5 Trends Aimed at Reducing Costs in the Healthcare Industry

by John Hansen

stethoscopeThe outcry in the marketplace is: “It costs too much!” For those now getting subsidies, many are finding California health insurance more affordable than ever, but for everyone else the price went up. Tax payer dollars will now be collected to pay for these subsidies. Many question, how long will America be able to foot the bill? The healthcare industry including hospitals, doctors, other medical providers and health insurance companies are now having to deal with greater bureaucracy than ever. More paperwork. More government regulations. Reporting regulations. Budgeting regulations. Delivery of care regulations.  And on and on! So, the industry is screaming for solutions. How can we make healthcare more affordable in this new marketplace that has been radically transformed due to the Affordable Care Act? Like it or not, here are four trends in the industry that are aimed at reducing cost:

1. Reduction in Choice of Doctors:

Some health insurance carriers have chosen to offer “narrow networks” in order to lower their costs and pass savings on to the consumers. The carriers create new distinct networks where they offer lower payouts to doctors for covered benefits. Doctors that are more desperate to build up their business prostitute themselves to the prevailing trend and sign up for these narrow networks in hopes that they will be able to build up their clientele and then get out of the network. For consumers, this means less doctors take your health insurance coverage. After the last Covered California Open Enrollment (October 2013 to March 2014), many new enrollees got the shocking news that they would have to find another doctor. Consumers complained, “But my doctor said he takes HealthNet!” Yeah, he takes the old HealthNet, but he didn’t sign up for the new narrow networks, so you’re out of luck.

trends2. Accountable Care Organizations:

Most Americans will agree that medical spending is out of control. People are getting unnecessary procedures and over-medicating. It’s a waste of money, and we all have to pay for it. In response to these concerns, Accountable Care Organizations, or ACO’s have been set up. These medical organizations seek to hold healthcare professionals accountable, improve care, and reduce costs. Through outcome driven reimbursement, healthcare professionals are rewarded (and sometimes penalized) based on the health/efficiency target goals they achieve. If implemented well, Affordable Care Organizations can save everyone money. However, when you are the individual that is being told that the procedure you want is not approved by the ACO, then you might start questioning whether you want to run back to your good old PPO that let you get whatever procedures you wanted.

3. Virtual Medical Care:

In this day and age, do I really have to go to the doctor? Can’t I get the healthcare advice I need over the phone or through a video consultation? More and more the answer to these questions is yes. Nurses and doctors who interact virtually with patients are often able to serve more clients more efficiently in the same amount of time. Why pay two to three doctors who service clients face-to-face when you could just pay one doctor who services clients through virtual means? Kaiser Permanente has been offering an over the phone nurse advice line for years, but now they and other carriers are experimenting with virtual doctor consultations as well.

4. Consumer Engagement Tools:

Healthcare more and more is going online. Consumers are utilizing online health programs to lose weight, lower risk of cancer, care for diabetes and more. Also, more and more treatment cost calculators are becoming available online.

Posted: September 30th, 2014 under California Marketplace