Provider finance execs bracing for unfavorable shift in payer mix, survey finds

Provider finance execs bracing for unfavorable shift in payer mix, survey finds

Dive Brief:

Provider executives are bracing for a shift in payer mix over the next 12 months as they piece together their projections of key operational areas, according to a survey conducted by the Healthcare Financial Management Association and analyzed by the Guidehouse Center for Health Insights.
About 70% of the 150 CFOs and revenue cycle executives surveyed said they expect an increase of Medicaid and self-pay patients and a decrease of commercially insured patients as unemployment remains high.
At the same time, leaders are prepping for a squeeze on IT budgets and are evaluating whether to turn to vendor partnerships and outsourced services, the report showed.

Dive Insight:
For decades, commercially insured patients have been highly prized among health systems and providers. But as the COVID-19 pandemic continues to hobble the economy, industry experts have been warning providers that they need to actively engage their Medicaid book of business — not view it as an afterthought.
It’s no surprise that health systems and providers prioritize the commercially insured. Commercial plans typically reimburse providers far more compared to Medicaid programs.
Most Americans receive health insurance coverage through their jobs, so when unemployment reached historic levels earlier this summer, it put millions at risk of losing coverage.
The shift in payer mix is likely to be significant. Policy experts have previously said that the nation will likely witness the greatest coverage losses ever recorded.
Centene, the nation’s largest Medicaid managed care organization, said it has added more than 1.1 million members since March — a majority of them Medicaid enrollees — as a result of the historic job losses.
“Healthcare leaders need to closely evaluate their payer mix and develop winning consumer experience strategies to overcome a slow recovery in patient volumes and an uptick in self-pay and Medicaid enrollees,” Timothy Kinney, Guidehouse partner, said in the report.
Nearly all of those surveyed said they were using telehealth tools to better engage with consumers in a number of areas beyond clinical care, including financial counseling, payment plans and price estimates. Telehealth use has soared amid the COVID-19 crisis, and most experts expect higher levels of usage will continue as patients get used to the model and providers invest in it.
For those outside clinical care, work was moved to a remote option. Survey respondents said they are now reassessing future space needs and only 12% expect staff to return to pre-pandemic arrangements.

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