The earlier hospitals begin to plan and strategize for how they will handle the healthcare environment once health insurance exchanges are operational, the better, said Purva Rawal, senior manager of health reform at Avalere Health, during a webinar Thursday.
The webinar, hosted by market anaylst firm Avalere, focused on the impact of the new health exchanges on hospitals and their relationships with payers and patients.
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As hospitals face more payment pressures, they will also see increased patient volume, Rawal said, noting that there will be an estimated 24 million new health insurance enrollees through exchanges and 12 million new Medicaid enrollees, along with $158 billion in ACA provider payment cuts and $7.1 billion in readmission penalties for hospitals.
"The 2014 coverage expansion through exchanges and Medicaid are intended to partially offset the payment reductions in the ACA," she said, "making them critical focus areas for hospital to recoup losses."
Rawal explained some ways for hospitals to position themselves for success with health insurance exchanges including capitalizing on exchange coverage by identifying and influencing state implementation decisions and leveraging value-based payment efforts by creating a value-based payment strategy across payers.
Preston Gee, senior vice president of strategic planning and marketing at Trinity Health in Novi, Mich., also explained how Trinity launched an extensive planning initiative for accountable care, clinical integration and other core facets of healthcare reform.
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But what is essential for hospitals to successfully compete in the new market is early strategic, operational and market readiness said Preston Gee, senior vice president of strategic planning and marketing at Trinity Health in Novi, Mich.
Gee said that because the number of individuals that could eventually utilize exchanges may hit 30 percent. "Exchanges and marketplaces represent a potential sea change in the way care is purchased and the medium by which healthcare decisions are made," he said.
According to Gee, some of the preparations that have been made at Trinity include researching the health insurance exchange experience in Massachusetts, creating an organizational structure to assess and implement the changes, assigning accountability at each Trinity organization, developing a predictive model for volume and financial impact and developing detailed work plans and accountability milestones.
"We're using the disruptive nature of health exchanges as a way to grow," he said. "We anticipate this to be an opportunity to really grow significantly in this space."