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Blueprint for Integrated Preventive Healthcare Services: Payers, Patients and Providers

Shared by Thanh Tran, CEO, Zoeticx | 0 0 0 | about 2 months ago

Blueprint for Integrated Preventive Healthcare Services: Payers, Patients and Providers

According to the Polsinelli-TrBK Distress Indices Report, 20 hospitals have filed for bankruptcy since 2016. Looking ahead through 2019, medical cost trends remain stable, but extremely high as healthcare costs continue to rise. HRI projects 2019s medical cost trend to be 6%. This is consistent with the last five years, which have seen trends between 5.5% and 7%. By integrating preventative healthcare services, payees, patients and providers can all look forward to better results.Beginning with Obamacare, healthcare has been shifting its focus from acute to preventive care, using a 6:1 cost savings ratio model. CMS (Center of Medicare and Medicaid Service) has led this change by rolling out multiple initiatives supporting re-imbursement for preventive care. The initiatives consist of Annual Wellness Visits (AWV), Chronic Care Management (CCM), Remote Patient Monitoring (RPM), Transitional Care Management (TCM) and BHI (Behavioral Health Integration).Care collaboration among providers has been a unifying theme for these initiatives. While CMS led the shift to preventive care, private insurance payees have also offered similar initiatives.Connecting The DotsCMS rolled out these initiatives as separate Current Procedural Terminology (CPT) codes. They are designed to be integrated in order to contain care costs, improve patient care outcomes and encourage care providers to focus on preventive care through revenue incentives. To illustrate these financial differentiations, suppose one of these initiatives is operating by itself without connectivity.A healthcare clinic reaches out to a patient who is AWV eligible. The AWV is performed and the clinic files for AWV reimbursement. If the clinic does not follow-up, based on the risk assessed during the AWV session, the impacts would be that the clinic fails to generate additional preventive care revenue due to a lack of follow-up. CMS fails to contain the overall cost as there is no follow-up for preventive care, leaving the acute cost to remain a major risk for the patient and the patient fails to improve his or her care quality.Furthering the scenario, assume that the patient is confirmed with at least two chronic conditions; therefore, he or she is eligible for CCM service. But without an integrated healthcare delivery, there is now another level of disconnection for all stakeholders. These same problems will be found in RPM, TCM and BHI, proving that an integrated healthcare service is required for preventive care. And that service must also be supported by an integrated health IT solution offering seamless, economical workflows across all these initiatives.

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