ACA Will Soon Drive Up Demand for Health Care Services

Written by on July 1, 2013 in Insight - No comments

With implementation of the federal Affordable Care Act (ACA) just around the corner, health care organizations throughout the United States are making plans for an influx of new patients and increased demand for their services.  The American Public Health Association estimates 30 million Americans will be eligible for insurance under the ACA, and another 11 million may be covered under Medicaid.

While implementation of the ACA varies from state to state, the impact of the new coverage rules on providers and insurers is only a few months away.  On October 1, current non-covered Americans will be able to enroll in new state-run health insurance marketplaces, with the full rollout of ACA’s health insurance mandate scheduled for January 1, 2014.

The goals of the ACA are clear: give more Americans access to quality health care, providing incentives for staying healthy, and reduce usage of emergency rooms and other high-cost inpatient services.  That means sweeping changes for health care providers throughout the nation.

For instance, the health care reform act encourages the formation of integrated service delivery systems, such as Affordable Care Organizations (ACOs). These typically involve affiliations among physician groups, hospitals and ancillary services to deliver coordinated care – hopefully at a lower total cost – to patients.  An ACO provides care to a group of patients based on a certain payment model, such as capitation, and is held accountable for the quality and cost of care provided to those patients.

However, creating a new ACO – other another form of integrated service delivery system – is not a simple task. The various providers need to share a common clinical and business perspective in order to build a sustainable partnership.  In addition, technology investments may be needed to create a common platform for patients’ electronic medical or health records (EMH/EMRs) as well as scheduling, billing and collections applications. Also, additional staffing may be necessary on a short-term project basis or over the longer term to meet greater patient demand.

Other important aspects of the ACA focus on encouraging disease prevention and wellness through more frequent patient visits and ongoing patient and family education. The ACA also emphasizes the importance of chronic disease management programs, through follow-up and outreach services provided by case managers.

Under the ACA, independent review firms will play a growing role in analyzing provider’s billing and claims, as well as utilization of facilities and chronic disease management programs.  Finally, the ACA places a great emphasis on quality improvement (QI) initiatives, a greater use of technology to reach patients in and out of providers’ offices, and the use of data such as HEDIS (Healthcare Effectiveness Data and Information Set) to improve patient outcomes over time.

From patient enrollment and scheduling to billing and claims, the ACA will place greater demands on health care providers and insurers than ever before. Therefore, it’s essential to understand the law, keep current on its implementation and continuing to plan for these sweeping changes in the health care landscape.

By Lisa Catania

Lisa Catania is a National Business Development Manager with the Dallas office of All Medical Personnel, Inc., which provides a full range of staffing services to medical and healthcare organizations throughout the nation.  Lisa can be reached at Lisa.Catania@AllMedStaffing.com.

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