Winning a Losing Game

[BlogWinning a Losing Game, Healthcare Edition

(Trilliant Health, January 12, 2021)

Poker players know that if you sit down at the table and cannot figure out who the "mark" is, then it is you. Health system executives don’t have to wonder. In a world of payer consolidation, new market entrants, technology, alternative payment models, changing federal and state regulations, pharmaceutical innovations, benefit plan design, and consumer choice, hospitals and health systems have been dealt the worst hand. Now, more than ever, hospitals and health systems need to grow revenue and increase market share by successfully acquiring net new patients while keeping their existing patients loyal.

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Price Transparency Compliance

[Article] CMS has started price transparency compliance audits:
6 things to know

(Becker's Hospital Review, January 13, 2021)

"Under the rule, which took effect Jan. 1, hospitals in the U.S. are required to post their standard charges online. Hospitals must post a machine-readable file with all items and services and display prices of 300 services in a consumer-friendly format.

Six things to know: 
1. CMS complaint form.
2. What happens if there's a violation. 
3. There are no hardship waivers or exemptions.
4. How a price estimator tool can help compliance.
5. Appeals of civil penalties. 
6. Results of the audits."

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[Article] The future of healthcare: Value creation through next-generation business models

(McKinsey & Company, January 4, 2021)

"The healthcare industry in the United States has experienced steady growth over the past decade while simultaneously promoting quality, efficiency, and access to care. Between 2012 and 2019, profit pools (earnings before interest, taxes, depreciation, and amortization, or EBITDA) grew at a compound average growth rate of roughly 5 percent, aided in part by incremental healthcare spending that resulted from the 2010 Affordable Care Act. The next three years are expected to be less positive for the economics of the healthcare industry, as profit pools are more likely to be flat. COVID-19 has led to the potential for economic headwinds and a rebalancing of system funds. New and innovative business models are beginning to show promise in delivering better care and generating higher returns."

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PCR Cycle Threshold

[Op-Ed] Why PCR Cycle Threshold Is Useful in Coronavirus Testing

(MedPage Today, January 4, 2021)

"With the increase in positive COVID tests, knowing COVID patients' cycle threshold (Ct) values could benefit patients, physicians, and their community. Many patients test positive for COVID without any symptoms. What does that mean? [It could mean that] patients with symptoms who come to the hospital and have a high Ct number (meaning less viral load) and few comorbidities might be best triaged to outpatient treatments, while symptomatic patients with comorbidities with lower Ct values (indicating higher viral loads) would need more elaborate inpatient treatment and monitoring."

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Price Transparency - Insurers

[Blog] Trump Administration Finalizes Transparency Rule For Health Insurers

(Health Affairs, November 4, 2020)

"On October 29, 2020, the Departments of Health and Human Services (HHS), Treasury, and Labor issued the “transparency in coverage” final rule, in which plans and insurers must disclose cost-sharing estimates at the request of an enrollee and publicly release negotiated rates for in-network providers, historical out-of-network allowed amounts and billed charges, and drug pricing information. With more information about health care costs, consumers can make cost-conscious decisions; face fewer out-of-pocket surprises; and potentially lower overall health care costs. This rule complements the hospital transparency rule by extending to items and services provided by other health care providers, such as physicians."

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