By Brian Robertson
It’s a good bet that almost all of us have wished for the ability to see into the future at one time or another. Unfortunately, that ability to predict with absolute certainty escapes most of us. When it comes to healthcare, however, there are a few trends that healthcare executives should keep a close eye in 2020.
Not surprisingly, a major shift from fee-for-service (FFS) to fee-for-value/value care as the dominant form of reimbursement isn’t one of them. We still have some miles to travel before value care is ready for prime time, especially since FFS is still much easier to administer and render payment than reimbursement for value (although value care is making strides in reducing the complexities). So while the healthcare industry will continue to move toward aligning reimbursement with the incentives to deliver higher-quality care at optimized costs in 2020, it will be more of a slow jog than a great rush.
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That said, I believe the following four trends will be the ones to watch (and act on).
1. The need for analytics around self-pay solutions
This one requires zero psychic ability. The patient portion of healthcare bills has been on a steep, steady rise over the last few years and shows no signs of stopping. The Centers for Disease Control and Prevention (CDC) says that more than 45 percent of Americans aged 18-64 now have high-deductible health plans (HDHPs) through their employers — a roughly 25 percent increase since 2013.
To manage this major shift in payment responsibility, providers and payers need to gain an atomic-level understanding of the financial underpinnings of their patient’s/guarantor’s portfolios. They must then use this knowledge to develop new strategies that encourage patients to pay an “affordable” share of the cost.
Of course, affordable is in the eye of the beholder so payers and providers must understand what that means to patients, as well as patients’ ability and propensity to pay. Finding the “sweet spot” for optimal payment and liquidity requires deep segmentation that comes from analytics powered by deep data science and machine learning (ML).
The continued growth of patient self-pay will also make it critically important to offer convenient payment options such as Venmo, PayPal and other mobile payment platforms. Especially when you consider that a provider’s best chance of receiving patient payment is while the patient is still in the office/care setting. For larger out-of-pocket expenses, providers will need to create payment plans in line with the needs of their populations while again offering easy and broad payment at the point of care/sale.