Beyond the Rankings
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Beyond the Rankings | National Payor Study, ReviveHealth, “Turning the Corner Toward 2014,” Brandon Edwards, ACOs.

Brandon Edwards
Nashville firm’s 2012 survey results discuss impact of payor patterns from hospital standpoint

 

 Editor’s Note: This article marks the second in a 2-part series summarizing Nashville-based ReviveHealth’s sixth annual National Payor Study. In October, Medical News focused on standout statistics.

 

Hospitals are considerably more skeptical about the risks and benefits of health reform for the hospital industry than they were last year, according to results of the sixth annual National Payor Study. Conducted by Nashville-based ReviveHealth, the 2012 survey, “Turning the Corner Toward 2014,” paints a broad picture of administrators’ opinions about various industry issues.

“Seventy-six percent of survey respondents said they feel healthcare reform will decrease their private payor rates, which is 4 percent higher than last year,” said Brandon Edwards, president of ReviveHealth.

The summary also assesses opinions on accountable care organizations (ACOs), clinical integration, and other issues facing the medical community as the pivotal presidential election draws near.

Beyond the Rankings:

  • Fifty-seven percent of hospitals have no ACO strategy or plans, even if they plan to clinically integrate in some way. Only 36 percent of hospital executives said they’re planning an ACO or have one in the works.
  • Seventy-one percent of hospitals ranked population health management near the top of the agenda, reporting that they either have a population health program in the works or in the planning stages. Only 12 percent of hospitals said they have no immediate plans for a population health initiative.
  • Eighty-one percent of hospitals said they have a clinical integration effort in the works or in the planning stages. Only 6 percent said they have no immediate plans or aren’t planning any clinical integration as a strategy.

Edwards said he was surprised about the low percentage of ACO strategy or plans, even though it matches what he’s seeing in the market.

“I’m hearing hospital administrators are working on various programs,” he said. “They’re not sitting still.”

Part of the delay may include waiting for the presidential election outcome, possibility of repeal, or more pressing higher priority items, such as regulatory mandates and EMR implementation.

“Also, they may look at ACOs as not the best way to solve accountability problems,” Edwards pointed out. “The cost of care for patients and the population doesn’t need an ACO. If this were ‘09, or ‘10, I’d say people are on the sidelines waiting to see what’s going to happen. Lately, I’ve heard people say they can’t wait to see what’s going to happen. They’re moving forward with strategies they believe are best for their hospitals to remain competitive and deal with payors in their market. Some of them are more concerned about what Blue Cross is going to do than Congress.”
When asked who he predicted would be at the core of ACO formation – insurers or hospitals? – Edwards said maybe neither one.

“Physician groups are making a play, particularly in California, where a large number of groups have operated in a capitated or delegated environment,” he said. “You certainly have payors looking to be in the center of ACOs in different markets. But then you also have hospitals working on it, such as Norton/Humana, Piedmont/Cigna. That said, I haven’t talked to anyone doing it long enough to hear them say it’s going to solve all their problems. People are being more cautious.”

Edwards noted that insurers were “oddly quiet” about the Supreme Court ruling in late July concerning health reform. He also mentioned the myriad mandates and overall uncertainty about upcoming changes have healthcare administrators rethinking their positions.

“It’s a tough environment for them,” said Edwards. “We have a number of CEOs and CFOs in the industry who are 60ish, who want to make it a few more years, with a strategic plan to retire. We have to distinguish between the tough environment we’re facing economically and then separately for health reform. We’ve heard from most clients and industry partners, the environment would be tough no matter what. With the economy down, benefit design that’s increased patient responsibility and therefore bad debt, and other factors, they’re seeing that health reform in particular is taking a difficult environment and making it even harder for them.”

 

 


ACOs., “Turning the Corner Toward 2014, ” Brandon Edwards, National Payor Study, ReviveHealth



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