Looking to 2019: Our Experts Weigh In
Consumers Will Expect Affordable Financing Options from their Providers—Spurred by Growing Use of HDHPs – Over the past few years consumers have gone from being worried about how they’ll pay their out-of-pocket healthcare costs to now, expecting their healthcare provider to offer affordable financing options. In 2019 we’ll see more consumers express their voice and choice in healthcare provider by evaluating the financial experience equally with convenience and care outcomes. According to the ClearBalance® 4th annual Healthcare Consumerism study, 94 percent of respondents expect their provider to tell them about payment options, including long-term financing. Consumers also will share and compare their healthcare financial experiences with friends. More health systems will adapt their revenue cycle and patient access process to be consumer-friendly, communicating options to #makecareaffordable.
Its been 10 years since the Recovery Audit Contractors rocked hospital providers world with a record number of audits and overpayment determinations. Commercial health plans took notice and refined the art of audits and denials, creating even more administrative burdens and financial liabilities for hospitals and patients to shoulder. 2019 will be no different, commercial health plans will continue to deny short stays, experimental procedures, high cost drugs and common costly procedures for lack of medical necessity. There will be even more growth in clinical diagnosis validation denials which are not only costly but time consuming to appeal. More and more hospitals will escalate their payment disputes and look for settlements to alleviate some of the burden brought on by heavy denials. Hospitals need to work together within their internal departments to fix true denials and externally with their peers to identify egregious behavior and look for wins to stop the abuse from payers.
In 2019, healthcare providers will need to keep their focus in two areas: 1. performance and 2. patient engagement.
- The movement toward pay-for-performance has been happening in healthcare for years, but the incentives/penalties are finally hitting the bottom line for many practices. Those not using the right tools to measure performance, utilization and patient outcomes will find themselves being left behind by the competition.
- Simultaneously, with insurance rates and deductibles continuing to climb, patients are fighting their higher out-of-pocket expenses through tools like Zocdoc, Vitals and RateMDs to compare physician reviews and identify quality. Providers will need to sell their value to these savvy shoppers more than ever before, and I see the convenience of patient portals and online bill pay becoming standard in 2019. Practices not providing these types of patient engagement services will be at a disadvantage.
In 2019, I predict we will witness the convergence of social determinants data, health plan benefit design, and consumer demand in creating the most widespread provision of health services in effectively targeting and addressing patient needs beyond clinical intervention. The stage was set in 2018 through a number of innovative housing pilots and CMS guidance expanding the definition of health-related supplemental benefits. This freed Medicare Advantage plans to more creatively address the functional needs of their most vulnerable populations.
Health plans have long collected social determinants of health data on populations, but the question has remained how to use that data in ways that are both targeted to member needs and scalable. 2019 will give us our first glimpse of plans attempting to use such data through coordinated supplemental benefits. And thsi only marks the beginning. It creates the opportunity for health plans to learn more about the customers they serve and become smarter at designing care programs. Utilizing member data beyond claims history will become increasingly important, and care organizations who fail to embrace the expanded potential to impact the health and social well-being of consumers risk falling behind in an ever-evolving market.