Dual Eligibles represent the most vulnerable, complex and expensive patients in the healthcare system – they cost roughly $300 billion annually. Moreover, care is often poorly coordinated between Medicare and Medicaid. The new political landscape and healthcare policies have also created new opportunities to develop a higher standard of care as well as lower the cost of care for the Dual Eligibles population. Health plans have been viewing these government-subsidized markets as very attractive new business opportunities and are gearing up to serve the market via acquisitions and alliances. As these new programs evolve, service providers and the government must rethink how services are delivered, coordinated and administered. They also must ensure that adequate performance measurement standards are in place, and that all participants involved are incentivized.
The healthcare industry is undergoing tremendous and rapid transformation in order to substantially reduce healthcare spending while simultaneously improving patient outcomes and population health. Payment reimbursement models are transitioning at a furious pace from traditional fee for service payment structures to value based models. Bundled Payments is at the forefront of payment reform and it is ushering in a new era of healthcare, further propelled by the new political landscape and recent CMS mandates. In addition to reducing healthcare spending costs, hospitals and health systems assume accountability for both financial and patient outcomes for the entire episode of care. Health plans are encountering challenges of how to process Bundled Payments claims and develop new infrastructures.
There is a great focus today on Medication Therapy Management (MTM) as it serves a crucial role in improving healthcare, achieving greater health outcomes while significantly reducing costs. There has been a recent wave of new mandates and impending policies addressing MTM programs and services, thus challenging the nation’s health plans and providers to further refine and improve their MTM strategies and programs. Today, nearly 40 million Medicare beneficiaries are enrolled in a Medicare sponsored plan providing drug coverage and access to affordable prescription drugs. Medication therapy, when properly utilized, can significantly improve health outcomes, manage illnesses as well as greatly reduce healthcare costs. However, when medication is improperly utilized, it will result in harmful and adverse effects, which could have been prevented.
Healthcare beneficiaries suffering from behavioral health disorders have been falling through the cracks for decades, due to several issues such as a lack of education and attention to mental health issues, insufficient access to qualified providers, inadequate behavioral health insurance coverage and a fragmented healthcare system. Health plans and behavioral health providers are recognizing the need for new payment and care delivery models to enhance the overall well-being of their members.
Today, telemedicine is one of the fastest growing sectors in healthcare. It is reshaping the landscape of healthcare delivery in the United States, and is being recognized as the future of global healthcare. Telemedicine addresses and achieves the basic tenants of Healthcare Reform: providing the population with access to improved and convenient, high quality patient centric care, enhancing outcomes, while reducing per capita expenditures. Today, nearly 50 percent of hospitals throughout the United States are engaged in telemedicine programs. Studies have shown that the benefits of telemedicine include significantly improved outcomes, efficient care delivery as well as reduction in mortality rates, hospitalizations, length of stay, readmissions and healthcare costs. Telemedicine has greatly enhanced access to quality care in rural areas and patient satisfaction has increased due to its convenience and patient centric approach.
We are currently at a crucial point in time for corporate healthcare – employers are operating in a political and economic situation that has considerably evolved. Building and expanding on-site employee health clinics has become an imperative in enabling employers to offer competitive benefits, control costs, and provide quality healthcare to employees. Moreover, employers must redefine their corporate healthcare strategy, and innovation will be key to success!
Population Health Management is surging across the healthcare landscape in the effort to deliver the highest patient care, enhance quality, implement preventative measures and reduce healthcare spending by over a trillion dollars per annum. Innovative processes have been implemented and are continuing to evolve and expand, including collaborative efforts between Providers and Payers. The current political landscape and new healthcare policies are challenging both Providers and Payers to continue to transform the nation's healthcare and maintain a healthy population. The keys to success are being shaped by employment of technology and health information, innovative strategies in care coordination across the continuum of care, collaborative approaches, identifying high risk populations, and integrating preventative measures.
The state of U.S. healthcare has experienced significant changes during this past year, particularly regarding Medicaid legislation. Medicaid is on its way toward becoming the nation’s largest health insurer. More states are turning to Medicaid Managed Care to control costs and promote innovation in healthcare delivery. New policies and the expansion of coverage has led to extraordinary growth in Medicaid enrollments, and the number of Medicaid managed care enrollments is expected to exceed 61 million by 2021.