Healthcare

2015 was a tumultuous year in many ways. Mergers and acquisitions changed the landscape for both healthcare providers and the insurance industry, and legal challenges to the ACA provided uncertainty. Healthcare organizations continued to move from volume to value as they restructured and addressed costs and service delivery. Improving population health moved from discussion to action in many organizations.

It amazes me how seemingly disparate ideas, when considered together, can create new ways of seeing the world. Bear with me for a minute, and I’ll share an insight I’ve received lately based on two seemingly unrelated ideas.

Here’s the first idea: NY Times bestselling author Bruce Feiler gave a TED talk a couple of years ago about how to apply the concept of agile programming to families. He said that when using an agile programming model, teams meet once a week to answer three questions:

Home healthcare enables many patients to receive appropriate medical attention from the comfort of home. Patients utilizing these services also enjoy considerable cost savings in comparison to a hospital setting, proven research of better health, and reduced stress for the patient and family. Home health agencies (HHAs) treat patients who may only require a short-term need for care, as well as patients who may need long-term treatment for illnesses such as diabetes, heart disease, and pulmonary disease.

I’ve been thinking about the implications of UnitedHealth Group’s recent announcement to reduce its exposure on the healthcare exchanges.

The company’s CEO Stephen Hemsley said UnitedHealth had sustained heavy losses this year from policies on the exchanges, and as a result, will stop marketing efforts for 2016 plans and will cut commissions to brokers in efforts to limit the number of enrollees in exchange plans next year. He also indicated that the company is considering complete withdrawal from the marketplace in 2017.

Historic times are taking place in the healthcare industry.  Are you going to stay on the sidelines or are you going to get in the game? 

Yesterday’s sessions at the HFMA Region 9 Conference in New Orleans reinforced two key themes:

While attending the Healthcare Financial Management Association Region 9 Conference in New Orleans, we learned that bundled payments are near and healthcare facilities should start preparing now.   

Bundled payments consolidate reimbursement into a single payment for the care and services related to a specific procedure or episode along the continuum of care. These payments are designed to incentivize the coordination of care among various health care providers, such as physicians, hospitals and post-acute care facilities, as well as to emphasize accountability for the cost and quality of care provided to patients. The Centers for Medicare and Medicaid Services estimates that by 2016, 30 percent of Medicare payments will be value-based and will expand to nearly 50 percent by 2018.   

On Nov. 2, President Obama signed the Bipartisan Budget Act of 2015 (H.R. 1314).  One of the more significant provisions, aside from the suspension of the national debt ceiling and aversion of a government shutdown, is the matter of site-neutral payments, the antithesis of the site-of-service differential. This legislation is not completely unexpected, as MedPAC has recommended for quite some time that payment differentials should be eliminated. 

Clinically Integrated Networks (CINs) are gaining traction in many areas of the country, but the concept of clinical integration isn’t new. The terminology pre-dates the ACA by over a decade, as the FTC coined the term in 1996 in its Statements of Antitrust Enforcement Policy in Health Care. Today’s CINs, however, have a different look and feel than one of their more common predecessors, the Physician-Hospital Organization (PHO). The PHO similarly attempted to integrate hospitals and physicians through hospital sponsorship and physician membership, but most PHOs never reached the levels of financial and clinical integration necessary to accept risk-based payer contracts. Today’s CINs, spurred on by ACA reforms and the gradual shift from fee-for-service payment models, are making strides in collaboratively increasing the quality of care while reducing costs.

Healthcare reform has undoubtedly created more integrated delivery and payment models based on a culture of quality-focused and cost-efficient clinical management. In one example, many healthcare systems have begun implementing clinical co-management arrangements (“CCMAs”) to accomplish the physician alignment and integration required to achieve these goals. 

If I had to guess, I’d say you are reading this on your iPhone, iPad, Galaxy or some other mobile device. I’m not clairvoyant; research shows more than half of all emails are opened on mobile devices. It’s likely that if you use tablets or smart phones, you use them in almost every facet of your life from communicating with your friends, family members and work associates to helping with homework, paying bills and working from home. Fortunately, the security built into the systems is generally adequate for most of your personal needs. 

Keynote speaker Joyce Branda presented top trends in healthcare enforcement to more than 600 members at the American Health Lawyers Association’s Fraud and Compliance Forum in Baltimore, Maryland. Here are our top 3 take-aways from her presentation: 

We’ve been publishing blogs about healthcare for more than a year, and we hoped we’ve provided some good information about where the industry is and where it might be going. Sometimes we write about trends in the industry, sometimes we write about what we’ve learned, and sometimes we write about what might be possible in the future. We hope you’ve enjoyed our blogs and have taken something from each one to help you do your job better.

As a healthcare consumer, I feel an urgency to do my part to decrease unnecessary cost and improve quality. As a member of HORNE's Healthcare team, I have a greater understanding of why our healthcare system cannot continue in its current state and I've learned that reducing variation and eliminating waste is our “how”; however, since I am not a healthcare provider, my impact is limited in what I can do as a patient as I view my own healthcare, and the care of my loved ones, through a new lens.