Healthcare reform remains in the news and on the minds of everyone with an economic interest in care delivery. As providers we know change is coming but until now the only thing different has been speculation on how we will be paid for what we do. Not waiting for change to dictate what to do, payers and providers are experimenting with alternative ways to conduct business. This week two news articles caught my eye. Both led me to reflect upon changes happening in both the payer and provider side of care delivery.
Speaking at the HIMSS conference in Las Vegas, Aetna CEO, President and Chairman Mark Bertolini announced the end of insurance companies and pointed to a transformation in the way they run their business (http://www.healthdatamanagement.com/news/HIMSS12-Aetna-CEO-insurers-face-extinction-44041-1.html). The unique combination of factors and circumstances create an inflection point in the business of insuring people against health risks. The traditional business model of underwriting medical risk is unsustainable over the long haul and has forced insurance companies to look to alternative business models.
Mr. Bertolini suggested that model is managing populations through a different relationship with providers, physicians and the hospitals with whom they do business and requiring a dependence upon current and accurate information about the effectiveness of patient care delivery. By giving away the tools to make information sharing possible, Aetna hopes to partner with providers to make it easier for everyone to be better informed about the effectiveness and efficiency of caring for patients.
Provider transformation was also in evidence as traditional service delivery through nursing homes is being shifted to home care management. Joseph Berger’s article in The New York Times (http://www.nytimes.com/2012/02/24/nyregion/managed-care-keeps-the-frail-out-of-nursing-homes.html) details the change in care delivery models that move services and patients out of nursing homes and into their communities as a way to combat the rising costs and decreasing payment for institutional care.
Time will demonstrate the effectiveness of transforming services and delivery of care to alternative less costly sites; but these early attempts and initial successes are prompting others to ask why not “us” in seeking alternatives. For inpatient rehabilitation facilities the question will be: which of our patients could be managed in a SNF if we provided the rehab personnel and resources to deliver the intensity of care required? If that is sounding like bundling perhaps we better reconsider our positions.
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