Why do finance executives in healthcare organizations need a little TLC these days? Because according to Healthcare Financial Management Association’s survey of 150 of these folks, they’re worried about how a shift in payer mix over the next 12 months will impact key operational areas.

Perhaps the most telling survey analysis provided by the Guidehouse Center for Health Insights is that 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 with unemployment remaining high. The report also noted these leaders believe that a squeeze on IT budgets is inevitable and are evaluating vendor partnerships and outsourced services. 

Sounding the alarm

For decades, commercially insured patients have been at the top of health systems’ and providers’ lists. But as fallout from the COVID-19 pandemic continues to erode the economy, industry experts have been sounding the alarm for providers to be proactive about their Medicaid book of business rather than dismiss it as an afterthought.

Of course health systems and providers prioritize commercially insured patients because commercial plans typically reimburse providers far more compared to Medicaid programs. However, since most Americans receive health insurance coverage through their jobs, when unemployment reached historic levels this summer, millions were at risk of losing coverage.

The result is likely to be a significant, perhaps seismic, shift in payer mix. There are already signs attesting to policy experts’ warnings that the nation could experience 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 historic job losses.

What can be done?

“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,” said Timothy Kinney, Guidehouse partner.

Nearly all survey participants 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.

Technology has also enabled those outside clinical care to work remotely. In fact, survey respondents said they are reassessing future space needs and reducing facility overhead since only 12% expect staff to return to pre-pandemic on-premise work environments.

Beyond workforce support, technology that helps health systems and providers quickly and accurately identify payers for patients who no longer have commercial insurance is essential for addressing the shift in payer mix. Insurance discovery software that locates unknown commercial and government coverage (including Medicare, Medicaid, Tricare) varies greatly in capabilities, pricing structure and processing methods.

This chart helps organizations research insurance discovery providers. If you can’t find answers to your questions or want more information, contact us for a 30-minute demo or for our no-charge, no-obligation test file. Learn more at www.maxrte.com

Christopher Fisher, CRCP-I, maxRTE Business Development Director