Posted by Mike Fontana on 11 Apr 2014
As a result of these changes in the market, the amount of out-of-pocket funds the patient is responsible for will increase if many of the health plans offered by employers lower their actuarial value to control costs. The individual market, whether state, federal or private based exchange, will require the consumer to meet significant out-of-pocket responsibilities, in many of these plans, up front for non-preventative services. If the patient decides not to stay in network, the costs and what the actual out-of-pocket the patient may encounter for the year may also increase, as was previously applicable with out of network services. The question is to what extent the patient is likely to access these non network medical facilities.
If employers decide to offer their employees lower actuarial coverage than previously offered, and individuals continue to flock to the Bronze level (60% AV) and Silver level (70% AV)Individual Market Exchange Plans, with many requiring significant if not total deductibles be met initially, healthcare providers will have an increased need, and importance, to collect from the individual. The government exchange figures, for both state and federal run, for the period 10/1/13 to 3/1/14 for what plans consumers are interested in indicates;
81% of consumers will be covered by either the Bronze (18%) or Silver (63%) Plans during this initial year of the Marketplace.
94% of the Silver Plans purchased will be subsidized by the government.
With this changing environment, including the change for healthcare providers to go more to a value based institutional payment approach for their services, for government health plans and commercial, collecting more of what the individual is responsible for becomes more important. With many of the institutions and practices having very low operating margins, being more adept in the new retail consumer environment will be necessary.
This will mean that having effective patient facing administrative services, including a patient portal which offers the appropriate functionality to cross-communicate and meet the needs of both patient and the health provider, is now required. This includes, most appropriately, online payment services which have electronic payment plans, discounts, pre-authorizations, as well as one time, any time payments. Touching the new consumer will mean not just new services, but new procedures also. Changing the thought process and culture around these new actions has to take place in order to be successful.
Making these changes by committee will be difficult, and must be driven from the top down with someone leading the charge, and getting all to understand.
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