With startling serendipity, a month to the day after the ACHA passed out of the House, Anthem joined Aetna, Cigna and Humana in quitting the ACA health plan marketplaces in Ohio. The very next day, Premera Blue opted to end participation in two counties in Washington state, adding another region of the country poised to be without coverage through the ACA. Blue Cross and Blue Shield of Kansas City is also planning exits impacting some 25 counties in western Missouri.
And now that we’ve seen what’s in the Republican’s senate healthcare bill, it’s unlikely those health insurers will reverse their business-driven decisions. In the process, the problems for individuals and families with coverage through an ACA marketplace will get worse in all probability. What’s more, those who have employer-provided health plans are contending with their own set of healthcare-related troubles.
According to the Kaiser Family Foundation, 83% of workers who are getting some form of coverage through their employers have plans with deductibles. That dollar amount has gone up nearly 50% in the last five years. Data from the Centers for Disease Control and Prevention show one quarter of those covered have high-deductible health plans (HDHPs), and most anticipate this form of policy will soon become the standard. Kalorama Information, a medical market research firm, noted recently that Americans will be shelling out a stunning $608 billion from their own pockets by 2019.
Congress’ absence of collaborative behavior on healthcare legislation, fewer insurance choices from fewer health plans and skyrocketing patient out-of-pocket expenses should set off alarms in your head to take swift action to ensure the financial health of your medical group.
If you are waiting for our elected officials in Washington, D.C., to save the day, you might be in for a rude awakening soon. The situation you’re facing will only get more severe. Regardless of what healthcare law eventually gets signed at 1600 Pennsylvania Avenue, HDHPs will become more prevalent as all market dynamics point to that being the case. By extension, the amount of financial responsibility sitting with the patient will most certainly increase. Today we’re seeing 20%, 30% or as much as 50% of a medical group’s revenue coming from patients.
In challenging times, the business—and, make no mistake, your medical group is a business—that succeeds is the one that tosses off the status quo and embraces new, better and more efficient ways to do things.