Healthcare in America is undergoing massive change, and that will ultimately alter how payers and providers define their roles, according to a recent blog post by Paul Keckley, managing director for the Navigant Center for Healthcare Research and Policy Analysis.
Thanks to the Affordable Care Act and other new regulations from the federal government, financial risk is going to be shifted from payers to doctors and hospitals, and doctors will be paid based on their management of cost and quality of care that they give, Keckley writes.
In the past, insurance companies and health providers worked in parallel--insurers took care of the payment part and providers took care of the health delivery. Now, providers are now responsible for both providing information about insurance coverage and health management. Patients often ask their doctors about what's covered and what's not in their insurance plans, only to find out that their physician has no way of knowing without calling the insurer, Keckley notes.
While this new idea of cross-breeding physician and insurer would seemingly cause more headaches than help, any provider organization's core operating model already relies on physicians being well-versed in insurance risk, Keckley argues. In the long run, he says, insurance risk will come from an integrated team of doctors, hospitals, allied health professionals, pharmacists and post-acute facilities that will be responsible for both cost and quality. This scenario is nothing new to private insurers, as most will offer to rent out their data capabilities in order to partner with integrated systems of health in shared-risk arrangements.
"Some are buying integrated delivery systems themselves, bolting them onto their insurance chassis," Keckley writes. "And all are carefully navigating their course to new markets, new services and leveraging their data to maintain a prominent role in the U.S. system going forward."
Polls show that Americans generally trust their doctors and hospitals more than they trust their insurers. Yet the line between payer and provider is increasingly blurring.
To learn more:
- read the blog post