Here are a few statistics that might be of interest to you. It involves the ranking of insured people under the age of 18 as a percentage of the total US population in 2012:
Nevada was ranked first with 18.3 percent
Michigan was ranked 50th with 3.5 percent
Tennessee was ranked 29th with 7.3 percent
(Source U.S. Census Bureau, Current Population Survey)Industry experts have speculated what 2014 will bring and how implementation of the Affordable Care Act will affect medical group professionals. The question, “Does healthcare reform represent incremental change or a fundamental shift?” was posed during the U.S. News Report Hospitals of Tomorrow conference, in Washington, D.C. last November and hospital executives pointed to mergers, acquisitions and new forms of integration to suggest that it is more of a fundamental change that demands new types of collaboration. I have mentioned in numerous articles that as the MGMA/ACMPE board of directors went through three years of transforming its organization into fundamental change (1) Beginnings; Focus and Action toward the desired state. (2) Neutral Zone; A time where we are between what has been and what are in the future. (3) Endings; Letting go of what has been a consistent and/stable mindset, philosophy, belief, structure, time, environment, role, responsibility, idea, world. We must stop doing things one way and begin doing them another way. Providers must move quickly out of the neutral zone or we will find ourselves reactive to the payers. The terms clinical integration (CI), accountable care organizations (ACOs) and population health management (PHM) are often uttered these days but can be somewhat ambiguous depending on the organization and the particular stakeholders. Although the terms allude to quality care, cost efficiencies and the future healthcare environment, it’s often difficult to ascertain the specifics. I have been working in healthcare since 1987. One of the biggest barriers to successful integration is physician resistance (sometimes rightly so) because physicians aren’t used to thinking and acting in concert with hospital executives and others. My biggest concern is that if physicians and hospitals don’t change this way of thinking we will lose control and insurance companies will continue to rake in millions of dollars at the expense of the patients and the providers. Insurers will be closely watching the rolling implementation of federal and state exchanges through the coming year. The initial rocky launch caused mass confusion and hindered enrollment. In particular, they’ll be scrutinizing the demographics and health risk composition of the emerging marketplace. Most experts say the key will be whether the risk pool is balanced between younger and healthier people and older and sicker people. If the website kinks are worked out – and they seemed to be at year’s end, insurers are poised to take advantage of a huge expansion in their customer base. “What’s not to like about the government saying everybody must have this product and we’re going to help people pay for it?” asked Joel Ario, former director of HHS’ office of health insurance exchanges.The first hint of how insurers did during the problematic first three months of open enrollment on the exchanges – and how investors will regard their prospects – came on January 16 when UnitedHealth Group detailed its fourth-quarter finances. Observers are also watching to see how the 80 new entrants to the individual and small group markets fare in 2014.Experts also anticipate more employers will buy coverage for their employees through private insurance exchanges offering multiple plan options, similar to the public exchanges. In this arrangement, firms give their employees a fixed contribution and let them choose an insurer and plan.Insurers are banking on continued growth in the Medicare Advantage. More than a quarter of all Medicare enrollees are now in private plans, and roughly 40 percent of new Medicare beneficiaries are choosing Advantage rather than traditional Medicare. Insurance consultant John Gorman expects the number of individuals enrolled in private Medicare plans to grow by 8 percent to 10 percent annually. When we were organizing the fundamental change/changes of the MGMA/ACMPE the board recognized that we had to have various stakeholders and volunteers from throughout the organizations. We knew we could not be lacking in data and sound information and had to be transparent with our membership. If not the chances of success would be virtually nonexistent. The organization is the leading association for medical practices administrators and practices has been in existence since 1926. Its national membership represents more than 33,000 medical practice administrators and executives in practices of all sizes, types, structures and specialties. Organizations and associations have very strong, deeply ingrained cultures. They have profound, long-standing traditions. They have powerful and intricate political dynamics. They are manipulated by influential and formidable personalities, in many cases, a bank of opinionated past individuals. They often value the status quo. Most are reactive than proactive. Quite frankly, most organizations and associations are hostile environments for change. In this type of environment, you don’t stand much of a chance of making a case without data. But the facts can be a powerful strategic resource in promulgating change, particularly fundamental radical change. Although the following four thoughts may seem too simple, I will tell you they were most helpful for the MGMA/ACMPE in our change and sanity. And they may help us keep our cool as we navigate the ACA waters that lie ahead…
Don’t get overwhelmed.
If your data voids are considerable, prioritize and get to work.
Concentrate data gathering in a short, specific time frame.
When perfect data is not available, use the best you have.
Bill Appling, FACMPE, ACHE, is founder and president of J William Appling, LLC. He is a national speaker, presenter and a published author. He serves as an adjunct professor at the University of Memphis and is on the boards of Hope House and Life Blood. For more information contact Bill at j.william.appling@outlook.com.
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