Navigating the Winds of Change

Obamacare. Managed Care. Meaningful Use (Stages 1, 2 & 3). Value-based reimbursement. MACRA. Obamacare repeal. And who knows what comes next? No one does for sure, but it is clear that healthcare providers will no longer be able to just provide healthcare services and submit a bill to their patient’s insurance.  What’s a provider to do? How do they adjust? How can they keep from being so overwhelmed with financial concerns that they can’t focus on their patient’s health?

First, make sure you understand your healthcare payer’s changes. Many of the payment changes will require care coordination, the performance of certain quality based measures, and more patient engagement. If you are already excelling in these areas you will still likely be asked to document your actions. Knowing what reporting will be required from each of your major payers is a good place to start in preparing for the changes.

Second, watch for opportunities to improve. Many healthcare practices have been forced by the fee-for-service payment structure into a volume-based treatment system that attempts to process as many sick patients as possible to achieve financial viability. Properly designed value based systems should provide rewards for keeping patients well and avoiding adverse events (such as preventable hospital readmissions). These new value based systems should allow for providers to focus on the promotion of wellness in addition to just treating illness.

Finally, stay alert. No payer has figured out how to fully optimize value-based reimbursements. That means, for better or worse, you will see variations in payment structures from one insurer to another. As insurers learn what is effective, you will also see changes in requirements from the same insurer over time. Make sure you keep your finger on the pulse of these changes or you may miss out on opportunities for bonus payments or worse yet be penalized.
All of these changes will require information. The more you know about your patient, the better chance you have of keeping them healthy. One Health Record® can help you put together your patient’s complete health record. We are also in the process of implementing Admission, Discharge, Transfer (ADT) alerting so you can know when your patient is admitted or discharged from the hospital. This is the kind of data that helps you navigate the changes in reimbursement. If you would like more information on how One Health Record®’s services can benefit you, please contact us at onehealthrecord@alabama.medicaid.gov or give us a call at 844-746-3540.

Paul Brannan was appointed by the Governor to serve as the state’s coordinator for health information technology in 2015.  He previously served as Director of the Project Management Office for the Alabama Medicaid Agency where he was responsible for providing project management support for all enterprise-wide Agency projects including Medicaid’s transition to Regional Care Organizations.