Christopher KernsKerns said that with the long-term challenges of an aging population and the rising incidence of chronic disease, managing these patients more effectively outside the hospital will be essential to maintain the provider’s own profitability, whether in the traditional fee-for-service environment of today or the emerging world of
ACOs and risk-based payments.Kerns said the fact that the Supreme Court ruled it would be unconstitutional for the federal government to withhold Medicaid funding for non-compliance with expansion provisions “only underscores the need for providers to be able to manage that population much more effectively, especially because they can no longer count on that additional reimbursement. They have to manage them at a low-cost manner that prevents a lot of expensive utilization.” He added that hospitals were going to be more “on the hook” for payment collections to drive the new reimbursement model and would be increasingly investing in point of service collection mechanisms.Value- and evidence-based practices will be a part of these cost containment practices that healthcare organizations will be moving toward, said Van Kooy. “I wouldn’t be surprised if you saw more of a shift to more generic, lower-cost drugs,” he added. “We’re also seeing more recommendations to evaluate the effectiveness and limit ineffective therapies, [as well as] constraints around the recommendations for prostate cancer and mammography screenings based on evidence.”
Patients EngagementThe ACA will give new urgency to patients, who through the new mandate will have to buy healthcare insurance or pay a tax, to be more accountable for the costs of their care, experts say. “There will be an influx of individual purchasers of healthcare coverage who are going to want to know if they are getting value for their healthcare coverage dollar,” said Jordan Battani, managing director of the Waltham, Mass.-based Global Institute for Emerging Healthcare Practices at the Falls Church, Va.-based CSC, “and that is going to accelerate healthcare delivery organizations to be able to quantify, demonstrate, and report on the value they are providing.”