Chair_ProfileApprehension is reasonable during times of change, but we’ve got to keep moving forward.

 

Clearly, we are living through times of extraordinary change. It seems that everywhere we look, new arrangements are being forged and old ones are being broken. The scope of our work is also changing—in some areas, providers are called on to do more; in other areas, less. And we continue to see a conversation between providers and payers regarding future rates in the health insurance marketplaces, or exchanges. 

At the same time, hanging over all of this change is a concern over whether providers will be able to continue to move toward value under the exchanges—improving quality while reducing costs. Given these uncertainties, what can providers do?

For one, they can take steps to make their organizations stronger, drive value, and modify systems and procedures to the coming payment landscape. No matter what the future holds, creating a foundation for organizational effectiveness is always a good bet.

I think the feature “Helping Individuals Obtain Health Coverage Under the ACA” in this issue of hfm provides some great ideas. I especially like the authors’ suggestions around improving both enrollment practices and outreach to more vulnerable populations.

One of the issues in flux right now is who will bear the onus of enrolling the uninsured. Should hospitals and health systems be responsible for directing populations toward the exchanges? Some have suggested that they should. Others say that providers should be less involved in this aspect of care. Whatever the ultimate role of providers should be in pointing the uninsured toward enrollment, tremendous value can be found in preparing written guidelines for this eventuality. What will your organization do when uninsured patients arrive who could be educated about the exchanges? What if they ask to be educated about the process, or ask to be enrolled? Providers that have determined who will be responsible for what (and when) can respond much more efficiently. In an increasingly integrated healthcare landscape, it will be unsatisfying for patient and provider alike if an attitude of “That’s not my job” prevails.

Thinking about outreach to more vulnerable populations is also a valuable way to prepare, and can create cost savings that will make a positive impact regardless of future payment environments. For example, some innovative providers have made great strides in addressing the needs of segments most likely to have frequent emergency department (ED) visits. Leading-edge programs across the country are reaching out to populations with high ED use and working with patients to create alternative ways to manage their symptoms. Some providers have even found that it’s cost-effective to hire caseworkers devoted to regularly following up with high-ED-use patients before a visit becomes necessary. Providers should build on these and other innovations to create processes that minimize unnecessary care and drive value while still attending to the care needs of patients.

Even amid ambiguity, there is a tremendous opportunity here to create efficiencies and put procedures in place that make us stronger. In doing so, I’m confident that we can forge the way toward a bright future…whatever it takes!

Publication Date: Tuesday, October 01, 2013

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