The expansion of Medicaid and the healthcare exchanges set up by the Patient Protection and Affordable Care Act are expected to result in millions of newly insured Americans. In fact, Truven Health Analytics estimates that about 14 million Americans will gain insurance from the insurance exchanges and Medicaid expansion in 2014, and that number will grow to about 34 million by 2017.
The impact that the newly insured will have on hospitals and health systems is yet to be seen, and many organizations are unsure of how to prepare for a patient population they know so little about. Here, two healthcare experts from Truven Health Analytics share five key factors in preparing for the newly insured.
1. Think local. "Because healthcare is still local, hospitals need to profile their local market," says Bob Kelley, senior vice president of the Center for Healthcare Analytics at Truven. Hospitals and health systems need to anticipate the number and characteristics of the newly insured that is specific to their service area. Using national numbers will ultimately leave hospitals underprepared for what will happen in their local market.
2. Prepare to take on risk. In order to make the health plans within the health insurance exchanges successful, care must be provided in an effective and efficient way, and Mr. Kelley expects hospitals and health systems will be expected to share in the responsibility of population health management. "It's an opportunity to get on the right track and approach it as a population health management opportunity as opposed to business as usual, fee for service model," he says.
3. Gain insight into the health of the population. In order to meet the population health management expectations that come along with caring for the newly insured, it is crucial for hospitals and health systems to gain insight into the health of the population they will be caring for. "They're going to want to understand things about the population and their underlying health issues…and clinical characteristics," Mr. Kelley says. For instance, hospitals should look for underlying health issues, such as the prevalence of diabetes or heart disease, in their population of newly insured patients.
4. Prepare sufficient capacity. The newly insured will drive up the demand for healthcare services in most markets. "Demand is still a function of coverage," says Linda MacCracken, vice president of advisory services for Truven. "If people have coverage and access, they will use it." In order to handle the increase in demand, most hospitals and health systems will need to provide additional capacity to help drive care to appropriate settings, instead of expensive service sites, like the emergency department. To succeed, hospitals must forecast specific demands for their local markets
5. Engage the newly insured properly. To help provide care to the newly insured in an efficient and effective way, hospitals should engage them based on their health status and behavioral preferences. For instance, baby boomers generally are loyal to care decisions made by their primary care physicians, while younger generations are more open to care extenders and care teams, according to Ms. MacCracken. To achieve this, hospitals should know the consumer profile of the newly insured and their service requirements.
Looking for more information on what to expect from the newly insured? Sign up for the Becker's Healthcare free webinar, "What to Expect From the Newly Insured," sponsored by Truven Health Analytics, taking place Aug. 29 at 1:15 p.m.