Predicted Healthcare Reforms in 2016


The year 2015 saw several healthcare reforms bring changes into the way healthcare is practiced in America, the main goal being to provide healthcare for all and also improve on the delivery of healthcare. With the number of footfalls coming into healthcare provider organizations and the insurance sector too gearing up to deal with the numbers, healthcare reforms in all aspects will be seeing major changes. So let’s see what we can expect for 2016

1. Increase in Digitization: Going digital – documentation of patient’s records, employing the ICD-10 coding systems, changes in fee based system, insurance payments etc.  now need to be digital and online. Appointments, accessibility to patient records, physicians and organizations are now reaching out to patients via social media, new software to deal with the new coding systems and the rules and regulations. This has all built up an energized and significant digital health.  This year major changes in the way healthcare providers interact and work with patients and vendors will soon see a major change and use of the digital system which will lead to improving the Revenue Cycle Management.

2. Alternative Payment Models: The year 2016 will witness the gradual emergence of shift from fee-for-service payment models to value-based care, given the unprecedentedly large aging population. Hospitals and healthcare providers will work towards providing effective models to deliver effective and efficient clinical care. This has already led to several complementary service payment models that physicians have begun to practice like the boutique service payments. This shift will also lead to a point of care testing and an increase in usage of medical devices and their innovations which will give a thrust to the Accountable Care Organizations. With Medicare getting stricter, penalties for Meaningful Use, Value Based Modifier, E-Prescribing, the impending MIPS program, and new revenue opportunities for CMS Chronic Care Management and Advance Care Planning and other Medicare programs, the commercial payers are becoming more aggressive with alternative payment models.

3. Employers & Employees healthcare plans: Although both employers and employees foresee a slight increase especially in terms of raised plan deductibles and coinsurance requirements, yet they feel that these may still be lower than that that was predicted for 2015. Moreover, the Affordable Care Act has a provision effective in 2018, which will impose a 40 percent federal excise tax on the portions of group plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage. This itself will help keep costs under control.

4. Shift from Providers to Consumers: 2016 will see the shift from what healthcare providers want, to what consumers want. Consumers will now play a more active role in plan selection and healthcare decision making. This shift is already visible in the number of social media platforms providing healthcare information to the consumers, the way insurance companies have started wooing employees rather than employers, and ways in which higher deductible plans consumers can be prevented from not availing treatment on time. Healthcare will soon akin to an online shopping like experience.

5. Shift from Individual to Community: This year will see a tiny discernible shift from concern towards individual well-being within the hospital walls to a more encompassing community wise response, more so after the Ebola outbreak and the terrorist attacks in Paris and California. Minimizing mortality and morbidity, and delivering better healthcare  as part of the Obamacare Act, or known as the Affordable Care Act, tied up with the new payment models, emphasis will now be on the community led events rather than just handling hospital like cases.

Thus, changes encompassing both healthcare providers as well as community at large, leading to the goals of the ACA, will see better streamlining of Revenue Cycle Management processes, better diagnosis and documentation as demanded by the ICD-10 coding systems now in place. This will eventually lead to better revenues for healthcare providers and initiation of improved healthcare reforms for the community of Americans at large.