Of this we can be certain in the year ahead: the new administration brings with it significant changes on many fronts, and health care is certainly at the forefront. The current model shift from volume- to value-based care will continue to develop throughout the industry. On its own, this shift significantly alters the healthcare landscape. To successfully navigate these changes, the healthcare industry must adapt, innovate and change its methodology.
Alicia A. Weissmeier, Esq, CHFP
With the advent of managed care, health care has gone through many changes. The current shift from volume to value over the past 10 years can be best classified as a fundamental shift in the delivery and payment model. Under health care’s current ideology of value-based care, the industry will need to continue to adapt through innovation and method change.
Uncertainty continues to provide opportunity and foster innovation. It isn’t all about politics — there are greater forces in play. A repeal of the ACA or even an adjustment of its ideology would require hospital systems to prepare for a worst-case scenario — elimination of the marketplace and a reversal of the expansion of Medicaid, which would require a close examination of the effect on the current payer population. This worst-case scenario would necessarily result in a dramatic increase of uncompensated care, reverting the healthcare landscape to the pre-ACA era.
This possible upheaval creates strategic opportunities for new or existing insurers as it relates to marketplace exits by some of the larger insurers. It also places more than 1 million individuals back in the marketplace along with the premium money they had been paying. Insurers with innovative business plans may have an open marketplace providing hospital systems new contracting opportunities.
The continued move toward paying for value as opposed to volume on the insurer/provider end necessarily correlates to the patient seeking value relative to the services needed and insurance coverage contracted for. The necessity to be innovative and provide higher quality, lower cost care requires healthcare providers to develop an approach that can quickly and accurately identify and analyze efficient and effective ways to provide better outcomes from both a clinical and financial perspective. The simple answer is analytics. Now more than ever, healthcare providers need to be able to integrate clinical skills into a robust technology infrastructure.
The method change for healthcare providers is effective partnerships and collaborations in the utilization of technology, which reduces clinicians’ data burden and enables them to spend more quality time with patients, which on its own will drive value-based care. Ten years ago, providers first began to embrace EHRs to capture and store patient records. Today, it is difficult to find a medical office that relies on paper-based records. Providers need to look toward data-guided care, based on optimal outcomes and efficiencies. This can work in both clinical and financial settings.
Long-term planning, coordinating the clinical side and the financial side, will be necessary for health systems to successfully adapt to the continued changes in health care. Success is predicated on improving quality and cost simultaneously. As with any change, this will not happen overnight. Administrators experienced in making financial projections and who manage cash flow accordingly will best manage the coming systemic changes.
Ms. Weissmeier is the firm’s Chief Operating Officer and Managing Attorney and has over 20 years’ experience as an attorney in a management role. Ms. Weissmeier is a member of the Nassau County Bar Association, the New York State Bar Association and is actively involved in the Healthcare Finance Management Association. She holds a Juris Doctor and LL.M degree from Pace University School of Law. Ms. Weissmeier is licensed to practice law in the states of New York and New Jersey, including the United States Court of Appeals for the Second Circuit, United States District Court for the Southern, Eastern, and Western Districts of New York and the District Court of New Jersey.