Posts Tagged ‘HIE’

ACA Afterlife: Unwinding Obamacare Under the Trump Administration

November 14th, 2016 by Patricia Donovan

The people have spoken: the future of the ACA is healthcare's most pressing concern for 2017.

The people have spoken: the future of the Affordable Care Act is healthcare’s most consuming concern for 2017.

If U.S. President-elect Donald J. Trump delivers on his campaign promises, the ‘repeal and replacement’ of the Affordable Care Act (ACA) should be an early priority for the nation’s chief executive-in-waiting.

That prospect sent shock waves through the healthcare industry, as evidenced by a snapshot of post-election responses to the ongoing Healthcare Trends in 2017 survey sponsored by the Healthcare Intelligence Network.

“The change or replacement of Obamacare might affect us significantly, including changing our USA market priority over other markets,” contributed one respondent.

“We don’t know what ACA repeal implications will mean for us,” offered another.

Other respondents identified “changes to our government structure and the unknown impact” as well as “lack of clarity post-election” as their most pressing concerns for the year ahead.

Take the Healthcare Trends 2017 survey and receive an executive summary of the results.

Given Trump’s ambitious healthcare agenda, much is at stake for industry stakeholders. But is it possible for the incoming administration to unravel the ACA, when the public already has been exposed to many of its provisions? And if repeal is possible, how long might the process take?

Greg Mertz, managing director for Physician Strategies Group, LLC, advises healthcare organizations not to panic about the ACA’s demise. “A ‘“repeal and replace’ means that Trump admits Obamacare can’t go away. Nothing will happen quickly, and whatever happens will be less dramatic than many expect,” predicts Mertz, who points to Trump’s lack of specifics as to what might replace Obamacare as further evidence.

“House Speaker Paul Ryan, R-Wisconsin, has already put forward his plan for healthcare reform, so I would think his ideas will be a pivotal part of what eventually gets passed,” continues Mertz. “However, Congress still decides what happens, so whatever Trump proposes will be mired in hearings, staff work, and debate for at least the next year. This means that we limp along with a broken program as we argue what is better.”

Also based on Ryan’s healthcare proposals, Travis Ansel, senior manager of strategic services for Healthcare Strategy Group, is advising providers to brace for more Health Savings Account (HSA)-related payment woes. “Ryan’s plans for Medicare, which have loomed over the industry for five years, bring with them increased patient payment obligations,” Ansel explains. “Expect more and more employer-based coverages to shift to HSAs as well. We can expect payors to raise insurance premiums across the board as the Republican-led Congress unwinds the ACA.”

Ansel pointed out that major payors were forced to shift their business models and infrastructure to compete in an ACA-focused market. “The quick shift back will be a reality these payors are not prepared for and not prepared to succeed under,” he concludes.

As payor margins suffer, adds Mertz, pressure will be placed on commercial insurers to raise reimbursement to offset the gap. “Employers will howl and the feds will be pressured to control costs, especially big pharma.”

Where Mertz does expect activity is within the Health Insurance Exchanges created by the ACA. “The insurance exchanges are in trouble already, so we would expect that providers that were seeing significant numbers of exchange-insured individuals would have likely seen a drop in those numbers regardless. I think the number of uninsured will increase in the short-term, as many will decide that paying the penalty is better than paying the premium.”

As to what healthcare might look like under the Trump administration, Mertz thinks the industry will see tax credits or vouchers. “However, I seriously doubt we’ll see a government-sponsored alternative, which I think we would have seen with (the Democratic presidential nominee) former U.S. Secretary of State Hillary Clinton.”

On the provider side, Mertz expects that while physicians will see little impact, hospitals will see a rise in charity care, and no major increase in income.

For a post-election roadmap to the challenges and opportunities facing healthcare in the year ahead under GOP leadership, don’t miss Trends Shaping the Healthcare Industry in 2017: A Strategic Planning Session, a live webcast on Thursday, November 17 at 1:30 Eastern.

Take the Healthcare Trends 2017 survey and receive an executive summary of the results.

Healthcare Delivery Advice for 2013: Shore Up Payment Before Shifting Model

October 23rd, 2012 by Patricia Donovan

Eying a move to an ACO or the patient-centered medical home model in 2013? First, adjust the payment structure to support it, advises Steven Valentine, president of the Camden Group. Shifting to one of the popular post-reform healthcare delivery models before changing the payment system is courting financial disaster, Valentine warned during HIN’s ninth annual Healthcare Trends & Forecasts strategic planning session.

Valentine charted anticipated trends for healthcare providers in 2013, while Hank Osowski and Dennis Eder, both managing directors for Strategic Health Group, covered business opportunities for health plans during the 60-minute webinar.

All of the analysts agreed that the outcome of next month’s presidential election would have little impact on healthcare reform.

“Regardless of who gets elected president, many of the things I’m talking about — bundled payment, patient-centered medical home, co-management agreements, clinical integration, accountable care organizations — are all going happen due to the economics of healthcare.”

“The reform train has left the station,” agreed Eder. “Folks who are waiting around to see what happens in the election, or who waited around for the Supreme Court decision on the Affordable Care Act, are too late.”

The election results will “likely influence the pace of change to the healthcare system, but probably not the direction,” added Osowski. The continued acquisitions and consolidations evident in the industry are proof in the market’s belief in the longevity of reform-based initiatives, he said.

Common ground across the industry continuum includes potential from collaborations — hospital-physician co-management service agreements on the provider side, and strategic partnerships in population health management on the payor side. Partnership opportunities are more plentiful now than at any time in recent healthcare history, noted Eder. “I was involved in the original integrated health world in the mid-1980’s when systems were buying both hospitals and physician organizations and starting health plans. The sincerity and the desire to work as true partners are unlike any time I’ve seen before.”

The speakers identified the strategic focus for each sector, with Valentine indicating that the key investment for providers should be on growing their population — getting as large a defined population base at the bottom of the pyramid as possible, which encompasses the access points and primary care, he said.

For payors, the industry’s increasingly population-centric, value over volume sensibility offers many opportunities in coordinated care, particularly for Medicaid-Medicare dual eligibles, said Osowski. “Duals comprise about 18 percent of the state Medicaid population, and yet they account for almost a little more than a third of the total spend on Medicaid,” he said.

Duals are a complex population with unique health concerns, requiring a strong behavioral health component. “Duals tend to be very costly because they’re typically non-compliant patients and don’t really follow what is being asked of them in terms of their healthcare,” said Valentine.

“The dual population is not just frail elders; the dual population is 40 percent people under 65,” added Eder. And the vast majority of the people under 65 are disabled because of behavioral health-related issues. So for organizations considering getting into the dual market, if you’ve just done frail elderly programs and you think you’re going to be working with that same cohort of members, it’s going to be a painful learning.”

In other trends, the industry should expect delays in implementation of health insurance exchanges (HIEs), which face significant funding hurdles, said Osowski.

Healthcare may also see the reemergence of narrow networks, in which health plan members or employers benefit from lower costs when staying within their own health systems. Individuals will still have the choice of going outside the system, but face much higher copays.

“We’re leaving choice in place, but we are getting much better at directing back to a smaller, more narrow network that will help to steer volume back to the providers, and reduce the total cost of care and the out of pocket cost for the employee,” concluded Valentine.

Listen to an interview with Dennis Eder, Hank Osowski and Steven Valentine.

Infographic: Health Information Exchange Scorecard

October 4th, 2012 by Melanie Matthews

Growth in health information exchanges (HIEs) has increased with funding from The HITECH Act, aimed at helping healthcare providers meet meaningful use regulations. As of 2012, eHealth Initiative (eHI) has identified over 230 HIEs spanning from multi-state, single state, counties, cities and even single health systems.

A new eHI infographic looks at HIE challenges, states with the highest number of HIEs and components of successful HIEs.
Health Information Scorecard

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.