The Healthcare Federalist

Top Health Trends for State Health Policymakers to Watch in 2023

Part Three: Service Delivery, Quality, and Equity Trends
By Courtney Burke

This three-part blog series outlines 10 important health policy issues from 2022 that are worth monitoring in 2023. As the blogs are published they will be added here.

Part One: Broad Workforce, Economic, and Health Policy Shifts

Part Two: Internal Industry Economic Trends

Part Three: Service Delivery, Quality, and Equity Trends

The transition to a new year is a good time to reflect on what happened over the last 12 months and anticipate what it may mean for the upcoming year. For those in state healthcare policy, this three-part blog outlines the top ten important issues from 2022 that are worth monitoring in 2023.

The previous two installments in this series considered broader socio-economic shifts, and internal industry trends. Here, in the final installment, we discuss the focus being placed on health equity, quality, and modes of service delivery.

  1. Attention to health equity

    The need to eliminate health disparities was part of the goals set forth by the federal Department of Health and Human Services (HHS) in both Healthy People 2010 and Healthy People 2020. The Healthy People goals are set forth under HHS within the Centers for Disease Control and Prevention and focus on goals that will improve health through increasing life spans, reducing disparities in care and improving wellness, for example. The pandemic has further highlighted that inequities in our healthcare system have, however, persisted. The State University of New York at Albany’s Center for the Elimination of Minority Health Disparities report, “The Differential Impacts of COVID-19,” documents these disparities. The research shows that minorities, older adults in nursing homes, and people of color were disproportionally impacted by COVID-19.

    What states should watch in 2023. Achieving health equity is a big, but important, endeavor. To tackle this issue, some states, such as Oregon and Massachusetts, are leveraging their Medicaid programs to examine new ways to advance equity. Both states have modified their Medicaid programs to implement measures to reduce disparities. The modifications do this by addressing social care needs, such as housing, transportation, or food security, tied to health outcomes. Preliminary results from these efforts will become more widely available in 2023. The outcomes of these initiatives have the potential to inform other states’ efforts at reducing health disparities and will be worth watching in 2023.

  2. Digital telehealth delivery expansion

    A trend that accelerated rapidly during COVID was the use of digital and telehealth care. According the US Food and Drug Administration, “digital health,” includes mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine.” It also includes, “mobile medical apps and software that support the clinical decisions doctors make every day to do artificial intelligence and machine learning.”

    What states should watch in 2023. The ability of digital companies to propel innovation in care delivery is an opportunity. Although digital health is expanding in many ways, some of the most promising areas for continued expansion in 2023 include home health, hospice, remote monitoring, maternal care, behavioral health, and “hospital at home.” State government can play an important role in not only allowing these innovations to occur but in supporting efforts that result in better health outcomes. Already states are changing regulations about where, who, and how care can be provided and paid for. Better understanding the impact of these innovations on access, equity, and quality for patients will be important.

  3. Expansion of non-traditional providers in healthcare service delivery

    In recent years, non-traditional actors have begun to deliver healthcare. For example, Walgreens, once solely a retail pharmacy chain, is now providing a range of primary care in some of its stores. To further expand their ability to provide care, Walgreens-backed Village MD is acquiring Summit Health-City MD, a large physician group, at a value of $8.9 billion. Similarly, CVS, which also now provides healthcare at some of its stores, is expanding further into care delivery by partnering with Signify Health, a technology-driven in-home health platform for care delivery, an investment of nearly $8 billion. Yet another example of a non-traditional provider entering healthcare is Amazon’s partnership with One Medical. At an acquisition price tag of $3.9 billion, this partnership brings together what was once a bookstore with a tech-enabled private primary care physician network.

    What states should watch in 2023. The number, size, worth, and speed of these recent expansions and pending partnerships in the health marketplace is rapidly creating a system of care delivery that is very different from a decade ago. The challenge for state governments will be determining what their role should be in evaluating and monitoring the impact of the proliferation of non-traditional partnerships in healthcare. Because these entities described above are privately owned and operate in several states, regulating them will be complicated for states and may ultimately fall to the federal government under the Commerce Clause of the Constitution and the federal government may halt mergers that result in negative impacts on consumers. States can only intervene if the activity of an entity poses a threat to the public health or safety of their citizens. However, states may be able to contribute to the federal government’s thinking about their role by collecting data on the growth of these entities and how that growth may or may not be impacting healthcare access, cost, and quality.

The 10 trends to watch in 2023 outlined in this series are meant to help state health policymakers keep on eye on things that may impact their respective constituencies. Whether the focus is on addressing persistent inequities, the financial health of providers, staffing shortages, or consolidation, all will ultimately change what healthcare delivery looks like in the future. Armed with the right data on the scope of these trends and information on the impacts in and across states, policymakers will be better equipped to course correct or advance those efforts that are most helpful to improving the health of residents.


Courtney Burke is senior fellow for health policy at the Rockefeller Institute of Government