Freed Associates

Fresh Insights and Perspective on the Affordable Care Act

The impact of the Affordable Care Act (ACA) is far reaching; whether you are addressing medical loss ratios, participating in an Accountable Care Organization (ACO), or looking for ways to make Meaningful Use practices effective.

“Politics will continue to play a role in healthcare and the evolution of ACA is not an exception. We expect changes in the coming year, and a slowdown in some requirements. This will challenge healthcare organizational priorities and impact budgets.” – Scott Walkiewicz

“Since the ACA resulted in a much wider range of insurance plans, both providers and patients are struggling with a limited understanding of the variety of payment and reimbursement models available. Many of the new plans transfer substantial financial responsibility onto patients. In order to lessen the increasing bad debt issues associated with this change, providers need to focus more on pre-service and point-of-service collections, revise the scope of financial counseling, and consider self-pay policy updates.” – Brett Light

“Providers are struggling to determine their place within the new “world order” that healthcare reform is bringing. Those focusing on ACO participation need to shore up their internal systems and operations to accommodate the new business partnerships and structures that ACOs bring. Those replacing outdated systems with more modern ones to support new business models will be challenged with the complexity of these projects.” – Yeeling Wu

“As payers (especially government) reduce their reimbursement rates, healthcare providers will need to recoup higher cash factors (cents on the dollar) on the services they currently provide while minimizing revenue leakage due to inefficient processes. This will require organizations to utilize, structure, and report on the wealth of data they currently have. With the breadth of data now available through EHR systems, providers will have to identify key data, develop a framework for reporting it, and create a culture around using it for management.” – Rehan Mirza

“Keeping pace with the changing regulatory environment during the implementation of the ACA is going to be a challenge for 2015. Rules have changed, delays have been enacted, and state-by-state adoption of the ACA has been inconsistent for certain elements of the law. Lining up the resources to successfully remediate dozens of systems that already had full queues of enhancement needs and maintenance requests continues to be a challenge. The long lead times in the software development cycle push up against compliance deadlines and drive some businesses to invent manual workarounds for processes that used to be automated prior to changes necessary due to the ACA. Healthcare organizations should have a contingency planning process in place to provide discipline in evaluating the most effective way to ensure they meet their market readiness goals.” – Scott Walkiewicz

“For areas like behavioral health, where funding comes primarily from government entities, providers need to align with ACA changes in payment structure, supporting documentation, and maintaining quality data. In the absence of accurate data, precise reporting, and efficient workflows, already thin margins will become non-existent, which will eventually erode the ability to maintain a viable mental health support capability.” – Jim Larente

“CMS will start to provide funding for tele-health coordination of care services. Organizations need to assess how to take advantage of this program and weave it into their efforts to reduce hospital readmissions.” – Shanti Wilson

 

Read more Freed perspectives on 2015 on the following topics:

Triple Aim and Healthier Data: Envisioning a Better Healthcare System

Competitive Marketplace: The Need for Innovation and Flexibility

Health Information Exchanges: Using Gathered Data to Improve Healthcare

Scalability and Optimization: Identifying Improvement Opportunities