Masterclass: Essentials of Healthcare Policy

Posted By The Academy

August 4, 2023

Receive a comprehensive overview of key policies and governing bodies impacting LHS, including those addressing alternate sites of care, health equity and patient protections, public payer trends, and M&A.

Policies to Address Medicare Cost

1. Cuts in Medicare reimbursement present an additive concern for Chief Finance Officers as they navigate current financial pressures. Industry partners should assess how they influence total cost and generate an ROI for services rendered under Medicare reimbursement, as well as how they impact commercial patient acquisition/utilization, to mitigate losses.

2. Despite elevated scrutiny, rate increases in Medicare Advantage (MA) underscore CMS’ commitment to shift from traditional FFS models. The impact of solutions on premium capture (through patient acquisition) and accurate risk capture is critical for systems pursuing or expanding their MA plan.​

3. CMS’ continued push for risk-bearing value-based payment models parallels a shift also occurring in commercial payors. The recent focus on all-payer and all-model alignment is a notable redirect that aims to improve participation; industry partners can play an integral role in optimizing LHS performance under such models.

4. Generally, Medicare plays an integral role in setting standards for the broader payor market. LHS will continue to track the implications of these changes on commercial trends and use this to inform their payer market strategy. Partners should closely monitor how LHS reacts.

Policies for Health Equity

1. Policymakers view LHS as a primary lever to address health equity. However, limits remain on what LHS can and can’t do outside of healthcare. LHS are better equipped to address some social determinants of health but need community partners to truly make progress on health equity. Industry can play an important role in monitoring and addressing non-healthcare focus areas (e.g., education, housing, etc.) that LHS can't address alone.​

2. LHS approve CMS efforts to incorporate health equity within quality reporting requirements, but many disagree with how they operationalize and/or scope these measures. LHS and their relevant associations will play an active role in informing CMS on how to improve the logic and utility of these requirements.

3. CMS is enhancing requirements and financial incentives to address social determinants of health within value-based payment models. This generates a clearer ROI for LHS building out their social determinants strategy and provides an opportunity for industry partners who specialize in data tracking and analysis of these factors.

4. The public and commercial payor landscape broadly views health equity as an overarching priority. LHS will prioritize partners who incorporate health equity within their core mission and culture, and those who apply a health equity lens in their product development.​

Policies to Address Healthcare Consumer Empowerment and Protection​

1. Pricing pressures from Federal and State policymakers are compounding LHS efforts to cut costs and optimize workflows/processes. LHS will prioritize industry solutions that reign in labor costs (e.g., automation) and strategic shifts (e.g., outsourcing and self-disruption) that balance internal revenue goals with external pricing demands. 

2. Due to several factors, including policy, healthcare consumers are becoming more cost sensitive. Industry solutions focused on providing a comprehensive and transparent consumer price experience will be critical partners for LHS looking to improve consumer experience and retention.

3. The FTC’s increased scrutiny over mergers & acquisitions has implications for both LHS and their industry partners. The outcome of current LHS mergers will have a significant impact on the growth and partnership goals of LHS, as well as their aspirations to vertically acquire industry solutions.

4. Cybersecurity and information-blocking requirements reflect a burdensome juxtaposition for most IT leaders. Chief Information Officers continue to navigate an increasingly complex web of data security and data sharing requirements, often requiring additional FTEs and teams to ensure compliance. As a result, prospective tech industry partners will be expected to have a clear understanding of the cybersecurity assurances and interoperability functionalities of their data environments, as well as their alignment with the system’s own policies on data governance.

​Policies to Address Labor Supply and Sustainability

1. Every region is impacted by labor, albeit in various ways. Rural regions continue to navigate extreme shortages across clinical professions, while coastal and urban regions continue to navigate elevated contract demands regarding compensation and safe staffing. Industry leaders who understand the unique labor challenges of their LHS partners will be prioritized, especially if they help mitigate persistent shortages.

2. While labor cost growth has digressed to normal rates, LHS are still experiencing historically high baselines for labor expenses in 2023. As unionized states continue to advocate for improved compensation and staffing ratios, systems within and contiguous to these regions will continue to experience increases in nurse labor costs.​

3. Innovative staffing models, to combat workforce shortages and burnout, are largely enabled by state-level, COVID-era policies that vary significantly across the US. Industry partners should remain aware of the various staffing models, workflows, and personnel changes occurring across different states, and ensure seamless integration of their solution across these various models. ​


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