Tuesday, April 14, 2015

At look at – What is going on in the way we receive health care services?

I want to share some points from a report – Considering Healthcare’s Transformation. It was created following a gathering in January 2015 of healthcare executives. Specific comments made by individuals are shown in quotes. I added bold to emphasize some points I see as important to individuals.

● Much is being done to transition to value based care, which gets you and I as consumers involved in our health. About 1/3 of the providers – hospitals – physician groups indicate their concern in implementing this was “uncertainty about revenue streams”.

● The transition going on in information technology (IT) to store data in cloud based systems results in physicians thinking individuals electronic medical records (EMR) will be connected to all aspects of care.

● Consumers will be more involved in the way care is going to be managed and will “take more responsibility for health decisions".

● Surveys indicate “nearly half of consumers and 79% of physicians believe using mobile devices can help clinician’s better coordinate care”.

● Consumers are demanding more eVisits and done when they want.

● The chief medical officer at a North Carolina health system indicated – “The consumer wants to be more in the driver’s seat and less in the it’s-being-done-to-them seat as we move forward”.

● An individual from one health insurance company stated – “We work - - to move to population health in a new world order where payment structures will transition from fee-for- service healthcare to instead reward outcomes and value”.

● An MD who is a principal in the consulting firm PriceWaterhouseCooper (PwC) Health Industries Advisory service indicated – “We are now focusing on the 80% of people who are healthy, who we never paid attention to before. In the past, nobody cared if a member is healthy because as long as there is no cost and he is not sick, it’s not important. But now, because we are going to be accountable for the total cost of our population, we want to keep these folks healthy, which means we can attack the obesity problem to prevent people from getting sick and getting diabetics. That’s important”.

● The PwC MD also indicated – “My hope with the population health management approach is that we are able to bring the cost down so the financial burden is not significant on the consumer. Because otherwise we can be doing everything good but the patient is not willing to comply”.

Connecting to what the MD states, in the above comment about responsibility for treatment expenses, individuals in today's medical insurance have a larger cost share. Plans no longer just have visit co-pays. Now, to meet health reform requirements, plans use more cost sharing and a deductible. In some cases it is a deductible followed by cost sharing.

FYI - Traditional plans in CT include a provision in 2015, which limits a person's expenses during a plan year to a Maximum Out of Pocket (MOP) of up to $6,600. Health Savings Account plans follow IRS regulations and have have a MOP of $6,450.

Questions - Call my Google Voice - we can talk about things going on in CT. (860) 451-9793.

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