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Clinical and Financial Transparency is Positively Changing the Industry

The healthcare industry has gone through tremendous change over the past few years. This year may be the turning point where consumers will become key stakeholders in managing their healthcare. The changes created by the Patient Protection and Affordable Care Act (PPACA) have become a catalyst for consumers to have more control over the healthcare services they receive, where they receive care and how much their care costs.

This newfound responsibility comes at a price. Regardless of where a consumer obtains health insurance (through their employer or a State Health Insurance Marketplace (SHIM)), they are now responsible for a significant portion of the cost to administer their care. For example, in the SHIM exchanges, over 80 percent of consumers have chosen the Silver and Bronze plans which have very high deductibles. For 2016, the out-of-pocket maximum for any exchange plan can be no more than $6,850 for an individual and $13,700 for a family before a consumer may qualify for any exchange subsidies. These changes are placing additional financial pressure on providers and patients.

I’m pleased to see healthcare provider compensation transitioning from the fee-for-service model where the volume of patients a physician treat is the main criteria for their compensation towards a value-based system where quality outcomes are the economic driver. As a consumer myself, I’d like to see that everyone receives quality care and favorable results. By following the value-based structure, consumers have an opportunity to receive both.

Every day I am amazed to learn about new ideas brought forth by thought leaders and see the sweeping changes that occur improving the delivery, outcomes and financial stability of the healthcare industry. By publishing our healthcare journal, The Focus, our goal is to help keep you current with articles about the latest topics that are thought-provoking, compelling and relevant.

To that end, we have a terrific group of contributors for our spring edition. A previous author, David Johnson, CEO of 4sight Health, has written a compelling article titled Healthcare’s Productivity Paradox: Ferocious Exploitation of Payment Formulas. He addresses the exploitation of activity-based payment formulas and how they distort care delivery protocols and misuse care resources.

One of MiraMed’s own, Phil Solomon, Vice President of Global Services, has written a fascinating article, titled The Future of Healthcare Just Ain’t What it Used to Be. He highlights the trend of growing patient liability and the new techniques required to collect from this emerging patient population.

Lyman Sornberger, CEO of LGS Consulting, and Sheldon Hamburger, a principle consultant with the Aristone Group, are industry subject matter experts that have consulted with many of the largest health systems in our industry. Mr. Sornberger introduced an important topic as he explains many of the new requirements the Affordable Care Act imposed with the new Internal Revenue Code section 501 in his article 501(r) –Did You Know? Mr. Hamburger outlines the requirements providers must meet to comply with the Centers for Medicare and Medicaid post-acute care bundled payment initiative with his article Designing Bundled Payment Post-Acute Networks.

Buying a hospital these days is a risky and complicated matter. We have a unique opportunity to understand the challenges acquiring a hospital brings. Dr. Alan M. Preston, a professor in the Healthcare Management MBA program at Texas Health and Science University, participated in the purchase process as part of an acquisition team and shares his experiences in his article The Trials and Tribulations of Buying a Hospital.

Every company should be continually taking steps to improve corporate and patient communication and employee retention. To that end, I have the pleasure to introduce a new author to The Focus, Greg Zinser Vice President at Anesthesia Business Consultants. Mr. Zinser’s article Corporate Communication with Email – A Blessing and a Curse focuses on how to improve communication throughout the entire enterprise by initiating email best practices.

In closing, it has become apparent that every consumer must take his or her place as an active team member in their care. If the industry is going to evolve as a “patient-centric” system, we must embrace clinical and financial transparency as a core foundation for care. This concept will succeed if healthcare providers treat patients as partner's in their care and if patients assume more responsibility for their part. It is an exciting time for our industry, and I am proud to participate in its evolution.

As always, I am very interested in hearing from you by sharing any comments or suggestions you may have. I hope you enjoy reading this quarter’s edition of The Focus.

With best wishes,

Tony Mira
President and CEO


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