Healthcare Reform’s Third Act Has Many on the Edge of Their Seats

Deborah Lelinski, Director of Project Management, Ontario Systems – Healthcare Division

Now that the Affordable Care Act has survived a Supreme Court challenge and a presidential election that could have dramatically altered its future, states are now being tasked with taking steps to implement the law. With that framework in mind, consider the following assumptions and related impacts on a range of stakeholders:

1. Reduced Reimbursement – Healthcare providers will be expected to do more for patients at a lower reimbursement rate. Cuts to Medicare and Medicaid reimbursement rates to providers are projected. Concurrently, pressure to increase taxes will grow as the government looks to find a balanced approach for handling its debt. Assuming all provisions of the Affordable Care Act are enacted, an estimated 31 million currently uninsured Americans will have health coverage. But care for these newly insured will be reimbursed at rates that are a variation of Medicaid rate structures. insidePatientFinance.com recently published an article entitled Medicare, Medicaid and the ‘Fiscal Cliff’: Cuts Inevitable that addresses some of these concerns.
2. Risk Continues to Shift to Consumers – High deductible health plans (HDHP) are here to stay. Some in government have proposed programs that will require seniors to contribute a higher portion to Medicare premiums based on their income. If these up front premiums increase, many patients will be unprepared to pay for the cost of their care.
3. Diminished Overall Patient Health – Millions of baby boomers, including many with chronic conditions or those who have deferred treatment, are now enrolling in Medicare. Aging Americans who did not account for the cost of assisted living or skilled nursing care will become eligible for Medicaid. As demand increases, especially for patients with complex needs, more comprehensive approaches to care will be necessary. The care delivery system will need to undergo substantial changes.
4. Bottlenecks in Patient Access – As the baby boomer population continues to age, and the provisions of the new healthcare act increase access to care for those previously unable to obtain insurance, resources will become scarce. The pressure on the system, paired with a shortage of healthcare workers – a deficiency projected at more than 1 million doctors and nurses by 2020 – will cause bottlenecks for care to develop. To combat the difficulties with resource allocation, methods of patient intake, including registration and scheduling, will need to be restructured to optimize efficiencies. Healthcare providers will be forced to restructure care methods to maximize their time and avoid non-productive activity that diminishes time available for patient care.
5. Greater Focus on Quality of Care Standards – Payment methods that incorporate population management strategies will move to the forefront. Government, commercial, and private payers will increase their demand for quality results for their healthcare investments. As a result, value-based or bundled payment options may become more common. Along a similar line of thinking, rapid requirements for clinical system enhancements may cause some HIS and EMR systems to be unable to respond quickly to providers’ need for enhancements to address financial risk.

The healthcare landscape, as a result of the Affordable Care Act, is now more overtly competitive than ever before. As in any capitalist market, there are winners and losers. Those organizations that emerge as survivors will be ones that are best at managing care processes and relationships, engaging patients, staying on top of cash receivables, implementing receivables strategies, controlling expenses, and executing flawlessly in all facets of the changing healthcare business environment.

Deborah Lelinski is the Director of Product Management for Ontario Systems’ healthcare division and drives strategic product planning for the healthcare market. Lelinski has extensive health plan, software vendor and not-for-profit management experience, bringing a strong background in process improvement, product implementation, risk management and organizational change strategies. To learn more about Ontario Systems visit www.ontariosystems.com.