The key to successfully making the jump from the old era of healthcare — one where fee-for-service is king — to the new era of healthcare — one where transparency, consumerism and value dominate — may actually be as simple as improving clinical documentation, according to Anthony Oliva, DO, vice president and CMO of Nuance Healthcare.
“For those who thought, ‘Maybe we can just hold out and [value-based care] will all go away,’ it’s never going to go away; it’s only going to get worse,” Dr. Oliva said at the Becker’s 2nd annual CIO/HIT + Revenue Cycle Conference in Chicago.
Healthcare is a classic example of a model explained in Ian Morrison’s book The Second Curve, according to Dr. Oliva. This two-curve model posits that any market undergoing transformation has two curves: the old and the new. Companies must ride the first curve and learn how and when to jump to the second, Mr. Morrison explains in the book.
As high deductible health plans become more common, patients are becoming the new payers. This puts responsibility back in the hands of the provider to provide a consumer-friendly billing experience and collection strategy to maintain the speed of the revenue cycle management process.
At the Becker’s 2nd annual CIO/HIT + Revenue Cycle Conference in Chicago, the following five panelists discussed the top three challenges of consumerism and how RCM can meet those challenges: Steve Collins, vice president of business development at Zotec Partners; J. Wade Shields, owner and managing partner of Practice Partners; Susan Hawkins, executive director of revenue cycle at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif.; Amanda Cancelliere, vice president of operations and business performance services at McKesson Technology Solutions; and Brooke Murphy, writer/reporter with Becker’s Healthcare.
Alaska, Alabama, Kansas, North Carolina, Oklahoma, South Carolina and Wyoming, will have only one carrier per region.
As major insurers UnitedHealth, Humana and Aetna — along with smaller insurers like the Scott & White Health Plan in Texas — plan to leave theObamacare insurance markets, the exodus will leave some states without much competition on the exchanges.
A new study by Avalere predicts one-third of the country will have no exchange plan competition in 2017. Seven states: Alaska, Alabama, Kansas, North Carolina, Oklahoma, South Carolina and Wyoming, will have only one carrier per rating region in every region in the state, the Avalere study said.
States divide up their exchange market region into rating areas. Consumers may only purchase plans offered within the rating region in which they reside.
Nearly 55 percent of exchange market rating regions have two or fewer carriers, the Avalere study said.
Giant insurer Aetna announced this week that it was withdrawing from the Obamacare exchanges in 11 of the 15 states it had been doing business, becoming the third major insurance company to scale back its offerings dramatically in the face of heavy losses. The news led to a chorus of “I told you so’s” from critics of the 2010 healthcare law, who have long predicted that it would collapse under its own weight. But they are confusing the growing pains of a new market with the death rattle of a failing one.
It’s important to bear in mind what Obamacare, formally known as the Patient Protection and Affordable Care Act, set out to do. Over the long term, it sought to improve the quality of healthcare and rein in costs — an ambitious effort that may not yield significant results for years, if ever. In the short term, its goal was to extend insurance coverage to millions of uninsured Americans. To do so, it barred insurers from denying coverage or charging higher rates to those with preexisting conditions, required all adults to obtain coverage and offered subsidies to help poorer households pay their insurance premiums.
These changes reinvented the market for individual policies, which serves those not covered by large employer plans or government-run health programs. No longer could insurers minimize their risk by denying coverage to or gouging those with preexisting conditions. The new subsidies also attracted many previously uninsured people who had no track record to guide insurers on their needs and costs.
The result was a hotly competitive market with winners and, yes, losers. The insurance companies that have done well include those with experience serving low-income communities, as well as those in states such as California that have worked hard to bring young and healthy customers into the market. But Aetna and UnitedHealth, which announced in April that it would withdraw from almost all the Obamacare exchanges it had entered, had previously focused on serving large employers, a much less risky and volatile market.
For years, insurance provider Health Net Inc. used illegal severance agreements to try to keep departing employees from talking to state and federal officials about company violations, the U.S. Securities and Exchange Commission said Tuesday.
The Woodland Hills company agreed to pay a $340,000 penalty to settle the SEC’s allegations. It also agreed to contact former employees who had signed the severance agreements between Aug.12, 2011, and Oct. 22, 2015, and inform them that they were not prohibited from blowing the whistle about potential securities violations.
Health Net did not respond to requests for comment. The SEC said the company had agreed to the settlement without admitting or denying the commission’s findings.
The health insurer changed language in its severance agreements after the Dodd-Frank financial reform legislation was enacted in 2010. The law encourages whistleblowers to report possible securities law violations by providing financial awards and other incentives.
Under Health Net’s amended severance agreements, former employees waived their right to any monetary recovery that came from becoming a whistleblower. The SEC’s order does not address non-securities-related whistleblower lawsuits.
“Financial incentives in the form of whistleblower awards, as Congress recognized, are integral to promoting whistleblowing to the commission,” said Antonia Chion, associate director of the SEC’s enforcement division. “Health Net used its severance agreements with departing employees to strip away those financial incentives.”
Healthcare leaders are developing outpatient strategies that enhance access in an increasingly risk-based environment. This can happen by several means—through acquisitions, partnerships, building new facilities, and often through some combination thereof. From there, the possibilities are almost endless.
HENRY KOTULA 