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Two recent studies may be harbingers of changes in health care coverage that could affect how access departments do business. Those changes, suggest a veteran health care professional, could mean higher deductibles and a pressing need for more aggressive point-of-service collection.
The number of employers offering health insurance is likely to decrease as the economy remains sluggish and unemployment rises, according to a RAND study released in late February.
Using data from two national surveys of employers conducted during the 1990s, RAND economists sought to demonstrate the link between local markets and employer-sponsored health coverage in the most recent issue of the International Journal of Health Care Finance and Economics. RAND, based in Santa Monica, CA, is a nonprofit institution that aims to improve policy and decision-making in number of fields.
The report said employers are more likely to offer coverage, and to contribute a larger share of its cost, in communities where labor markets are tight. M. Susan Marquis, the co-author of the report, said she wouldn’t go so far as to say the slow economy will unravel the employment-based health insurance system, but the report’s findings do raise the issue as a matter of concern.
Meanwhile, the nation’s employees want more control and choice in health care, are interested in consumer choice models, and rank health care as their most important benefit, according to a recent study conducted by Hewitt & Associates, an outsourcing and consulting firm based in Lincolnshire, IL.
Overall, respondents to the Hewitt survey of 528 U.S. employees expressed confidence in their ability to make sound coverage decisions, with 87% saying they understood "fairly well" or "very well" how to choose the best health plans for their needs.
These reports come at a time when insurance companies find themselves at the end of a "premium development cycle," says Jack Duffy, FHFMA, founder and director of Integrated Revenue Management in Carlsbad, CA. "[Insurers] have gone to employers each year with double-digit increases on the premium side, and can’t go back to them again."
Just as employers have increasingly gone to "defined contribution plans" for employee pensions, Duffy predicts they will do the same with health care benefits if faced with more premium increases.
That means, he explains, that employers will be increasingly likely to make a contribution toward an employee’s health care coverage, rather than buy comprehensive coverage from an insurer such as Blue Cross Blue Shield or Aetna.
Employees faced with arranging their own coverage, in turn, are likely to have health care plans with large deductibles, Duffy says. "What kind of access environment do we enter into when our patients owe $5,000?"
Hospital administrators will be forced to ask, "Will you collect that $5,000 as you’re admitting the patient?"
"More and more patients will be presenting with multi-thousand-dollar deductibles, and if your department is not prepared with credit cards and financial counseling, you’re toast," Duffy adds.
Other innovations aimed at reducing revenue cycle time, such as call centers, "may have to be quickly replaced with the ability to have a much more in-depth financial relationship with patients related to copays," he says.
Hospitals that haven’t properly trained staff and that aren’t prepared to swipe credit cards or use an automated clearinghouse to enable them to take counter checks over the telephone "will be very vulnerable," Duffy says.