The U.S. healthcare industry has been undergoing a total revamp for the past few years. A significant development was the introduction of Affordable Care Act (ACA), which increased the number of insured Americans and healthcare opportunities. Now, the healthcare industry is moving beyond the ACA and onto consumer-centered and digitally enabled care, which will soon have a great impact on medical billing for healthcare services. Let’s take a look at the changing healthcare trends to watch for in 2015.
Private Exchanges
According to a Forbes article, the number of enrollees who select their health plans through private healthcare exchanges will rise significantly. With the ACA, businesses are looking to make crucial changes to the health plans and defined contributions they make available to their employees rather than dropping employees’ coverage as expected. Negotiating options via private exchanges is becoming their primary means to achieve this goal.
Healthcare IT
- Wearable and mHealth Products – There is a significant rise in the number of people using wearable tracking devices that monitor physical activity, sleep patterns, calorie consumption and a lot of other things, and mHealth products or mobile health apps that inform, instruct, guide, record, put reminder/alert and even communicate for the healthcare well-being of users. These kinds of products provide a greater awareness about health and allow people to take more preventive measures to avoid serious outcomes. The Forbes article mentioned earlier points out that employers provide incentives to employees for using mHealth products while consumers spend out-of-pocket on non-clinical health, wellness and self-disease management technologies and services.
- Patient-centered Care – Another significant change brought by technological revolution is patient-centered care that aims at improving patient satisfaction scores and engagement. Technology helps providers to engage with patients outside traditional office settings such as tele-medicine (engaging in a conversation with patients through video chat, examining their conditions and suggesting treatment), building social media relationships with patients and so on.
- Meaningful Use and ICD-10 – With meaningful use, providers are shifting their focus to electronic health records or EHRs. However, providers are required to address the drawbacks of EHRs such as unnecessary copy pasting, narrative limitations and ensure they are using a comprehensive and accurate documentation system this year. As the ICD-10 coding system implementation is due on October 1, 2015, you should improve your electronic health records to accommodate the increased complexity and specificity of ICD-10 codes.
Value-based Purchasing
Hospital value-based purchasing introduced by the CMS links Medicare payment to a value-based system to enhance the quality of care. Hospitals are already at the risk of decreased reimbursement from CMS due to this. There is proliferation of value-based contracts for the commercial sector as well. A new kind of risk is that the names of the hospitals are publicly listed when Medicare reduces payment. Health systems have started to implement risk strategies to overcome the risks of value-based payment models. Some of the strategies include applying for CMS’ Accountable Care Organization (ACO) status and engaging in bundled payment arrangements.
Population Health Management
As more and more patients shift to the providers as a result of the ACA and increasing number of insured people, healthcare providers should know more about the patients they serve. They should take long-standing efforts to effectively improve the health of various groups of patients. Population health management is the application of strategies and interventions to improve the health of the individuals at the lowest necessary cost. Accurate patient care data, execution strategy and clinical knowledge are very important for managing the health of patients.
Overall, this year the healthcare industry is heading towards a better system that promises higher quality patient outcomes at lower costs. PwC Health Research Institute (HRI) report on medical cost trend 2015 reveals four factors responsible for inflating medical costs such as economic upswing, development of new, high-cost specialty drugs, rise in prices owing to physician employment by hospitals and information technology integration challenges.
At the same time, the report highlights three factors that “deflate” medical cost trend in 2016 – looming “Cadillac tax;” virtual health becoming a valuable tool for primary care; and new health advisers directing consumers to more effective healthcare.
Healthcare practices should consider all these factors seriously and give more focus on providing quality care to better survive in 2015.
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