First, we have seen some commercial plans move to risk adjustment payments. This could be helpful or detrimental. We definitely have seen more time spent as health systems have moved to more risk payments, more two-sided models.
Next, a definition of financial responsibility (DoFR) will be critical: knowing all the various benefits that are offered and perhaps listing them on the left side of a spreadsheet. As you move across the sheet, what remains with a health plan, if anything? What would go with the physician organization? What would go to an inpatient facility acute hospital? To ambulatory providers and post-acute providers? We would advise you to begin to move in 2017 to standardize those DoFRs.
Then, if at all possible, exclude specialty drugs, where we’ve seen tremendous price increases. If you can exclude any new kinds of therapies, and I mention one there that’s been popular and growing in 2016, IVIG, and we expect a pretty good jump in 2017. Some doctors have labeled this the 'feel good infusion.'
Then, determine whether you can do anything on an exclusive basis that would help you capture more population. At the end of the day, strategically, in 2017, you need to grow your population base.
Next is effective use of comanagement agreements and a renewed focus on your risk adjustment factor (RAF) scores: there will be slight adjustments as they go down and you’re going to have to do a better and better job of documenting and trying to push those up.
Then we see patient engagement; we do want to see the patients engaged. The more you use various patient portals, the more helpful it will be.
Finally, we also look at the repatriation of patients, because if you have them under your care, you would be responsible for getting those patients and paying for them.
Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN's thirteenth annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.