The coming year will be challenging for the healthcare industry. If nothing else, questions about the Affordable Care Act’s continued existence or a possible replacement, if any, could keep executives up at night.
But that is a poorly defined problem at the moment because so little is known of what will happen. It’s impossible to build an adequate strategy and choose a direction when it’s dark and you can’t see the road ahead.
Instead of responding to still vague concerns, it would be more helpful for executives and managers to consider for other issues. The industry faces significant challenges that are definite, rapidly approaching, and in need of effective responses. Managed Healthcare Executive surveyed its readers and identified the top issues.
The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, created new payment models and performance metrics that go into effect this year, causing enormous uncertainty in compensation. Providers will have to understand the new options and find what works for them. There is the additional potential disruption of a new Congress that could conceivably interfere and create even more disturbance.
For years, healthcare organizations have seen trends move away from traditional procedure-based reimbursement and toward compensation based on outcome and value. The challenge is to understand true total cost of care for patients, conditions, and treatments. Without such information at hand, it is impossible for an organization to know such basics as whether payments actually cover its costs of doing business and where to look for greater efficiencies and stricter controls.
Technology — whether mobile, cloud computing, big data analysis, systems software, or medical device advancements — is a tool that can aid healthcare organizations in providing better care while reducing costs. However, choosing wisely and parsing through the promises of sales representatives requires expertise in house. Someone must be able to evaluate new potential systems, plan implementation programs, and know when and how to push back on vendors when problems occur. Providers also need to optimize the systems they currently have to be sure they are getting the most value possible and not searching for tools that should already be in place.
Drug costs have become a burden on everyone, from providers to patients. Many factors stack the deck in the favor of pharmaceutical companies, but providers can still consider what best practices can help them contain costs. That may mean performing a cost/benefit analysis on new drugs to be sure that the additional benefits claimed are worth the additional price. Physicians and pharmacists have to remain sensitive to their prescription practices and the impact individual choice can have on budgets.
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