Innovation fostered by government

New horizons - 2013 health care industry report

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With its predominant role in health care funding and regulation, the federal government is uniquely positioned to foster health care innovation.

Recognizing that spending on federal health care programs is a key driver of the nation’s long-term budget deficits, federal agencies are pressed to drive the development of ways to deliver care more cost-effectively through innovative payment models. They are playing an essential part in supporting industry innovation, and their activities offer many opportunities for providers, payers and other stakeholders to leverage government programs and resources while partnering to improve system performance.

Considerations for your board and executive leaders

For all heath care organizations

  • How is your organization tracking negotiations in federal and state budget and health care legislation to stay apprised of potential changes in payment methodology, funding amounts and coverage?
  • Has your organization reassessed its strategic goals and its ability to achieve them, given (i) changes that may be coming due to the full implementation of the ACA and restricted federal funding resulting from sequestration, (ii) federal budget and debt ceiling negotiations as well as (iii) possible changes to Medicaid payments to balance state budgets? What impact will new payment methodologies and changes to value­based outcomes have on your strategic goals? How are your leaders evaluating their individual roles in helping your organization meet its goals?
  • Does your organization follow health care innovation initiatives, seeking opportunities to apply for grants and awards where it has areas of expertise or serves a patient community suitable to specific proposals?

For providers

  • Has your state(s) decided whether it will adopt the ACA’s Medicaid expansion? Also, are any changes contemplated in the current Medicaid coverage, eligibility and payment structures in your state(s)? How is your organization following planned changes to the Medicaid program in your state(s) and the implications these changes will have on your census, emergency room visits, outpatient services and finances?
  • As Congress works to address the nation’s fiscal future, is your organization assessing its overall cost structure to determine how you can best deal with potential cuts in Medicare and Medicaid payments and changes in payment structure? Have you assessed which services could be discontinued or restructured? Have you addressed administrative changes that can contribute to cost savings?

For payers

  • Has your organization attempted to organize, or do you plan to participate in, community education services designed to (i) inform those eligible to purchase health insurance through the health information exchanges in your state(s) about the options available to them and the benefits of health insurance coverage and (ii) assist uninsureds in navigating their way through the maze of purchasing health insurance?
  • Has your organization assessed the impact of and determined how you can best deal with likely reductions in Medicare premiums and reimbursement of your costs of administering Medicare programs, both as a result of sequestration and future federal budget negotiations? Have you addressed administrative changes that can contribute to cost savings?