Emerging Trends in the Healthcare Economy

Healthcare billing services executives have a lot to ponder, from the transformation of value-based care to advances in regulatory policies and technology-enabled remedies. Here is a summary of current developments and a sneak peek into what the future may hold.

New Trends in People's Behavior

The healthcare billing system in our nation has undergone several changes, and the COVID-19 pandemic has challenged it severely, testing its capacity as much as any other industry. Healthcare billing service providers and organizations had to quickly adapt to changes in how they engage with patients. The pandemic triggered the accelerated adoption of virtual care and digital health tools. Telehealth platforms were implemented rapidly, and even those who were initially hesitant were compelled to embrace them. Payers also needed to adjust to accommodate these new reimbursement requirements.

The success of virtual care has ensured that it is here to stay, bringing with it several advantages such as greater access to care, enhanced patient experience, and improved person-centered care. Although traditional patterns in patient behavior are gradually returning, one concern is that people who deferred routine and preventative medical care may return at higher acuity and cost.

The COVID-19 pandemic has forced the healthcare industry to innovate and adapt rapidly. The adoption of virtual care and digital health tools has accelerated, which is likely to continue. Nevertheless, it remains to be seen how the industry will handle the influx of patients who delayed their medical care and how it will tackle the cost implications associated with this delay.

The invention of Value-Based Care

In the context of cost and care, the Centers for Medicare & Medicaid Services (CMS) has launched its value-based care initiative aimed at improving healthcare billing services outcomes and controlling costs over the traditional fee-for-service approach. The high spending associated with Medicare programs has necessitated the development of the initiative, with CMS putting considerable effort into programs such as the Medicare Shared Savings Program (MSSP) and Accountable Care Organizations (ACOs) to align quality and cost objectives.

The CMS has recently introduced a new value-based care initiative, the Geographic Direct Contract Model, also known as Geo. This innovative payment and care delivery model is being tested by the CMS Innovation Center, with the aim of improving healthcare outcomes and reducing costs. The Geo model has the following objectives:

·       Encourage state Medicaid programs and commercial payers to tie reimbursement to outcomes

·         Transform risk-sharing in Medicare fee-for-service

·         Allow beneficiaries more control of how they receive healthcare

·         Empower providers to meet their population’s needs more effectively

To enhance care coordination and delivery and improve outcomes for beneficiaries, Direct Contracting Entities have been appointed to oversee specific regions and exercise greater control over provider funding. This move towards more centralized administration is a promising development for the future of our healthcare economy.

Additionally, there have been several key regulatory and legislative developments introduced in 2023 aimed at driving positive changes in people's healthcare billing services and rights.

E-Prescribing

To keep up with modern technology and improve convenience, CMS has mandated electronic prescribing of controlled substances (EPCS) for Medicare Part D. This development is a significant step towards more advanced technology and efficient workflows for crucial medications.

Under the Medicare Coverage of Innovative Technology (MCIT) pathway, a component of the 21st Century Cures Act, CMS will now allow Medicare coverage for innovative medical devices.

Surprise Billing

Surprise medical bills can often come as a surprise to people who have no reasonable alternatives available within their medical networks and must turn to out-of-network providers. New legislation aims to address this issue and end surprise bills for out-of-network services.

Price Transparency

To make it easier for consumers to compare medication prices, CMS has finalized a rule to modernize the Medicare Advantage and Part D prescription drug programs. This rule is expected to result in significant savings of over $75 million for the federal government over a 10-year period.

Strategic Direction

In order to navigate the uncertain times ahead, healthcare billing leaders will need to establish a clear sense of direction. This will require developing robust data sources and intelligent analyses to guide strategic decision-making and evaluate business outcomes. Teams should prioritize strategy over traditional budgeting practices by leveraging data to identify needs, opportunities, and goals.

Reporting requirements have shifted to favor shorter-term forecasting over long-term planning. Predictive analytics can help healthcare leaders better understand dynamic trends driven by unpredictable fluctuations during the pandemic. Effective management of cash burn rates and understanding of operating costs will be crucial for organizations to achieve their desired business outcomes.

Protect Your Mission

To safeguard your organization's mission, vision, and values while remaining competitive in the rapidly evolving healthcare economy, it is essential to partner with a trusted advisor and have access to carefully cultivated data. A reliable healthcare billing services revenue cycle advisor can ensure your organization is on track toward success. Practice management solutions can offer valuable insights through sophisticated reporting solutions like predictive cash modeling, expected allowable analysis, encounter detail trends, telehealth utilization, and more. Forward-thinking leaders will leverage technology and seek strategic partnerships to gain a clear view of what lies ahead. 

Read our previous blog: Switching to a New EHR: 4 Tips to Ease the Transition

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