As we wind up the HealthFlock Blog, I think it is important to leave healthcare providers and consumers with a listing of the top 5 things they should look for as healthcare reform initiatives are implemented.
1. Increase in Patient Accountability
Healthcare reimbursement is changing to remit payment based upon the patients’ outcomes instead of the number of patient visits. Specifically, state and federal healthcare programs will pay providers based upon whether or not the patient had a quality outcome and avoided unnecessary admissions, tests or visits. In order to achieve quality outcomes, providers are focused upon engaging patients to be more accountable for their health. Likewise, healthcare payors are modifying payor programs to make patients more responsible financially for out-of-pocket expenses. Many self-insured employer plans are already modifying premiums and benefits for employees who engage in a wellness program, have good nutrition practices or participate in exercise programs. Again, this is to motivate the patient to be more accountable for his or her healthcare needs and ultimately reduce the cost for the employer, the payors and the overall healthcare delivery system.
2. Patient Engagement in the Delivery of Care
Providers will continue to engage their patients to ensure the patients are following the treatment plans, obtaining medications and taking the medications in accordance with the physician’s instructions. These types of patient engagement tools will continue to develop in the healthcare information technology arena. We are already seeing an influx of mobile applications to track patient’s weight, exercise and diet. We will continue to see mobile applications develop enabling patient communication with his or her physician, whether it is through video conferencing, telemedicine services or facilitating one-on-one communication through e-mail and on-line visits. Patient personal health records are another way to share real time healthcare information with the patient. Engaging the patient will be essential to impacting healthcare costs and quality outcomes.
3. Increase in Compliance Efforts
Healthcare providers should focus on compliance programs. It is essential that every healthcare provider maintain an effective compliance program that proactively audits the operations of the healthcare practice to prevent and to detect potential illegal or improper activities. Government agencies will continually audit and investigate healthcare providers based upon complaints, data analytics reporting and random audits to determine whether or not the providers are potentially billing improperly or violating laws that apply to healthcare providers. A healthcare provider’s best defense is to proactively engage in audits and take prompt remedial action to ensure its operations comply with the complex healthcare regulations.
4. Clinical Integration
As healthcare reimbursement continues to migrate from a fee-for-service to quality outcome payments, healthcare providers are being forced to integrate with one another based upon patient-centered protocols. Specifically, groups of individual physicians who have not been affiliated in any manner, but have operated individual practices, are being forced to coordinate in providing care to a patient to ensure that the patient is on one coordinated treatment plan and medication regimen regardless of the specialists that the patient visits. These interdisciplinary approaches to providing care are essential to ensuring that patients are receiving coordinated care across the entire continuum of their healthcare needs. Further, reimbursement is moving to pay providers as one group through a bundle payment program. These bundle payments will force providers to work together to maximize reimbursement while minimizing the cost associated with delivering care. Ultimately, in order to achieve real efficiencies and reduce the healthcare costs, the providers must coordinate on how the clinical care will be delivered and work together to reduce the associated expenses.
5. Consolidation of Healthcare
The changes in reimbursement and the shortage of healthcare providers will drive additional consolidation. Over the last four years, we have seen a significant number of mergers and acquisitions. The increase in reimbursement for primary care physicians and surgeons in health professional shortage areas that started with the Healthcare Reform Act will decrease after 2015. We anticipate that there will be many healthcare providers in rural and underserved areas that will be adversely impacted by this change. This may alter the types of providers that are providing care in the rural areas such as rural hospitals converting over into freestanding emergency departments or more urgent care clinics providing stabilization services for patients to be transferred to a larger metropolitan area hospital.
All of these market pressures are changing how healthcare is delivered. Because of the potential shortage and decline in the number of providers and facilities that are available for patients, we will see an increase in the use of healthcare information technology that facilitates the delivery of care through new innovative methods. We will also see shrinkage of the healthcare marketplace. Healthcare providers and payer plans will cross industry lines and the payer and provider may become one entity. Ultimately, this will consolidate how care is delivered and paid for into one organization that can impact both sides of the spectrum.
Healthcare is an industry governed by extremely complex regulations. It will continue to migrate and change. However, one thing to remember is that healthcare is local and controlled by the healthcare provider, the payer and the patient. The goals to reduce costs and increase quality outcomes is contingent upon all three participants being actively involved in transforming how healthcare operates in the future.