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Best of Business 2011
In the Zone
The Business of Intelligence
When Opportunity Knocks
HOWARD: Individuals need to take on more responsibility and accountability for their own health conditions. Employers want to play an active role in that. They want to address that so that our healthcare system can be preserved for the future. There’s always going to be illnesses and diseases; there’s always going to be lots of things to treat. But what about the abuse in the system from people that do not take accountability for themselves?
Employers are taking an active role in programs that incentivize wellness, and then tracking it with data so we can compare that with the data systems that are already being accumulated and measure the return on investment of employers’ time and money to help their employees gain control of their own health. The best claims in the world are those that never happen.
How are the uninsured and underinsured impacting providers, insurers and, ultimately, the whole system?
ADAMS: We’re all dealing with that issue. Because of federal requirements and regulation, we become, as hospital providers, a safety net in the community. I don’t know if we’re dealing with it really well because the number of uninsured is growing, and most of us are trying to figure out ways to decrease our cost, be more efficient, and figure out how to deal with this challenge and continue to operate a viable healthcare system.
We don’t have the options we used to have in the past to cost shift. Most of us have fixed payment contracts with most of our payers. And so whether we raise our charges or not doesn’t make a difference. There’s some cost-shifting that still occurs there, but that’s becoming much more limited as a hospital provider.
So I think what we do is start to evaluate programs and services; and if some programs or services aren’t viable, they may not be developed or they may be discontinued. And so it has a real impact on hospitals and what we provide and how we provide it.
CAMPBELL: The hospitals have to provide a safety net, but in our analyses of emergency room visits, we’ll see that there are some people who abuse the system. We had one person who had over 64 emergency room visits, and that’s because they’re going to the emergency room to get all of their care.
They need to have other pieces of the puzzle fit together for them so that they can get care in appropriate ways. And if providing insurance coverage to these uninsured people switches a number of emergency room visits that cost thousands of dollars into just a regular physician office visit, which is just a hundred dollars, then we can save a lot of money in the overall system.
ADAMS: When we see them at the hospital, it tends to be at the point where it’s an acute episode that requires emergency room and other acute inpatient services—uninsured individuals will avoid accessing healthcare until the last minute because they don’t have coverage. And then it becomes very expensive.
In 2014, if nothing changes, we’re going to have an individual mandate on everybody to buy insurance and we’re going to have 50 percent more people qualifying in this state for Medicaid. How are we going to pay for this, and how are we going to find the providers to treat that additional 50 percent?
MCOMBER: There will be a great influx of patients, but they won’t all seek primary care immediately. They’re not all going to go in to the doctor the next day.
There are options for treating patients. As an example, we have a pediatric clinic down in Utah County that has after-hours urgent care for any of their patients that have something come up—they get sick, they have a sore throat, they can come in. We’ve been fighting with Medicaid to reimburse them appropriately because it is after hours and they’re on call and they’ll come in if the patient needs it. And we’ve had a hard time getting reimbursement at the level it should be paid at for after-hours care.
The other thing is when you have all of these patients coming into the system, there are options as we increase different technologies. Some of the things that haven’t been reimbursed in the past, like providing care over the internet via email or video chats, could enable extended care, and we’re going to have to look at those in the future.
We can’t continue to cut graduate medical education and think that we’re going to have enough providers. People aren’t going to go into medicine anymore if you regulate them so much and they have no options as to how they provide care. They’re not going to make that choice. There’s plenty of other choices out there.