Provider healthcare reform webcast series
Starting in the fall of 2010, PwC hosted a 5-part series addressing the impact of health reform for healthcare providers. The program provides insights into both challenges and opportunities that healthcare providers need to be considering. Listed below is more information about each webcast.
Collaboration and convergence between providers, payers, pharma/LS and employers
Tuesday, February 15, 2011 from 12-1PM ET
In the past, hospitals, physicians, suppliers, and health plans all understood their roles and responsibilities. They focused on making their own organizations as efficient as possible. However, in a post-reform era, huge opportunities are evolving in what is being described as convergence. As organizations converge, they strip away competing agendas to improve care and lower costs.
Convergence makes sense as health systems become more wired, share data and depend on new methods of payment that reward coordination and quality over quantity. The convergence trend is unfolding in new alliances, mergers, acquisitions and partnerships. Once disparate entities are re-thinking their views on competition and collaboration, and organizations that were once vendors or adversaries now see each other as allies.
This program will include an interesting conversation with industry leaders who will talk about how they're positioning their organizations in a converging marketplace. PwC's recent report, Top Health Industry Issues for 2011
, has characterized 2011 as a makeover year for the industry. This webcast is a first step in understanding the scope of convergence.
HOW do you thrive on governmental reimbursement?
Thursday, December 16, 2010 from 12-1PM ET
Health reform may mean more money for providers (particularly for primary care physicians, general surgeons, and pediatricians), but increasingly restrictive government sector payments will pose significant challenges to providers. A plethora of often confusing new regulations affecting the amount and timing of reimbursements will need clarification before the country reaches its aim of reducing the number of uninsured citizens by more than 60 percent.
For example, a 40 percent increase in the Medicaid population by 2014 will seek primary and preventative care services -- many for the first time. Providers will face many related challenges, such as gathering resources to verify these patients’ insurance eligibility, generating data to fulfill quality measurements tied to bonus payments; and caring for these patients in an era of a severe primary care physician shortage. Knowing effective cost-containment strategies and efficient processes for delivering services is essential to thrive under new government reimbursement models.
HOW do you measure up?
Thursday, December 9, 2010 from 12-1PM ET
Value-based purchasing (VBP) is not new. Payers have been experimenting for some time with various VBP reimbursement models. What is new is that many payers — particularly Medicare and Medicaid — are planning to implement punitive measures against poor performers and reward top performers across the board. For example, starting in FY 2013, CMS’s new VBP program will target five specific patient conditions on which providers will be rated in relation to efficiency, patient satisfaction, and quality of care. Providers who don’t measure up will see decreased reimbursement, and top performers are likely to receive bonuses.
HOW do you ensure you are doing the right thing?
Thursday, December 2, 2010 from 12-1PM ET
New regulations under the banner of health reform are putting increasing pressure on not-for-profit providers to continually prove their eligibility for tax-exempt status. Health reform legislation requires 501(c)(3) organizations to conduct community health needs assessments for each of the hospitals these organizations operate, taking into account input from the individuals who live in their communities. This is in addition to the community benefit reporting they already do. Organizations must subsequently make the results of those assessments publicly available. Other regulatory changes in store for both for-profit and not-for-profit providers include:
- Increased funding for fraud and abuse prevention, including RAC audits
- Some Medicare exceptions to the prohibition on certain physician referrals to hospitals
- New prohibitions on Medicare contracts with physician-owned hospitals
HOW do you think outside of the hospital/health system box?
Thursday, November 18, 2010 from 12-1PM ET
Traditional models of care are increasingly unable to meet the needs of the average healthcare consumer. In response, health reform is ushering in an era of accountable care that operates under an umbrella of multiple caregivers that treat the same individuals and communities. This unprecedented professional collaboration among hospitals, ambulatory practices, physicians, nurses, social workers, rehabilitation centers, etc., will make hospitals fundamentally rethink the way they do business.