What Does Healthcare Transformation Mean for Risk Managers?

Susan Carr, editor of Patient Safety & Quality Healthcare, does a good job on the PSQH blog of beginning to answer questions about healthcare risk managers and the transformation of care. Carr discusses comments by futurist Ian Morrison at the annual conference of the American Society for Healthcare Risk Management.

Morrison says the Affordable Care Act isn’t the only factor shaping the changing world of healthcare risk managers. Other influences —consolidation, cost reduction, and realignment of risk—are also crucial.

Morrison’s key issues as outlined in Carr’s article:

1. ) Implementation of the Affordable Care Act and expansion of healthcare coverage to previously uninsured individuals. We may be heading toward two Americas, represented by Texas and California. The difference? The first is one of about half of the states that have refused to expand Medicaid. California, in comparision, has embraced the ACA and expanded Medicaid.

2.) Growth of the individual consumer market in which people have to make many more choices about details of their health insurance: “Morrison believes that individuals’ awareness of the narrow provider networks that come with ‘cheap’ plans is a ‘shoe still to drop.’ “

3.) Realignment of risk. Morrison foresees a country of “100 to 200 large regional systems of care across the country that assume risk on a population basis.”

4.) The changing business model for hospitals and health systems. That means more price pressure, along with an emphasis on value-based purchasing. “Morrison believes this shift ultimately means that hospitals will go from being in the business of filling beds to the business of emptying beds” – while trying to remain financially viable.

5.) Implementing and sustaining a culture of low risk and high quality is critical, and we’re not there yet. It will, he said “make the difference between life and death, between affordability or not.”

More from Carr’s article here.


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