Inside Managed Care Today

Those working in the healthcare industry are dealing with many challenges these days as the industry attempts a complete overhaul in the wake of the Affordable Care Act (“ACA”).  Executives working in managed care are far from being immune to such challenges.  Some of the key challenges in managed care include: transitioning to value-based payment, figuring out how to better use data, addressing rising pharmaceutical costs, responding to healthcare consumerism, and adjusting to industry consolidation.

Below are some highlights of the recent 2015 State of the Industry Survey conducted by Managed Healthcare Executive.  The survey garnered responses from over 600 executives at health plans, health systems, and pharmacy benefit organizations.

General

  • The top two diseases respondents are focused on for 2016 are diabetes (67%) and cardiovascular (60%), followed by obesity (41%), cancer (40%), and respiratory illness (34%).
  • 55% think the ACA is mostly good, but not all good; 32% feel the ACA has been a mistake.
  • 60% are currently using business intelligence and analytics; 51% are using patient registries.
  • 47% utilize health information exchanges to share data with other organizations.
  • 34% use telemedicine. (Sadly, this is rather low.)

 

Value-Based Payment

  • 35% have started a few initiatives.
  • 19% have not yet started and are waiting to see what works for other organizations.

 

Using Data

  • 54% feel they have come a long way but still have a lot of work to do; 27% stated they do not use data very well and are confused about how to fully utilize big data.
  • 37% noted difficulty turning data into actionable information.
  • 26% cited issues with securing appropriate funding for IT initiatives.
  • 14% feel they have a problem with keeping patient data secure. (Surprising percentage.)

 

Drug Costs

  • 24% believe that government interference is the best way to control rising drug costs; 23% feel the focus should be on integrated pharmacy and medical benefits.
  • 19% stated the focus should be on utilization management.
  • 15% claimed that cost-effective pharmacy plan design would have the biggest impact on drug costs.

 

Healthcare Consumerism

  • The top two patient-centered areas respondents are focused on for 2016 are: expanding customer service improvement initiatives (60%) and increasing consumer outreach (53%), followed by expanding consumer relationship management capabilities (43%).
  • 34% are focusing on more cost transparency. (So, not much industry headway being made yet.)
  • 54% believe that incentives/wellness programs are the most effective way to increase consumer engagement in managing their own health; 16% feel the focus should be on increasing awareness of free healthcare services; 14% stated remote patient monitoring / mobile health would be most effective.

 

Industry Consolidation

  • 54% stated the increase in consolidation of providers and payers will lead to higher overall healthcare costs.
  • 33% believe the consolidations will lower overall healthcare costs.

 

More on the survey can be found here.

 

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Contact ABISA, a consultancy specializing in solo and small group practice management.  Visit us at ABISALLC.com.

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