In the United States, the Centers for Medicare & Medicaid Services (CMS) and other federal agencies are typically seen as the entities responsible for mandating what quality care looks like and how we measure it. However, due to the lengthy legislative and bureaucratic process, federal agencies always lag behind real-time trends. Those trends are far more heavily influenced by national health insurance companies.
National health insurance companies are more motivated to make changes in healthcare quickly and to make them meaningful simply for the fact that they aim to lower the cost of healthcare for their clients. While this may seem like a superficial, money-driven process, the financial drivers are just an after effect of a more efficient and effective healthcare system.
Health plan companies are determined to drive down the costs of health care, but at the same time they are increasing the level of healthcare that their clients receive and, ultimately, improving the overall health of their clients. In this way, health insurance companies have become the new regulators of:
Because national health insurance companies are at the forefront of not only healthcare technology and reporting, paying attention to the top priorities in the eyes of health insurance companies can give us considerable insight into what we can expect in the months and years to come in the healthcare industry.
After 5 years of working with healthcare plans and insurance companies, I have seen specific patterns emerge. As we kick off 2019, here is what I anticipate we can expect in terms of changes in technology and care that stem from health insurance companies’ priorities.
One of the most prominent trends emerging in healthcare today is that of telehealth. Telecommunications technology – such as video conferencing tools – allow providers to deliver healthcare to patients remotely. Although telehealth technology has been available for several years, improvements in accessibility and security are making telehealth a more viable option.
Historically, a patient who is suffering from the common cold, for instance, would need to make an appointment with his or her primary care physician, travel to the physician’s office, and be evaluated. The physician would likely run tests and then prescribe the patient some sort of medication. Finally, the physician and patient would complete their respective paperwork and the patient would travel back home.
Now, telehealth is allowing physicians and patients to connect via commonplace tools such as FaceTime or Skype to complete the same process. Thanks to secure patient portals and EHRs, physicians and patients can exchange documentation privately through the use of computers. Not only does this process allow physicians to see more patients in a day, but also several operational costs – such as office space and administrative expenses – are reduced or eliminated.
As an added benefit, patients are able to remain in the comfort of their homes, which contributes to a more satisfying level of care. Additionally, ill patients are less likely to expose others to contagion when the patient is not required to travel to receive care.
By staying on the cutting edge of technology, national health insurance companies are able to simultaneously reduce healthcare costs, increase access to care, and improve the quality of care patients experience.
In any sort of health plan, the top 10 percent of utilizers are responsible for more than 60 percent of the total cost of care for a given health insurance company. Therefore, by beginning to push those top utilizers toward a value-based care system, everyone will save money all around.
However, the changes we are seeing emerge in terms of monitoring, measuring, and reporting patient health outcomes have the potential to affect everyone – not just that 10 percent of majority users – to the betterment of healthcare quality and patient health outcomes.
New delivery and payment methods are also dramatically affecting patient care. For example, as our healthcare industry moves increasingly toward a value-based care system, national health insurance companies are shaping the guidelines for measuring and reporting on patient health outcomes.
As national health insurance companies develop increasing influence within the healthcare landscape, they will also take on a bigger role in terms of federal regulations and policy-making.
Over the past five to ten years, health insurers and health insurance companies have had a large presence at the table in terms of federal regulations. That presence is only going to increase as national health insurance companies continue to drive what types of technology are utilized to deliver healthcare. Over the next two to three years, we will likely see health insurance companies having more direction over how those requirements are crafted.
Right now, all key stakeholders in the healthcare industry have a chance to give feedback to the federal government with regard to policy-making. In the coming years, however, we will likely see the federal regulators reach out to health insurance companies and ask for help to craft regulations. The health insurance companies are the ones who have been able to test many of the changes on a small scale with their client populations. Their raw data gives them valuable insight into what is going to work well, what is not going to work, and what makes the biggest impact.
Furthermore, the health insurance companies have the funds to finance trials of new technology, which are necessary but may be out of reach for federal agencies or standard health care providers.
As national health insurance companies drive the changes we are seeing take hold in the healthcare industry, federal agencies will be forced to keep up. Until then, as your reporting requirements change, healthcare providers are going to be spending more and more time reporting up to each individual health plan as opposed to doing it en masse to one regulating agency.
If your current systems are based on having one reporting system for a specific program or for a specific type of care, what you can expect to see in the future is multiple different ways of reporting to multiple different healthcare agencies. This is especially true as value-based payment models gain more traction.
Additionally, quality data analytics is going to become more and more important as healthcare changes and morphs into something new. If data analytics and reporting are already a pain point for your healthcare organization, now is the time to utilize the technology you have to its fullest potential and then plan for using different types or better technology in order to stratify that data. Without data stratification, healthcare providers cannot expect to get better rates in the future.
If you need help optimizing the use of your existing technological systems and planning successfully for these inevitable changes, let us know. The healthcare IT experts at John Lynch & Associates are dedicated to advancing healthcare one organization at a time and preparing providers for enduring success.
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