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Three Provider Challenges For 2018


How politics, value-based reimbursement and patient collaboration will impact providers in 2018.

The big question coming in 2018 is how will providers respond to the growing financial squeeze in the healthcare industry? The increasing pressure is political, economic and patient-based.

There could be significant financial impacts due to the changing healthcare landscape, including:

•Politics, providers and the Affordable Care Act (ACA)

•Value-based reimbursement and patient health outcomes

•Patient collaboration and communication


Political Pressure

The heavy thumb of politics lingers as the news about the ACA changes daily. For now, total repeal of the ACA appears highly unlikely. But next week or next month? It's anyone's guess as to what will happen and when, and the effect it may have on providers, patients, and payers.

Recently, the administration canceled payments to insurers intended to defray some costs for low-income Americans. In turn, many state attorneys general got involved to challenge what they viewed as a potentially negative impact.

The payments were intended to help fund premiums and other healthcare-related expenses for some low-income Americans. The result could be more insurers leaving the ACA marketplace, increasing costs for taxpayers, fewer healthcare choices, and more changes.

One immediate concern is that the financial crunch could trickle down to physicians who already contend with non-payment pressures. A study by The Henry J. Kaiser Family Foundation found 43 percent of adults with health insurance say they have trouble paying deductibles. Moreover, about 33 percent have difficulty paying premiums. Once the patient gets to the doctor's office, the money problems continue with 29 percent of adults reporting they have problems paying medical bills.

Will these numbers increase as ACA subsidies decrease? It certainly seems possible, but only time will tell.

Value-based Reimbursement, Patient Outcomes

Value-based reimbursement (VBR) remains of interest to payers as they work with providers to make the shift from fee-for-service. Fostering quality care and positive health outcomes bode well for payers, providers and patients. For participating providers, VBR offers an opportunity to continue utilizing high-quality, outcome-driven treatments. VBR can also help providers address healthcare consumerism, when working closely with patients to promote and communicate positive health outcomes and encouraging patients to become part of the process.

Paying for services is a top concern and opportunity for payers with the ability to adopt digital technologies. Healthcare consumers are looking for payment options beyond credit cards and checks.

Seventy-one percent of patients say mobile payments "have improved their actual satisfaction with the provider," according to Black Book, a market research organization. The same study found 89 percent of those who run the financial aspect of the provider office know and understand patients will want to make payments this way by the end of 2018, but only 20 percent are ready to receive digital payments.

Patient Collaboration, Communication

Understanding of and acting on incoming and outgoing communications can help improve the efficacy of the provider practice and can play well with VBR. Expanding communications as it relates to health wearables also may positively impact VBR, as both focus on positive health outcomes.

In 2016, 25 percent of consumers in the United States used a wearable health device or smartwatch, according to Kleiner Perkins, a venture capital company. In the same year, users downloaded an astounding 200 million health/fitness apps, an increase of 5 percent from the previous year, according to the firm. "Of those insured adults who own a wearable, 78 percent would want their doctors to have access to health data from their wearable devices, so providers can have a more up-to-date view of their health," Harris Poll found.

Patient health data exists. Bringing it into existing provider IT systems and acting on it will be an opportunity to engage with and potentially affect health outcomes. The ability to utilize this additional health information can help providers when it comes to positively impacting patient health outcomes and achieving VBR payouts.

Thirty-eight percent of patients say they would choose a primary care physician based on their ability use wearable data to improve and manage health outcomes, according to a 2016 Harris Poll/Salesforce survey. Furthermore, 50 percent of Millennials-the most of any age group-say they would select a doctor based on their ability to use data from a wearable, the survey found.

Connected health devices are primarily used by health conscious, physically-fit users and chronically-ill users, according to an IBM report. While there's less opportunity to move the health-outcomes needle with healthy patients, the likelihood of improving the health of the chronically ill is high.

Politics, value-based reimbursement, and patient collaboration will be important to providers in 2018. There will be ongoing financial challenges caused by shifts in politics and healthcare consumerism. More provider payments will be derived from patients, who are sometimes difficult to collect from, while payers likely will decrease payments through new and changing methodologies.

Patients will continue to exert more pressure on providers as they advocate for new ways to pay bills, including user-friendly mobile and online payment options. Providers who respond swiftly may benefit from the political uncertainty and continued, increasing patient involvement in 2018.

Kevin Lathrop is President of TriZetto Provider Solutions, a Cognizant Company, which is one of the nation's largest revenue cycle management organizations, offering patient access, claims and denial management, contract management and patient financial solutions.

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