How Will the Implementation of the Affordable Care Act Affect Your Business?

pan styleSome providers have become very successful using the “At Risk” model, whereby they receive set premiums from an insurance company (similar to the old per member/ per month type arrangement but with incurred but not reported costs (IBNR) holdback portions). Although these providers are accepting the risk and responsibility to provide all healthcare to their covered members, those who do it well become very profitable and therefore very marketable when they sell their practices.

In order to be successful and profitable, the providers who use this model must practice proactive, collaborative and educational medicine with their patients. The most successful providers utilize a team approach in that each member of the practice who interacts with patients is trained to use each contact as a marketing opportunity.

FOR THIS MODEL TO BE SUCCESSFUL, PROVIDERS MUST DEVELOP SYSTEMS THAT:

• monitor the frequency of patient visits and patients’ respective medical conditions. Frequent “check-up” visits reduce future costly procedures.
• collect data to thoroughly determine and document each illness and chronic condition that the patient has;
• have a plan to behaviorally modify patients to a healthier lifestyle and to improve medication compliancy;
• refer sick patients to specialists for preapproved procedures so costs are monitored and specialist costs are limited;
• monitor patients in the hospital and have a transition plan when they are discharged to reduce the frequency of readmission for the same diagnosis and to promote medical progress;
• constantly train physicians and staff members how to interact with patients in a friendly and pleasant way, so patients enjoy coming back to the office;
• have a catastrophic insurance program designed for each specific office and patients’ medical severities to limit catastrophic costs to a manageable level.

Developing a system to capture the required data and cost accumulation, and to create reports to review practice profitability might be difficult, but the key ingredient is the creation of a culture that delivers healthcare that is friendly and makes patients feel healthy. Hopefully, the profits will follow.

It takes a lot of management, systems and planning—and implementation is everything! Marcum can help you achieve these results.

Source – South Florida Hospital News and Healthcare Report