3 MLR Questions Payers, Providers Should be Asking
- What can providers and payers do to comply with this regulation?
Hospitals and payers will need to continue to look at new mechanisms for reimbursement and shift away from episodic and disease state care. They will have to work toward prevention and wellness. They also need to look at different reimbursement models and changes that can be made to current models to incentivize prevention and wellness.
Providers and payers are going to have to start a real dialog around this topic. A number of payers and providers are experimenting with this [different approaches to reimbursement for wellness care] already and they’ve become very creative, using approaches like group appointments. In the future, payers may reimburse more for group appointments than they’ve done in the past to achieve the long-term goal of prevention and wellness. The payers new goal is to keep patients healthier and out of the hospitals, and that’s should cost them less in the long-term.
Of course, Snow is right: If the payers reduce their costs long-term then that’s better for them, but also better because it means healthier patients. Moreover it’s a good reminder that providers also need to think differently now in order to stay ahead of the curve too. Hospitals and health systems need to invest more of their attention and dollars on outpatient and preventative care programs; lest they suffer financial losses when their inpatient volumes dwindle. It’s truly the circle-of-life for the patients, payers and providers—everyone’s ultimate health or demise depends on the other person moving in the same direction to stay healthy.
Karen Minich-Pourshadi is a Senior Editor with HealthLeaders Media.
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