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Top Healthcare concerns 2017, value-based models

The year 2016 was a year of change and unexpected events. This is defiantly true in the field of healthcare. To start off the new year, here are three major issues facing health and medical professionals in 2017. At ABCS RCM, our clients share many of these same concerns, but here are the major concerns that are repeatedly voiced.

[1] The future of the Affordable Care Act:

President-elect Trump has stated that he plans to repeal and replace the ACA with a different program. However, completely repealing Obamacare would eliminate the ACA’s health insurance exchanges and reverse the expansion of Medicaid, adding 20 million to the ranks of the uninsured. Hospitals, especially those in states that expanded Medicaid, could experience a dramatic increase in uncompensated care.

Meanwhile, insurers likely would lose most of the $1.9 trillion in federal ACA-related subsidies slated to be doled out over the next 10 years. Any drastic change in the healthcare market will likely create opportunities for some, while limiting growth for others.

[2] Changes in the pharmaceutical industry:

As the reimbursement and regulatory environment for pharmaceutical companies become more stringent, they will have to persuade patients in order to justify the price for prescription drugs. They will also have to satisfy healthcare regulators and demonstrate that they are providing customers with the best possible value. The government’s emphasis on patient engagement may increase the “value” of pharmaceutical companies offering services to providers that help patients collect, analyze and understand their own health data and health conditions.

In this way, a more informed patient is a healthier patient. The hope is that companies will be able to identify and better meet patients’ needs, which will calm regulators who increasingly are focusing on successful patient engagement. To accomplish this goal, these companies will need to build customer trust in order to offer effective engagement, which includes data sharing with their existing customers.

[3] The expansion of value-based payment models:

The transition to a value-based system has been a gradual transition. Until recently, these changes have had little consequences for most health professionals. However, this will start to change in 2017 as the penalties increase for facilities and practitioners not using and performing well in the value-based payment model. Next year is the first performance year for the Medicare Access and CHIP Reauthorization Act of 2015, the physician payment reform law (MACRA) and healthcare providers will be asked to participate in one of two payment tracks.

For the first time, both of these payment tracks emphasize downside risk if “value” is not delivered to the patient. In order to provide this higher quality, but lower cost care; medical professionals will require an analytics-driven approach to deliver focused care management solutions based on specific healthcare needs. Achieving this goal requires a robust infrastructure of technology and clinical skills, which will take time to build and optimize.

Special thanks to Healthcare IT News.

At ABCS RCM we specialize in revenue cycle management for a variety of healthcare professionals. For additional questions about this topic or general questions about healthcare revenue cycle management, please contact us. We offer experienced medical billing solutions, credentialing services, web design/SEO/PPC and workforce management tools for healthcare agencies.

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Top Healthcare concerns 2017, value-based models