We’re putting 2020 in the rearview mirror and gazing into the crystal ball to see what 2021 holds. Stephen Grossbart, PhD, and Dan Orenstein, JD, tackle the challenge of predicting what’s next for healthcare in 2021. Stephen and Dan discuss the trends and policies most impactful to the industry and attempt to answer the following questions on everyone’s mind. - Healthcare technology—Where is it headed? What’s the next big thing? - Care delivery—How will COVID-19 continue to impact healthcare systems, physicians, and patients? What changes will the industry make to prepare for future pandemics? What will happen with value-based care? - The new Biden administration—What changes will it make that will impact healthcare? What will the Supreme Court/Congress do about the ACA?

1. 2021 Healthcare Trends:
Embracing an Unpredictable Future
January 20, 2021
Stephen Grossbart
Senior Vice President, Health Catalyst
Dan Orenstein
General Counsel, Health Catalyst

2. New Biden Administration
• What changes will the administration
make that will impact healthcare? What
will the Supreme Court/Congress do
about the ACA?
Care Delivery
• How will COVID-19 continue to impact
healthcare systems, physicians, and
patients? What changes will be made to
prepare for future pandemics?
Healthcare Technology
• Where is it headed? What’s the next
big thing?
Journey
For Today

3. © 2020
Health
Catalyst
Will the Affordable Care Act (ACA) be repealed?
• Yes, in full
• Yes, partially
• Maybe
• No
Poll Question #1
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Health
Catalyst
ACA
• California v. Texas - It is unclear whether the Supreme Court would
uphold the appeals court’s ruling.
• Even if the Supreme Court affirms the appeals court in California v.
Texas, it will take some time for the issue of severability of the mandate
to work its way through the court system.
• It appears unlikely that the entire ACA would be repealed if the individual
mandate is found to be unconstitutional. Also, Congress can fix the
issue by reinstating even a nominal penalty, which is likely with both
House and Senate under Democratic control.
• Even if the ACA programs were dismantled, it seems very likely that
multiple programs, including the various CMS value-based care (VBC)
programs and the Medicare Shared Savings Program (MSSP), would
continue or would be resurrected by Congress.
What Is the Future of the ACA and Efforts to Challenge It?
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Catalyst
ACA
• Individual mandate – Congress may take action to restore the
penalty for failing to obtain health insurance.
• Increased resources for demonstration projects
• Tax credits/subsidies to purchase insurance on the exchanges for
low- and middle- income families
What Changes Are Possible?
5

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Catalyst
Biden Administration
Who’s on the Healthcare Team?
6
• Attorney General of California and former member of U.S. House of Representatives
Xavier Becerra Secretary of Health and Human Services (HHS)
• Previously led Healthcare.gov turnaround
Jeffrey Zients COVID-19 Coordinator
• Served as Surgeon General in Obama administration
Vivek Murthy Surgeon General
• NJ Human Services Department commissioner and former Obama administration official
Carole Johnson Chair, National Pandemic Testing Board
• FEMA official in Obama administration
Tim Manning COVID-19 Supply Coordinator

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Catalyst
Biden Administration
Who’s on the Healthcare Team?
7
• CDC official
Cyrus Shahpar COVID-19 Data Director
• The current director of the National Institute of Allergies and Infectious Diseases, will remain in his
post and also serve as Biden's chief medical adviser
Anthony Fauci Director of the National Institute of Allergies and Infectious Diseases
• HHS official
Sonya Bernstein Senior Policy Advisor
• Former FDA Commissioner, to replace Moncef Slaoui after a brief transition period
David Kessler Chief Scientific Adviser to Operation Warp Speed
• To continue to control vaccine distribution logistics
Gen. Gustave Perna Operation Warp Speed COO

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Health
Catalyst
Biden Administration
Who’s on the Healthcare Team?
8
• Chief of infectious diseases at Massachusetts General Hospital and professor at Harvard Medical School
Rochelle Walensky Director of Centers for Disease Control and Prevention (CDC)
• Professor at the Yale School of Medicine and the founding director of Yale’s Equity Research
and Innovation Center
Marcella Nunez-Smith COVID-19 Equity Task Force chair (new role)
• Senior health policy adviser to U.S. Representative Jan Schakowsky of Illinois
Osaremen Okolo Policy Advisor
Andrea Palm Deputy Secretary HHS
• Wisconsin health official and former Obama administration official

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Health
Catalyst
Senate committee leadership:
• Sen. Patty Murray (D-WA) is in line to lead Health, Education,
Labor and Pensions (HELP) Committee, who has advocated for a
stronger federal response to COVID-19
• Sen. Ron Wyden (D-OR) is in line to lead the Finance Committee,
where he has pushed for drug pricing reform
Senate Healthcare Leadership Changes
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Catalyst
COVID-19
• National plan to coordinate vaccine distribution, reporting
• More support for states and localities for healthcare infrastructure, relief
Expansion of funding for ACA programs, including coverage
and value-based care programs
• This could be accomplished using budget reconciliation, a tool that
requires only a simple majority
Medicaid expansion
• Encouraging states to adopt Medicaid expansion
Medicare drug price negotiation
Likely Biden Administration
Top Healthcare Policy Priorities
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Catalyst
• Public option
• Medicare for All
• Lowering Medicare eligibility age
What Is Unlikely to Move Forward Even
With Democratic Control of Congress
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Catalyst
Mount a National Vaccination Program
• $20 billion to states, localities, Tribes,
territories to launch vaccine centers
around the country
• Community vaccination centers around
the country and mobile vaccination units
Testing and Contact Tracing
• Invest $50 billion to expand testing,
including in-home and instant tests
• Fund 100,000 public health workers to
assist in vaccine distribution and build
public health capacity
Healthcare Elements of Biden’s
National Plan to Address COVID-19
12
Equitable Distribution of Tests,
Treatments, and Vaccines
• Address disparities for equitable
distribution of vaccines, supplies
• Expand services and vaccine availability
for underserved populations
Domestic Production of PPE
• Fully utilize the Defense Production Act
to increase production of masks, face
shields, and other PPE
• Invest $30 billion in Disaster Relief
Fund and $10 billion to expand
manufacturing capacity

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Catalyst
Support Tribal governments’ response
to COVID-19
• $20 billion to support Tribal
governments’ response to the pandemic
• Support access to PPE, clean water,
electricity, expanded Internet access
(e.g., for education, telehealth access)
Public Health Surveillance
• Expand surveillance of new strains
of COVID-19
• Monitor effectiveness of new
treatments, therapies
Healthcare Elements of Biden’s
National Plan to Address COVID-19
13
Support for First Responders and
Essential Workers
• $350 billion in emergency funding to
state, local, and territorial governments
to ensure support of front-line workers,
e.g., in healthcare, education, and
vital services
Preserve and Expand Healthcare Coverage
• Subsidize COBRA continuation through
end of September 2021
• Expand and increase Premium Tax Credit

14. How will COVID-19 continue to impact:
• Healthcare systems?
• Physicians/Providers?
• Patients?
• Value-based care programs
What changes will be made to prepare
for future pandemics?
Care Delivery

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Catalyst
COVID-19’s Toll on the World
15 Source: Washington Post

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Catalyst
Daily & Cumulative Cases & Deaths
Through January 13
16 Source: The MITRE Corp.

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Catalyst
Change in Mortality Rates From Expected
17 Source: KFF Analysis of CDC data

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Health
Catalyst
Risk Factors:
• Working in a high-risk
department
• Diagnosed family member
• Inadequate/suboptimal hand
hygiene, suboptimal hand
• Improper PPE use
• Close contact with patients
(≥ 12 times/day) or long
daily contact hours (≥ 15 h)
• Unprotected exposure
The Physical and Mental Health of Health Care
Professionals Has Suffered During COVID
18
Source: KFF AnSource: https://www.theguardian.com/us-news/ng-interactive/2020/aug/11/lost-on-the-frontline-covid-
19-coronavirus-us-healthcare-workers-deaths-database

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Catalyst
CDC Initiative to Reduce Infections
Among Patients and Staff
19 Source: https://www.cdc.gov/infectioncontrol/projectfirstline/about.html

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Health
Catalyst
Unanticipated Consequences of COVID-19
Decrease in Preventative Services
20 Source: Kaiser Family Foundation

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Catalyst
Even with the CARES hospital operating margin
fell dramatically in 2020.
Financial Impact on Hospital COVID
Source: KaufmanHall National Hospital Flash Report: December 2020
21

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Health
Catalyst
Even with the CARES hospital operating margin
fell dramatically in 2020.
Financial Impact on Hospital COVID
Source: KaufmanHall National Hospital Flash Report: December 2020
22

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Catalyst
Vaccine
How Do I Get It?
23 Source: Washington Post

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Catalyst
Who Wants It?
24 Source: Kaiser Family Foundation

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Catalyst
Now That It’s Here
People Are Changing Their Minds!
25 Source: Kaiser Family Foundation

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Catalyst
Role of Primary Care Providers
in Vaccine Support
26 Source: KFF COVID-19 Vaccine Monitor (KFF Health Tracking Poll, Nov. 30-Dec. 8, 2020)

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Catalyst
Policy Changes That Can Help to Be Better Prepared
at the Health System, Local, State, and National
Levels:
Funding to States and Localities for Public Health Response
Infrastructure
• Provide funding to States to build out their public health response data
systems, including registries, reporting, surveillance, dashboards
Data use
• Expand the availability of platforms that ensure patient data security and
expand data use rights to enable use and disclosure for research and
surveillance purposes.
– This will enable accelerated research on effective clinical interventions and treatment
pathways, and will help expand patient monitoring and help with public health reporting
and tracking vaccine distribution.
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Catalyst
Policy Changes That Can Help to Be Better Prepared
at the Health System, Local, State, and National
Levels:
National Patient Matching
• Establish a national patient matching strategy, such as implementing a
national patient identifier. This will be critical in public health
emergencies to (a) enable healthcare organizations to link patients
across providers and across HIEs, and (b) for surveillance and contact
tracing efforts.
Interoperability
• Continue to support interoperability across the healthcare industry, and
enforce against information blocking practices.
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29. © 2020
Health
Catalyst
Policy Changes That Can Help to Be Better Prepared
at the Health System, Local, State, and National
Levels:
National Public Health Response Infrastructure
• Provide funding for the development of a national Epidemic/Pandemic
Information Network.
– Overhaul CDC’s data aggregation and reporting system
– Expand the mission of PCORI and National Patient-Centered Clinical
Research Network (PCORNET)
– Mandate healthcare data vocabulary standards in EHRs
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Catalyst
In your opinion, what will be the top healthcare story in 2021?
• COVID
• COVID
• COVID
• COVID
• Cosmetic Surgery
Poll Question #2
30

31. • Where is it headed?
• What’s the next big thing
Healthcare
Technology

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Health
Catalyst
“[A] priority for governments is to build a system for the
flow of health-care data. Individuals should have control
over their records and grant permission to providers to
gain access to them. India is creating national health IDs
that will aim to combine privacy with mass data. Around
the world hundreds of millions of medical records need to
be anonymized and aggregated more efficiently so that
research can scour data sets for patterns.”
Data Can Be Leveraged to Improve Research
Into Effective Diagnosis and Treatment, and to
Assist With Vaccine Distribution and Tracking
32
The Economist, December 5, 2020, p. 17

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Catalyst
Leveraging Data and Advanced Analytics:
• COVID has heightened the need for centralized data management and secure
storage and more timely refresh rates and clinicians and administrators are
review hourly updates
• Artificial intelligence and machine learning is now critical for health systems and
vendors who have developed predictive models to track the virus and estimate
risk of COVID-19 patients with severe symptoms.
• Health systems expanding their capabilities to practice precision medication and
predictive analytics.
Telehealth and remote care continues to expand rapidly and hospitals are developing
improved digital front doors and Digital Portal to enhance online experience
Emerging Technology Trends
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Catalyst
• Expanding Role of CIO as health system rapidly expand support for
their digital workforce and organization’s strategy and risk
management. Also playing a larger role in Cybersecurity to respond to
increase in ransomware attacks, threats for incoming email, secure
data storage
• EHR expansion with features such and digital voice assistants and
natural language processing.
• Clinical IT developments including augmented reality and wearable
technology
Emerging Technology Trends
34 Source: Becker’s Hospital Review

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Health
Catalyst
• COVID-19 created an urgent need. According to a McKinsey study,
the number of patients using telehealth increased from 11% to 46%
between 2019 and 2020 and anticipates that going forward, it could
account for $250 billion, or 20% of all total healthcare spending.
• Telehealth needs greater integration with existing technology platforms
• Telehealth presents cybersecurity and privacy concerns
Telehealth Is Here to Stay
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Catalyst
Increase in Telemedicine
but Decline in Office Visits
36 Source: Kaiser Family Foundation

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Catalyst
Telehealth
What happened in 2020
• CMS equalized reimbursement for telehealth services and in person visits
• CMS issued a waiver for clinicians to practice across state lines, and allowed both established
and new patient telehealth visits
• HHS allowed audio-only devices, expanded the list of eligible providers, and expanded eligible
technology (e.g., Facebook Live and Zoom)
• Most states temporarily loosened interstate licensure requirements and activated interstate
agreements on permission to practice
• HHS suspended enforcement for failure to collect patient cost-sharing during the
COVID-19 emergency
• 2021 Medicare physician fee schedule expanded and made permanent reimbursement for some
telehealth and remote monitoring services, although some of the changes remain temporary
• Commercial payors took similar measures, such as waiving copays and expanding telehealth
coverage reimbursement
Policy Changes to Enable Telehealth Expansion
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Catalyst
Telehealth
What’s next
• The Biden administration is expected to continue policies promoting telehealth,
including reimbursement parity and access enablers
• Expect continued government and payor expansion of billing codes and payment
methods to accommodate telehealth, including for remote monitoring and at-home care.
• Habits have changed, and this will create pressure for continued expansion and parity
of telehealth to be reflected in federal and state policy
Policy Changes to Enable Telehealth Expansion
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Health
Catalyst
If you would like to learn more about Health Catalyst products or
professional services, please answer this poll question.
• Yes
• No
Poll Question #3
39

40. Q&A

41. Thank You!