Register / Log In

Industry buzz identifies collective responsibility

Publish date: MAY 01, 2012


Julie Miller
One of the more interesting take-home messages from last month's World Health Care Congress was the fact that, by a show of hands, most industry leaders believe the Patient Protection and Affordable Care Act will stand. Nonetheless, the buzz I heard in the hallways clearly indicates that because so many evolutionary healthcare models are already underway, it doesn't matter how the Supreme Court rules.

It seems change will happen by sheer momentum alone. Insurers will likely be leading the way because managed care has long been the primary stakeholder at the table trying to keep costs under control.

At the conference, Lloyd Dean, CEO of Dignity Health, made some observations about how the industry has changed in the last decade, especially within the relationships among payers and providers. As a provider, he says such collaboration has become necessity because the ultimate cost of not reforming the system will be "catastrophic."

For example, most states have seen their education budgets crushed by the steep increase in funding earmarked for healthcare.

Dean also told attendees he is frustrated by the holdouts within the provider community who still insist that "clinical freedom" is more important than evidence. As a remedy, he suggests that incentives and legislation must be put in place to help drive evidence-based medicine.

In a session discussing private insurance exchanges, HCSC's Jeff Welch highlighted the importance of communicating the structure of defined-contribution plans to enrollees. He says the disconnect often comes from members not liking the coverage choice they made after they try to use the benefits.

I spoke separately to Tony Grove, vice president of reimbursement for BenchMark Rehabilitation Partners, a provider with 100 locations in the Southeast, and he tells me there are opportunities to innovate the healthcare system in light of the increasing out-of-pocket costs for patients. Specifically, he is concerned about the lack of solutions to manage the trend.

"It transfers a whole new business to providers to chase people down for the money," Grove says. "A significant portion of the revenue cycle is spent chasing down balances on patient statements."

HOW TO FOLLOW THE MONEY

His suggestion is to integrate claims adjudication with employee payroll deductions so that out-of-pocket costs are automatically paid. Not only would the fund transfer benefit the providers, but it would also create a paper trail of costs that the employee would be able to track and consider.

By realizing the total spent on healthcare, members might be inspired to make cost-effective decisions, choose more suitable plan products and take more responsibility for their health. Grove says the only way individuals will become more engaged with the cost of healthcare is to make sure they're meeting their payment responsibilities. He sees too many patients who receive care and walk away from the bill with no intention of paying their out-of-pocket costs.

All in all, comments from the conference indicate that tackling the cost crisis in healthcare will require significant change from all stakeholders—including the holdouts. That includes the holdouts that happen to be your plan members.

Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be reached at

The face of pharmacy benefit management continues to change in the wake of the $29.1 billion merger.

An increase in smartphone and e-reader use among older Americans has propelled the launch of a new health literacy initiative

Proven programs lead to better drug compliance among diabetic members.

No one is optimistic that Congress will make changes in benefits or outlays needed to improve the financial picture.

In this new era of business-to-consumer marketing, small plans might have an advantage.


Technology


More Articles