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Leading the Way Forward

Leading the Way Forward . Reginald J. Albert, FHFMA, MBA. National Board of Directors, HFMA. The Changing Healthcare Landscape CT HFMA Annual Meeting Rocky Hill Sheraton, CT June 5, 2014. Presentation overview:. The drive for transparency. HFMA’s leading role. The drive for transparency.

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Leading the Way Forward

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  1. Leading the Way Forward Reginald J. Albert, FHFMA, MBA National Board of Directors, HFMA The Changing Healthcare Landscape CT HFMA Annual Meeting Rocky Hill Sheraton, CT June 5, 2014

  2. Presentation overview: The drive for transparency HFMA’s leading role

  3. The drive for transparency

  4. Historical factors… • Historically, prices have served a wholesale function • Only recently have prices been viewed as retail • Without transparency, consumers have had no ability to compare charges among hospitals, nor did hospitals • There are thousands of chargemaster items

  5. Would this be a reasonable pricing system for buying a truck? Yet , that is the system hospitals and doctors are REQUIRED to use

  6. Transparency Today… • Rising deductibles and out-of-pocket payments • Continued growth in employer-sponsored HDHPs • High exposure to HDHPs in ACA plans • Employer pressure on private payers and providers • Third party transparency tools • We pulled back the veil; but, shouldn’t be shocked at what we saw

  7. Employee Cost-Sharing Percentage of Covered Workers Enrolled in a Plan with a General Annual Deductible of $1,000 or More for Single Coverage, By Firm Size, 2006-2013 • Estimate is statistically different from estimate for the previous year shown (p<.05). • NOTE: These estimates include workers enrolled in HDHP/SO and other plan types. Average general annual health plan deductibles for PPOs, POS plans, and HDHP/SOs are for in-network services. • SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006-2013.

  8. Prices remain a mystery for a majority of consumers Percentage of respondents to a 2013 survey who answered “Yes” when asked if they felt they had adequate access to price information for the following types of medical care: Source: PwC survey, 2013

  9. Hitting the Reset Button

  10. HFMA’s leading role

  11. Guiding Critical Conversations • Every day, healthcare professionals conduct sensitive financial discussions with patients. • Now there are accepted, consistent best practices to guide them in these communications. • Success will depend on a having a charity care policy that fits community needs. hfma.org/communications

  12. Setting Parameters Best practices for medical account resolution take the uncertainty out of the billing and collection experience for patients. hfma.org/medicaldebt

  13. Achieving Greater Transparency hfma.org/transparency

  14. Moving toward price transparency Price Transparency Task Force Members • Florida Blue (Blue Cross/Blue Shield) • Geisinger Health System • Healthcare Consumers • Healthcare Incentives Improvement Institute • HFMA • The Leapfrog Group • Maricopa Integrated Health System • Medical Group Management Association • National Rural Health Association • Priority Health • Sidley Austin LLP • American College of Physician Executives • American Hospital Association • America’s Health Insurance Plans • The Blackstone Group • California Hospital Association • Catalyst for Payment Reform • Catholic Health Association • Community Health Advisors • Equity Healthcare • Federal Trade Commission* * Advisory capacity

  15. What the Task Force Did Agree on definitions of terms Develop guiding principles for price transparency Recommend price transparency frameworks for different care purchaser groups Identify transparency-related policy considerations Chart the way to achievement of a more transparent healthcare pricing system

  16. Eliminating Babel

  17. Report Outline • Definitions and key terms (Price transparency, charges, price, cost, etc.) • Guiding principles • Policy considerations • B2B • Societal benefits, impact of transparency on price • Recommendations (13 of them)

  18. Related sticky issues. . . • Determining effect of transparency on prices • For consumers, more transparency is better. • But in the B2B marketplace, the jury is still out. • Surfacing issues with out-of-network balance billing • Inadvertent out-of-network use (e.g., anesthesiologists, pathologists) • Emergency care • Reassessing hospital chargemasters • It is time for change!

  19. Why do we do all this? • To provide tangible benefits to our members • To be the leading voice for healthcare finance • Because we’re the most qualified • Because it’s the right thing to do

  20. Contact Info Reginald J. Albert, MBA, FHFMA Vice President, Physician Services Pen Bay Healthcare Email: ralbert@penbayhealthcare.org Ralph E. Lawson, FHFMA, CPA 2012-13 Chair, HFMA Executive Vice President and CFO Baptist Health South Florida, Inc.

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