Get Both Feet in the Canoe. The Impact of the rise in High Deductible Health Plans.

Andrew Slotnick

Ina previous post, I discussed five ways that high deductible health plans (HDHPs) will drive change in healthcare. In my subsequent posts, I will dive deeper into each of the five changes,focusing on how providers may be affected and how a proactive approach can have long term benefits.

HDHPs and out of pocket expenses for patients are rising and will change how they consume care. This change is already transforming the healthcare landscape as the percent of healthcare associated with inpatient hospital services is declining and care delivered in physician office and other ambulatory centers, such as urgent care and ambulatory surgical centers, is rising.

Continued growth in out of pocket payments, may play a role in slowing national health expenditures, as patients seek to avoid costly care. Millions of newly covered patients will be entering the system, so this trend may be initially unclear at the national level, but for hospitals and physician practices alike, the bottom line is at risk.Specifically, if out of pocket expenses discourage patients from accessing care,costs for those patients may decrease, but so might their wellness. Any short term cost savings therefore would be lost in the form of a major and potentially avoidable event somewhere down the road.

imgHealth care executives and providers alike recognize these challenges. How can delivery systems provide the right care to prevent costly events while also keeping costs down? With patient-level financial (dis)incentives seemingly working against them, how can providers ensure patients seek the care they need? How to bring clinical and financial teams together to answer these questions?

At  HFMA’s Annual Institutein Las Vegas, these challenges were discussed in great depth.Keynote speaker  Dr. Atul Gawande’s story about a United States citizen, acting like a medical refugee within the US, illustrated the impact of clinical inaction on cost and patient outcomes. A separate session titled ‘Patient Financial Communication in the Revenue Cycle’ detailed how improving a patients’ financial experience can enhance their willingness to access the care they need and meet financial obligations. This dual level of patient compliance is the ultimate goal, and organizations that appear to be best positioned to achieve it have clinical and financial teams preparing for change ferociously.

Aligning clinical and financial teams on the patient journey will help improve outcomes for both parties in the long run. A great example is a best practice to improve the patient’s financial journey with HFMAs Patient Friendly Billing practices, which are designed to reduce the stress and anxiety commonly associated with high medical expenses. Using these methods, patients who face large out of pocket payments are identified early and coached through payment options to find one that best fits their financial situation so that they are more likely to follow through with care and less likely to do so in a state of distress.

Preparing with a sense of urgency will yield positive results; dabbling will not. Kenneth Kaufman, the CEO of the consulting firm  KauffmanHall illustrated the urgency that organizations should take when preparing for massive changes in healthcare such as, the change in care delivery from Hospital to Ambulatory settings, the transition from volume to value and the shift towards consumerism through increased out of pocket payments with a colorful analogy that those who dabble will “have one foot on the dock and one foot in the canoe”. Organizations therefore must move forward with a sense of urgency, with both feet in the canoe as it leaves the dock.


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