This is an exciting time in our healthcare environment — one filled with uncertainty, opportunity, new innovation and the ability to change lives.
As we all know, for the last 48 months, healthcare reform in the United States has been the center of extensive conversation and debate. The U.S. Supreme Court's recent ruling in favor of the Affordable Care Act's constitutionality marks an important point country's history, as well as the healthcare industry. Healthcare providers and business people alike continue to speculate about what is next and that speculation is only going to continue.
While this ruling has not come without controversy, I'd like to start by stating that this is not an opinion on the Affordable Care Act, but direction on how to leverage these rulings, as well as future implementation to continue to grow our healthcare market and continue to do what we do best. That is, find the best solution to deliver the highest quality of care possible to all of our patients.
While it is imperative that we all adapt our practices and businesses to capitalize on the benefits that can be derived from this progression, it is also important to note that first, we are all here to help people, and that occasionally there is conflict on the best path to do so. The points below will illuminate the opportunities that these changes have created to utilize our knowledge and expertise in order to grow our businesses.
As experts in the business of healthcare, our team at Advanced Healthcare Partners would like to educate you as to the ways in which we can all leverage our strengths in light of the Affordable Care Act. Here are just a few of the ways that the Affordable Care Act will benefit you as a healthcare industry executive, along with some tactical efforts to enable continued growth under this new paradigm:
1. Put the patient first. First things first...while there is continuous discussion as to the economics of healthcare change, one thing that must always stay consistent is the high quality care of our patients. When treated or educated, our healthcare professionals must always think of the patient first. We cannot lose sight of why we are all here and what our mission is. While this is not a finding from the regulatory changes, this should always be the first thing we consider when assessing our healthcare business strategies.
2. Leverage decreasing insurance cost. With these changes, there are likely going to be significant changes in insurance pricing, insurance benefits and access to healthcare. It is important to prepare for increased volumes, to always put the patient first from both a service and a treatment perspective, and understand what makes you different. This will allow you to identify the proper patients for the most efficient and effective care. You should leverage the decreased insurance costs to offer a wider range of services to a larger amount of patients.
With approximately 32 million U.S. citizens who were previously uninsured being given access to affordable healthcare, there will be a dramatic increase in the number of patients your practice is able to serve. An increase in eligible patients equates to growth in revenue for your practice.
3. Tighter insurer regulations. There will be tighter regulations on insurers, their payment protocols, as well as their scrutiny for their reimbursement to practices. Utilize these tighter regulations to expand the benefit and knowledge that the healthcare community has about your business by differentiating yourself from similar treatment options. In addition, since lifetime limits will be removed as of 2014, consider building a more comprehensive, long lasting, effective treatment protocol that engages your patients over a lifetime. Even if you offer one time surgical services, there are always opportunities for continued healthcare touch points for your patients.
As of 2014, insurers will no longer have the ability to deny coverage as a result of minor administrative errors made by the patient or provider. As a result, your practice will experience a sizeable decrease in insurer denials. Additionally, annual and lifetime limits that have been placed on coverage in the past will be removed, allowing patients to be provided the care they need.
4. Reduced administrative work. Beginning in 2013, providers will experience a reduction in the amount of time needed to file a claim as a significant portion of the administrative paperwork previously required by insurers will be eliminated. Less time spent documenting means more time that's available to serve patients. Utilize this as a way to create better economies of scale within your operation, and more importantly a more efficient and effective patient care cycle. You can do this through staff efficiencies, or more effective and simplistic automated systems.
5. Improved preventative care coverage. As of 2013, state governments will be provided more capital to allocate to preventative care coverage and as result, the market for preventative care services will expand exponentially. The provision of funding to state governments to cover preventative care will create the opportunity for your practice to increase its focus on preventative care or expand your scope of services to include preventative care. With this in mind, always think of ways to assist your patients in the prevention of more inclusive and concerning ailments. Consider introducing a preventative screening and treatment program into your practice. This can be done in the way of health screenings, routine visits and proper diagnosis of patient concerns based on historical trends assessed through the health information exchange. In addition, consider partnering with insurance companies and self-insured companies for employee screening programs, regardless of your area of specialty. This will lead to greater alignment with your patients before real problems arise.
6. The affordable insurance exchange. In 2014, the affordable insurance exchange will be launched, providing individuals and businesses the ability to compare insurance plans based on coverage and cost. As a result, business owners will be able to purchase more comprehensive coverage for their employees at a lower cost than ever before. Additionally, the exchange will force insurance providers to become more transparent in regards to reimbursement and will therefore allow providers to more accurately project revenue. Leverage this information to help your practice gear towards the needs of the patients, based on the trends that you are observing through this robust information exchange. By doing this, you will be able to create better practice growth visibility, as well as an understanding of healthcare trends that are taking place and how others are treating those trends.
7. Self-insured company partnerships. In years past, the option to forego the offering of health insurance to employees has attracted many business owners seeking to increase their bottom-line. As the ACA will eliminate that option, all businesses will incur the cost burden of providing health insurance to employees and therefore attract the same caliber of health insurance-demanding talent. For organizations that have historically avoided providing their personnel health insurance, the ACA will bring an increase in the number and quality of candidates they receive. Those organizations that have provided their staff with insurance coverage prior to the ACA will no longer be at a cost disadvantage. As a provider, consider partnering with larger, self-insured companies to offer your differentiated service to their employees. This will create a steady and predictable stream of patients, at a predictable financial rate.
Understanding that the Affordable Care Act is not a one size fits all model, there are also ways to growth your practice, create greater efficiencies and create a stronger brand, all while side-stepping the areas of concern as it relates to this act, if necessary.
1. Create an out-of-network strategy. Consider developing a strategy based on your unique services that is appealing to the healthcare community, but may be offered on a cash basis. This allows you to offer your services to those that may be seeking alternative forms of treatments in less of a mainstream manner. Direct-to-consumer marketing will be a significant factor in this strategy.
2. Find the best way to differentiate. Always look to create differentiated service, no matter what your program is. This will allow you to create a platform for strong word of mouth, and effective direct-to-consumer marketing of your out-of-network treatments. Regardless of your specialty, every one of you should have a form of differentiation in your service, treatment, protocols, or business offering.
3. Educate consumers on their plans. Consider a way to educate your current, past and future patients as to the ins and outs of their plan. This empowerment that you provide your patients will lead to a greater understanding by the patient of their healthcare coverage, thus providing better visibility to your level of reimbursement and compensation. This should be done well prior to your patients visit, and in fact should be done proactively with all patients within your network. This is a way to create stronger awareness of your patient's insurance details, as well as a way to generate trust with current and future patients and the healthcare market in general.
4. Build an in-house insurance verification team and revenue recognition program. It is important that you and your team understand the economics of the patients insurance plan, all before, during and after their appointment. The insurance verification team will provide to you and your patients a detailed explanation of what to expect from a reimbursement perspective. The revenue recognition process will allow you to understand not only the expected reimbursement, but the time of payment, amount of payment and expected denials. This level of detail will allow you to create more consistent business financial projections, which in turn, will arm you with more effective decision making power for the effective growth of your operation.
5. Create a direct-to-consumer marketing strategy. Direct to consumer marketing is the heart of growing a differentiated practice or service. Consumer-driven healthcare is at its highest level ever. Direct-to-consumer marketing should be performed through a diverse strategy including online paid advertising, search engine optimization, website optimization, offline media and direct-to-patient seminar education. It is, however, important to understand that this is not a tactic but a strategy, and should be created with a comprehensive practice overview in mind. This will lead to proper reputation, strong branding and consistent patient volume that are predictable in nature.
6. Create a customer-centric model by utilizing patient coordinators. While there are concerns in healthcare about efficiencies, there are also customer service concerns. A portion of the model that has been so effective for our operations has been to introduce a direct-to-consumer patient coordinator responsible for managing all patient questions, concerns, scheduling, travel, financial information and treatment logistics. The goal of this patient coordinator is to create a direct path for a very well educated patient to your practice. This has been very effective in creating educated, well informed, empowered patients who have control of their healthcare and are making empowered and accurate decisions on where to go for care.
The findings above, along with strategies recommended come from a model that we have proven on several occasions. Although the future of our healthcare environment is unpredictable, we believe in setting the stage properly, taking care of your patients and evaluating your strategies well prior to taking into account environmental indicators. While environmental indicators such as the Affordable Care Act are important to understand, be sure to first understand your practice and institute strategies that work within your operation.
I hope that you have found these observations, findings and strategies informative and helpful as you continue the growth of your operation. Together, we can leverage the opportunities created by these benefits to enhance the level of care provided while positioning our operations for profitable growth.
6 Characteristics of High-Performing Healthcare Organizations
As we all know, for the last 48 months, healthcare reform in the United States has been the center of extensive conversation and debate. The U.S. Supreme Court's recent ruling in favor of the Affordable Care Act's constitutionality marks an important point country's history, as well as the healthcare industry. Healthcare providers and business people alike continue to speculate about what is next and that speculation is only going to continue.
While this ruling has not come without controversy, I'd like to start by stating that this is not an opinion on the Affordable Care Act, but direction on how to leverage these rulings, as well as future implementation to continue to grow our healthcare market and continue to do what we do best. That is, find the best solution to deliver the highest quality of care possible to all of our patients.
While it is imperative that we all adapt our practices and businesses to capitalize on the benefits that can be derived from this progression, it is also important to note that first, we are all here to help people, and that occasionally there is conflict on the best path to do so. The points below will illuminate the opportunities that these changes have created to utilize our knowledge and expertise in order to grow our businesses.
As experts in the business of healthcare, our team at Advanced Healthcare Partners would like to educate you as to the ways in which we can all leverage our strengths in light of the Affordable Care Act. Here are just a few of the ways that the Affordable Care Act will benefit you as a healthcare industry executive, along with some tactical efforts to enable continued growth under this new paradigm:
1. Put the patient first. First things first...while there is continuous discussion as to the economics of healthcare change, one thing that must always stay consistent is the high quality care of our patients. When treated or educated, our healthcare professionals must always think of the patient first. We cannot lose sight of why we are all here and what our mission is. While this is not a finding from the regulatory changes, this should always be the first thing we consider when assessing our healthcare business strategies.
2. Leverage decreasing insurance cost. With these changes, there are likely going to be significant changes in insurance pricing, insurance benefits and access to healthcare. It is important to prepare for increased volumes, to always put the patient first from both a service and a treatment perspective, and understand what makes you different. This will allow you to identify the proper patients for the most efficient and effective care. You should leverage the decreased insurance costs to offer a wider range of services to a larger amount of patients.
With approximately 32 million U.S. citizens who were previously uninsured being given access to affordable healthcare, there will be a dramatic increase in the number of patients your practice is able to serve. An increase in eligible patients equates to growth in revenue for your practice.
3. Tighter insurer regulations. There will be tighter regulations on insurers, their payment protocols, as well as their scrutiny for their reimbursement to practices. Utilize these tighter regulations to expand the benefit and knowledge that the healthcare community has about your business by differentiating yourself from similar treatment options. In addition, since lifetime limits will be removed as of 2014, consider building a more comprehensive, long lasting, effective treatment protocol that engages your patients over a lifetime. Even if you offer one time surgical services, there are always opportunities for continued healthcare touch points for your patients.
As of 2014, insurers will no longer have the ability to deny coverage as a result of minor administrative errors made by the patient or provider. As a result, your practice will experience a sizeable decrease in insurer denials. Additionally, annual and lifetime limits that have been placed on coverage in the past will be removed, allowing patients to be provided the care they need.
4. Reduced administrative work. Beginning in 2013, providers will experience a reduction in the amount of time needed to file a claim as a significant portion of the administrative paperwork previously required by insurers will be eliminated. Less time spent documenting means more time that's available to serve patients. Utilize this as a way to create better economies of scale within your operation, and more importantly a more efficient and effective patient care cycle. You can do this through staff efficiencies, or more effective and simplistic automated systems.
5. Improved preventative care coverage. As of 2013, state governments will be provided more capital to allocate to preventative care coverage and as result, the market for preventative care services will expand exponentially. The provision of funding to state governments to cover preventative care will create the opportunity for your practice to increase its focus on preventative care or expand your scope of services to include preventative care. With this in mind, always think of ways to assist your patients in the prevention of more inclusive and concerning ailments. Consider introducing a preventative screening and treatment program into your practice. This can be done in the way of health screenings, routine visits and proper diagnosis of patient concerns based on historical trends assessed through the health information exchange. In addition, consider partnering with insurance companies and self-insured companies for employee screening programs, regardless of your area of specialty. This will lead to greater alignment with your patients before real problems arise.
6. The affordable insurance exchange. In 2014, the affordable insurance exchange will be launched, providing individuals and businesses the ability to compare insurance plans based on coverage and cost. As a result, business owners will be able to purchase more comprehensive coverage for their employees at a lower cost than ever before. Additionally, the exchange will force insurance providers to become more transparent in regards to reimbursement and will therefore allow providers to more accurately project revenue. Leverage this information to help your practice gear towards the needs of the patients, based on the trends that you are observing through this robust information exchange. By doing this, you will be able to create better practice growth visibility, as well as an understanding of healthcare trends that are taking place and how others are treating those trends.
7. Self-insured company partnerships. In years past, the option to forego the offering of health insurance to employees has attracted many business owners seeking to increase their bottom-line. As the ACA will eliminate that option, all businesses will incur the cost burden of providing health insurance to employees and therefore attract the same caliber of health insurance-demanding talent. For organizations that have historically avoided providing their personnel health insurance, the ACA will bring an increase in the number and quality of candidates they receive. Those organizations that have provided their staff with insurance coverage prior to the ACA will no longer be at a cost disadvantage. As a provider, consider partnering with larger, self-insured companies to offer your differentiated service to their employees. This will create a steady and predictable stream of patients, at a predictable financial rate.
Understanding that the Affordable Care Act is not a one size fits all model, there are also ways to growth your practice, create greater efficiencies and create a stronger brand, all while side-stepping the areas of concern as it relates to this act, if necessary.
1. Create an out-of-network strategy. Consider developing a strategy based on your unique services that is appealing to the healthcare community, but may be offered on a cash basis. This allows you to offer your services to those that may be seeking alternative forms of treatments in less of a mainstream manner. Direct-to-consumer marketing will be a significant factor in this strategy.
2. Find the best way to differentiate. Always look to create differentiated service, no matter what your program is. This will allow you to create a platform for strong word of mouth, and effective direct-to-consumer marketing of your out-of-network treatments. Regardless of your specialty, every one of you should have a form of differentiation in your service, treatment, protocols, or business offering.
3. Educate consumers on their plans. Consider a way to educate your current, past and future patients as to the ins and outs of their plan. This empowerment that you provide your patients will lead to a greater understanding by the patient of their healthcare coverage, thus providing better visibility to your level of reimbursement and compensation. This should be done well prior to your patients visit, and in fact should be done proactively with all patients within your network. This is a way to create stronger awareness of your patient's insurance details, as well as a way to generate trust with current and future patients and the healthcare market in general.
4. Build an in-house insurance verification team and revenue recognition program. It is important that you and your team understand the economics of the patients insurance plan, all before, during and after their appointment. The insurance verification team will provide to you and your patients a detailed explanation of what to expect from a reimbursement perspective. The revenue recognition process will allow you to understand not only the expected reimbursement, but the time of payment, amount of payment and expected denials. This level of detail will allow you to create more consistent business financial projections, which in turn, will arm you with more effective decision making power for the effective growth of your operation.
5. Create a direct-to-consumer marketing strategy. Direct to consumer marketing is the heart of growing a differentiated practice or service. Consumer-driven healthcare is at its highest level ever. Direct-to-consumer marketing should be performed through a diverse strategy including online paid advertising, search engine optimization, website optimization, offline media and direct-to-patient seminar education. It is, however, important to understand that this is not a tactic but a strategy, and should be created with a comprehensive practice overview in mind. This will lead to proper reputation, strong branding and consistent patient volume that are predictable in nature.
6. Create a customer-centric model by utilizing patient coordinators. While there are concerns in healthcare about efficiencies, there are also customer service concerns. A portion of the model that has been so effective for our operations has been to introduce a direct-to-consumer patient coordinator responsible for managing all patient questions, concerns, scheduling, travel, financial information and treatment logistics. The goal of this patient coordinator is to create a direct path for a very well educated patient to your practice. This has been very effective in creating educated, well informed, empowered patients who have control of their healthcare and are making empowered and accurate decisions on where to go for care.
The findings above, along with strategies recommended come from a model that we have proven on several occasions. Although the future of our healthcare environment is unpredictable, we believe in setting the stage properly, taking care of your patients and evaluating your strategies well prior to taking into account environmental indicators. While environmental indicators such as the Affordable Care Act are important to understand, be sure to first understand your practice and institute strategies that work within your operation.
I hope that you have found these observations, findings and strategies informative and helpful as you continue the growth of your operation. Together, we can leverage the opportunities created by these benefits to enhance the level of care provided while positioning our operations for profitable growth.
More Articles on Healthcare Reform:
Top 10 Non-Traditional Hospital Competitors to Consider6 Characteristics of High-Performing Healthcare Organizations