Budgeting for Uncertainty to Achieve Financial Stability

The roundtable panel talks about implementing changes to the budgeting process and financial forecasting, along with balancing long-term growth opportunities and short-term expense control measures.

Editor's note: This article is based on a roundtable discussion report sponsored by Vizient, Inc. The full report, How Will Healthcare Finance Change in the Future?, is available as a free download.

The ongoing COVID-19 pandemic continues to present financial challenges for hospitals and health systems, specifically around the deteriorating payer mix.

"We have already seen a 2% shift in our payer mix over the course of the last six months. Many aspects of the pandemic have caused us to look at ways to become more efficient, including matching resources to demand, redesigning care models and pathways, and ensuring the right site with the lowest cost," says Robin Damschroder, MHSA, FACHE, CFO at Henry Ford Health System, based in Detroit, Michigan.

While the payer mix is an obstacle for many provider organizations, some are trying to reach across the negotiating table to insurers for assistance navigating the crisis.

"For [Equality Health], it’s an interesting challenge. We’re working closely with payers to make sure we’re able to get folks on the plan and get them actual coverage," says Mark Besh, Chief Growth Officer, at Equality Health based in Phoenix, Arizona. "That’s been our biggest challenge: coordinating with the payers, getting [coverage] for folks that need to get healthcare, getting them into the primary care doctors safely, and people are hesitant to do that. We’ve done a lot more in the virtual world in terms of telehealth and how we’re supporting our primary care doctors in those areas."

Much like Equality, CareMount Medical, P.C., based in Chappaqua, New York, is looking to be proactive in its approach to the payer mix issues going forward and anticipating trends emerging from the pandemic.

"There’s more to come about the payer mix and how this manifests over the next year or two," says Kevin Conroy, MS, CFO at CareMount. "We’re likely going to see a payer shift and anticipate downward reimbursement pressure from the payers. At CareMount, we are a predominantly commercial business with a growing Medicare segment. We don’t have the significant Medicaid patient population that other panelists have spoken to. Recently, we completed a negotiation with one of the major payers and it was clear that they are thinking about how payer-provider relationships are going to evolve moving forward. CareMount is committed to moving from a fee-for-service rate environment to a value-based model. We recognize that the value space is the future, and [we’re] focused on patient care with a more integrated approach."

In addition to the payer mix issues, some provider organizations are analyzing the evolution of consumer expectations for care delivery and how to best expand those services in the future.

"We did drive-thru COVID testing and that was huge; everybody loved that, and they were pretty upset when we took it down and moved it back to the physicians’ offices. So, we are trying to figure out what other services could we offer in some sort of a drive-thru [setup]. Can you do other lab work in a drive-thru, like blood draws? Can you take vitals, renew a prescription, or some things like that?" says Denise Chamberlain, CPA, MAEd, CFO at Edward-Elmhurst Health, based in Naperville, Illinois.