PwC: Top 5 ACA trends affecting health plans, providers

The Affordable Care Act (ACA) was signed into law just over five years ago on March 23, 2010.  Since then, the healthcare industry has experienced massive change, from new reimbursement models to the opening of the health insurance exchanges to new regulations. But changes associated with the ACA are far from over.

Five years post-implementation, health plans, health executives, and healthcare providers must continue to adapt to changes associated with the ACA, and develop strategies to thrive in the new healthcare environment.

During a recent webinar presented by PwC's Health Research Institute, an organization dedicated to analyzing healthcare issues and policies, PwC identified five of the biggest ACA-related trends.

Here's how those trends are affecting health plans and providers:

More risk.

With the shift to value-based reimbursement that rewards providers based on the quality and cost of care provided, "risk," from a financial, enterprise, operational and market-share standpoint, is something that every healthcare player is encountering, said Ceci Connolly, leader of PwC's Health Research Institute, during the webinar.

"Medicare in particular has put in place a number of new payment strategies that are going to emphasize ... value," she said, noting that combined penalties associated with three Medicare quality programs - the Hospital-Acquired Condition Reduction Program, the Hospital Readmission Reduction Program, and the Hospital Value-Based Purchasing Program - put 5% of Medicare inpatient payments at risk for providers. "That's probably an important enough number for every hospital and health system to take notice [of] and think about what they need to do to deliver the right care, at the right time, at the right place."

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Payers also face significant changes due to the shift to value-based reimbursement, said Connolly, noting that many are beginning to invest in systems that propel value-based reimbursement forward. For example, UnitedHealth Group is using its Optum system, a data and analytics and technology solutions company, to "really move in the direction of value-based care." Connolly also points to Aetna's Accountable Care Solutions arm, which provides population health management, technology and health plan services to providers.

 

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