In the fourth in a series of articles, we explore the strategic issues to watch in 2012.
Fate of the Affordable Care Act
In 2012, the Patient Protection and Affordable Care Act will face its most significant threats since the 2010 midterm elections as both the Supreme Court’s ruling and 2012 elections could derail the law’s implementation. How will the outcomes of elections—both for the Presidency and Congress—affect the future of the health reform law? Will the Supreme Court strike down key provisions of the law? And how would any changes to the reform law impact provider strategy?
Where to learn more: To learn more about the Affordable Care Act, Health Care Advisory Board members can access the Health Care Reform Crosswalk.
Launch of the accountable care market
Hospitals, health systems, and medical groups across the country will have the newfound ability to experiment with accountable payment models in 2012. On the Medicare front, providers have several viable options for entering the accountable care marketplace, including the Bundled Payments for Care Improvement Initiative and the Medicare Shared Savings Program.
At the same time, commercial insurers and self-funded employers are also developing their own accountable payment models. Will providers gravitate toward performance risk or utilization risk? Will the public or private sector emerge as the pacesetter in incentive transformation? How will local market competition evolve as providers experiment with accountable payment models?
- For more guidance on strategic issues, register for the Health Care Advisory Board’s national meeting, Beyond the ACO.
Battle for PCP loyalty in the care management marketplace
Despite ongoing challenges to PCPs’ economics, the fight to secure PCP loyalty will continue across 2012. Stakeholders of all stripes—hospitals, payers, employers, and even some big-box retail stores—have recognized PCPs’ centrality in the emerging care management marketplace. At the same time, new payment programs that reward successful care management may enable independent PCPs to remain in private practice. How will PCPs ultimately pick sides? Can stakeholders succeed in the new care management marketplace without PCP loyalty?
Where to learn more: To learn more about the battle for PCP loyalty, Marketing and Planning Leadership members can read or order Maximizing Primary Care Access. Health Care Advisory Board members can read or order The High-Performance Medical Group for more on emerging trends exacerbating traditional employment drivers.
Durability of scheduled provider rate cuts
Providers face a number of high-profile reimbursement cuts in 2012 and 2013. The Sustainable Growth Rate (SRG) continues to be a perennial concern for independent physicians nationwide—and the many hospitals that increasingly employ physicians. Further, the sequestration process created by the Budget Control Act of 2011 calls for a decade of annual two percent cuts to the Medicare program beginning in 2013. Will Congress continue to pass short-term SGR fixes or allow the scheduled cuts to take effect? Will the sequestration process continue as planned—or will Congress intervene to stave off the rate cuts?
Where to learn more: To learn more about the challenge ahead, Health Care Advisory Board members can read or order Running on Medicare Margins.
The next chapter in health care’s identity crisis
Stakeholders across the health care industry will face an ongoing identity crisis in 2012. Mergers and acquisitions continue to reshape local market dynamics—but the new transactions may increasingly include payers as well as providers. Given the multitude of forces threatening inpatient economics and the challenge of running on Medicare margins, hospitals will continue to question their long-term business model. Will 2012 market the year that health systems begin to identify as population health organizations rather than hospital-centric organizations?
Where to learn more: The Health Care Advisory Board is now accepting registrations for the 2012 CEO national meeting series. Sign up today to secure a seat at your preferred location.
Stay tuned for the next installment of our series where we’ll explore issues in IT. Or catch up by reading our predictions for the 2012 workforce, service lines, and care transformation.