Healthcare Reform Doesn’t Have to be All or Nothing

By: Jeff Cohen

pulling hairHealthcare professionals today are constantly faced with views of what’s changing in healthcare, and all of them seem equally convincing.  “One day, everyone will be employed by a hospital” is one of the favorites.  Not surprisingly, the proponents of that perspective tend to be….hospitals.  “Everyone has to merge their practices” is another favorite.  The proponents?  Large super practices, of course.

How does one sort through this?  Who’s right?  The truth is that everyone is seeing part of the whole and is “right.”  But being “right” doesn’t mean right for you.  My opinion?

●More and more people will be entitled to receive insurance based healthcare services;

●Baby Boomers, who have traditionally footed the bill for the government’s contribution to healthcare expenditures, will drop off (or lower down) the income radar screen over time and thus contribute less;

●There will be increasing pressure on healthcare expenditures over time.  No, this does not mean all care will be paid in a full cap model tomorrow;

●One of the key ways payers will look to deal with the financial pressure will involve some sort of risk based compensation (e.g. case rates, partial or full cap, patient satisfaction modifiers, percentage of premium arrangements).  In short, payers are looking to offload financial risk to providers;

Alignment (with other solid partners—hospital, physician or otherwise) will help a lot!  Stronger, more diverse provider systems are better able to withstand change and manage financial pressure; and

●As base healthcare expands, a “top tier” will likely grow too (for people willing to pay more to get more).

One size does not fit all!  Though it seems true that the ability to bear financial risk and to show quality will be increasingly critical to success, healthcare professionals faced with so many options have to ask questions like—

Where do I want to be in five years?

What sort of professional financial risks am I will to take over the next five years?

Finding the right thing takes some time and analysis, some strategic thinking.  Jumping at whatever someone is selling doesn’t.  The danger in simply swallowing someone else’s perspective is obvious.

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