Thought Leadership

Assessing the Changing Healthcare Landscape

Which way is up?

It’s hard to make heads or tails of today’s healthcare landscape. Some people are ecstatic with the potential changes in policy that seem to be coming around the corner, and others feel that the sky is falling. No matter your political affiliation, though, most agree that the constant change in policies and regulations within healthcare have been detrimental to the industry as a whole. Providers, hospitals, patients, insurers, and even vendors have been trying to transition to a new reality since the HITECH and Affordable Care Acts (ACA) were passed, and now that reality is likely to shift again. These changes bring with them countless costs and inefficiencies to healthcare providers, many of which aren’t taken into consideration well during the political process.

A shift for the worse?

For providers, one of the most concerning changes with the likely replacement of the ACA, the American Health Care Act (AHCA), is the impact it is going to have on low income, elderly, and disabled consumers of healthcare. As part of the bill, it’s expected that Medicaid expansion will be ended in 2020, and the individual insurance marketplace will no longer be supported as it is today. An estimated 14 million people would lose coverage under the AHCA, a number that would rise to 24 million by 2026, according to a Congressional Budget Office report. In Michigan alone, almost 1,000,000 people would be affected.

Along with the basic issue of individuals not having healthcare insurance, there are also substantial impacts this will have on the healthcare system. Since the ACA was put in place healthcare providers have been taking care of less uninsured clients, which is obviously a significant benefit for their organizations. It’s also allowed providers like Community Mental Health organizations to expand their care to a larger population, which will immediately be affected if Medicaid expansion is cut or blocks grants become the new funding mechanism.

Another significant piece was that the ACA created a mechanism for some of the most needy healthcare consumers to get services before they were in an emergent state. With insurance, people tend to be more willing to get preventative care or services when they are not acutely ill, but without insurance they are much less likely to seek this care out. Because of this, there is a growing fear that primary care is going to be delivered through the emergency rooms once again, and this is one of the largest drivers of cost and poor clinical outcomes in the United States today.

How to protect yourself?

In this environment it’s important that businesses are always looking ahead to keep themselves well-positioned for any change that could be coming around the bend. This includes trying to run at the lowest margins possible, expanding with services that could potentially provide a competitive advantage, measuring and constantly improving clinical outcomes, and using technology to create any possible efficiencies. It’s also extremely important that healthcare providers begin to treat the entire person, not just their acute symptoms. Not only will this be better for the system as a whole, by reducing costs and increasing quality of care, but it will also position healthcare organizations well for the future of value-based care and reimbursement.

All Thought Leadership