that have been shown to reverse disease. In fact, we see many of these vendors taking on risk for clinical outcomes – lower rates of HbA1c, lower BMI – where physicians would not.

4. Will telehealth use expand and meaningfully drive lower costs or different behaviors?

Less than 5% of a health plan’s members used telehealth in 2019. And it’s not for lack of awareness – members know it exists but either have trouble figuring out the right time to use it or find it too cumbersome to register when a need arises. And even if members do use telehealth, the question remains whether it’s replacing expensive utilization or merely supplementing care. This past year plans went from incentivizing telehealth use to embedding it in the benefit design which may be what’s ultimately needed to make telehealth the first point of contact.

5. Will spend for new specialty medications outpace the new plan products that cover them?

There does not appear to be a slowdown in the pace of new medications coming out that will cure or dramatically alter the course of a disease; and do so at a significant price. We’ve seen new insurance products from Aetna/CVS and Cigna/ExpressScripts that aim to address the high and unpredictable drug costs through supplemental purchases. But as the number of high-cost drugs released outpaces the number of products a purchaser (or plan) must buy, their utility may remain a short-term fix.

6. Can pilots around social determinants scale to impact community health?

Social determinants of health had quite the year. This trendy phrase became widely used language across plans and providers alike in part due to additional federal funding, new benefit allowances in MA, and a majority of states requiring social needs screening. Every health plan case manager has a tremendous story of helping out a member in need. The question I have now is how all of these one-off examples will translate to a sustainable program. In particular, will plans develop the needed competencies to deliver goods and services to members rather than connecting them to providers?