The Progress We Need: Ten Health Care Imperatives for the Decade Ahead

Health Update


Editor’s Note: In a new white paper and companion infographic, Manatt Health addresses ten health care imperatives that we believe are critical for improving the health care system and achieving health equity. The paper shares our point of view on the strategies and actions needed to advance health care in our country—measures that will be more vital than ever, as we emerge from the pandemic and look to the future. Highlights are summarized below. Click here to download free copies of the full white paper and infographic. And watch your email for your invitation to our upcoming webinar series, including deep-dive sessions expanding on the key imperatives.


Manatt Health believes there are ten key imperatives central to advancing our health care system in the decade ahead.

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The first two imperatives—ensuring access for all and achieving health equity—are overarching requirements that must be collectively achieved for a just health care system.

Stabilizing the safety net and rebuilding our public health infrastructure are necessary pillars for a resilient health care system. The weakness in our system’s underlying infrastructure has been exposed during the pandemic, as has its lack of equity. Creating a just health care system requires us to address social determinants of health (SDOH) and to align our resources to health improvement and health outcomes.

We follow with the imperatives to help our children develop to their full potential and to support our elders with innovative new models enabling them to live longer, healthier lives with dignity. Accelerating the broad and equitable use of digital health capabilities will deliver on the promise of virtual care, helping us achieve better value for our health care spend and reallocating resources so that we can eliminate health disparities.

Advancing and sustaining academic medicine will provide the continued innovation needed to anticipate and respond to the emergencies of the future; open up new therapeutic frontiers; and help meet the growing, aging and diversifying population’s demand for clinicians. Delivering the new class of personalized therapeutics will require public and private payers to find innovative ways to price to provide affordable access. The accelerating transition to a digitally based society requires extraordinary attention to securing health care privacy. We believe that new policies to ensure this are imperative.

Each of these imperatives will need to be met while simultaneously bending the curve on health care cost growth, by focusing on high-value care, reducing complexity and aligning incentives. Success will require bold and activist leadership to meet these many challenges and deliver on the promise of a just health care system that will serve all with excellence, compassion and fairness.

The Ten Imperatives

1. Ensuring Access to Coverage and Care

Access to coverage and care is the linchpin of a high-functioning health care system. We expect to see the Biden Administration use its executive authority to strengthen and expand Medicaid coverage—and work with states to leverage Medicaid in promoting health equity. The Biden Administration also is likely to reinvigorate Marketplace outreach efforts and pursue other policies to promote comprehensive, affordable coverage. States also will be laboratories for innovation.

2. Achieving Health Equity Through Collective and Sustained Actions

The confluence of the public health emergency, economic crisis and racial justice reckoning has put in sharp focus that health equity is a foundational imperative for all health care organizations. The work to integrate health equity commitments into every organization’s strategic development will be a singular priority for the decade.

3. Stabilizing the Safety Net and Rebuilding Public Health Capacity

Safety net organizations face an existential crisis as rapid changes in health care payment and delivery threaten their sustainability. Compounding the stresses on the safety net, the COVID-19 crisis revealed the fragility of our nation’s public health infrastructure. Nevertheless, as we discovered through our work with city, county and state governments; health systems; foundations: and policymakers, coordination and communication resulted in powerful action to mitigate the worst effects of the pandemic.

4. Addressing Social Determinants to Improve Health for All Americans

The COVID-19 pandemic has cast a harsh light on the extent to which affordable and safe housing, food, schools and living environments—commonly referred to as Social Determinants of Health (SDOH)—are integral to health and well-being. The crisis has underscored just how critical the linkages between social services and physical and behavioral health care are to the well-being of communities. State Medicaid programs are leading the way in thinking creatively about addressing SDOH.

5. Helping Our Children Reach Their Full Potential

Disruptions to health care, education and community life due to the pandemic have been devastating for the health and development of our nation’s children. After decades of improvement, compliance with recommended well-child pediatric visits has plummeted. For children, the developmental moment is now, and missed or delayed screenings, diagnoses or treatments can have impacts reaching into adulthood. The decade ahead demands a new focus on mitigating the damage of COVID-19 and putting children—particularly our most vulnerable children—on track to reach their fullest potential.

6. Innovating Long-Term Care Models to Promote Living Longer, Healthier Lives With Dignity

Long-term care is becoming a pressing societal issue as growing numbers of elders living with disabilities or chronic diseases increase demand. The 65-and-over population is projected to increase 50% by 2030, and those over age 85 are the fastest-growing segment of older Americans. The time has come to implement solutions that enable our elders to maintain their autonomy with greater private- and public-sector support services. Our focus in the coming decade includes expanding innovative home- and community-based services through Medicaid and better integrating behavioral health support into those services.

7. Realizing the Promise of Virtual Health

Digital health adoption has skyrocketed during the COVID-19 pandemic, and this surge in use now has the potential to transform health care. In April 2020, telehealth utilization represented nearly 15% of all ambulatory services in the United States, up from less than 1% pre-pandemic. Achieving the full potential of digital health will require designing and actualizing new digitally enabled care delivery models that look fundamentally different than their in-person predecessors.

8. Advancing Academic Medicine

Academic health centers are recognized for their multi-mission commitment to clinical care, research and education and for their capacity to produce innovative solutions to health challenges. They have stepped into the breach during the pandemic to create COVID-19 tests and lead community coordination efforts, and they will be critical for effective vaccine distribution. To continue to fulfill their vital roles, academic health centers will need to transform into learning health systems focused on population health, caring for the whole person (including physician and behavioral health needs) and reflecting the diversity of the populations they serve.

9. Delivering Breakthrough Treatments

Scientific advances in understanding how to manipulate genes to alter the course of disease are now starting to bear fruit. Cell and gene therapies will bring hope to those with conditions once thought to be incurable or irreversible. The life sciences companies that pioneer these breakthroughs will have to navigate difficult business and political waters in pricing their products in the United States and around the world at the same time they are facing strong pricing headwinds. Payers will need to develop new tools to ensure appropriate access while keeping an eye on overall budget impacts.

10. Securing Health Data and Putting It to Work

When the Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996, there was virtually no Internet utilization, smartphones or artificial intelligence. During the past 24 years, the health data landscape has been remade—with vast amounts of personal data now being collected—but the scope of the privacy rule has not changed. It is time for a comprehensive federal health information privacy framework that reflects the realities of 2021 instead of 1996 and allows innovation without the confounding complexity caused by highly variable state laws.

Leading for Change

The next decade will require leaders to grapple with a broad range of new issues. Most especially, they will need to forcefully address diversity, equity and inclusion in addition to the disruptions rocking the traditional missions of many health care agencies and institutions. And they will need to reconcile the imperative to address growing costs while narrowing gaps in care and coverage. They also will need to identify, understand and introduce disruptive technologies as opportunities for rapid evolution and growth. Leaders who are bold activists and who recognize the importance of collaboration will define the future of health care.

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