The stakes are high for healthcare as 2017 ushers in a new administration under President Trump. As the industry waits for the dust to settle around coming changes, employee benefit and worker’s comp professionals can count on one thing: the momentum powering value-based care will continue unhindered.
The last few years have seen worker's compensation moving toward a value-based model in an effort to bring down costs and shift focus to an employee's long-term health and well-being.
The Department of Health and Human Services is pressing forward with plans to tie 50% of payments to value by 2020, while many private groups are aiming for 75%. As such, employee benefit and worker’s comp professionals must prepare for the future of risk-bearing healthcare models.
Historically, occupational health providers and payers have led the industry in this regard. They have bridged the gap between employer-based health services and community-based health through evidence-based absence management practices. These well-established models deliver the most effective, cost-efficient clinical guidance by leveraging tools such as duration tables, predictive modeling capabilities, evidence-based guidelines and analytics to drive performance improvement.
Regardless of the new administration’s new policies or programs, it is likely that leveraging evidence-based clinical decision support technology and protocols will only become more essential as employers and government agencies try to reduce healthcare costs while helping employees/patients return to health safely and quickly.
Free-market and infrastructure plans to impact workers’ comp
With this unhindered advance toward value-based care, expect free-market solutions to take precedence over the ACA’s individual and employer mandates under a Trump administration. While new legislation will likely keep current requirements for pre-existing conditions and dependent coverage, many believe a Trump agenda may bring back traditional underwriting and begin navigating the complexities of allowing carriers to sell across state lines.
In addition, a Trump platform will embrace expansion of health saving accounts, especially for younger Americans who tend to have fewer healthcare costs and are thus willing to pay higher deductibles in exchange for lower premiums. As part of any tax reform initiative, employee-sponsored healthcare benefits — and their tax-free status — are expected to be analyzed and potentially adjusted.
Positive impacts are expected on worker’s comp premiums based on the $550 billion infrastructure plan laid out by President Trump to repair and/or upgrade roads, bridges, airports and waterways. That said, many other questions remain regarding the impact of coming changes. For instance, will ACA amendments impact the ability of workers to acquire healthcare coverage for worker’s comp cases settled previously under the existing law? Or, how will Trump administration appointments approach worker safety issues and wage and hour regulations?
Worker’s comp laws are managed on the state level, which means that most impacts will be indirect. Likewise, expected immigration law changes will also affect states differently, such as the ability of undocumented workers in California to receive worker’s comp. Or, they could provide a path to citizenship, opening the door to more claims and coverage needs.
Value-based care: A certainty
For these injured workers, occupational health providers need to adopt the evidence-based decision support tools that can help them deliver the value-based care that fully aligns with the known elements of the Trump healthcare platform. A strong supporter of price transparency and consumer empowerment, clinical outcomes performance and cost will remain a focal point of future strategies. In fact, leading industry groups such as the American Academy of Family Physicians agree that the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will be minimally impacted — if at all — and notably advance adoption of risk-bearing reimbursement models.
While the evolution of value-based care will continue, expectations are that a Trump administration will take a less-regulated approach to alternative payment programs. In addition, new leadership will likely put the performance of current initiatives — such as Medicare shared savings programs and accountable care organizations — under a microscope. Many experts predict a pivot away from these models and increased focus efforts on bundled payment expansion and Medicaid reform instead.
The reality is that current efforts and future plans are likely to increase risk. For instance, MACRA introduces penalties for organizations slow to participate in the Quality Payment Programs included in the law. Meanwhile, bundled payment initiatives shift the burden of managing cost to health networks instead of employers, who will continue to demand faster returns to activity.
Future preparedness and positioning
Until changes are introduced, employee benefits and worker’s comp professionals must remain focused on complying with current laws related to reporting under the ACA. In addition, they should remain undeterred in their efforts to prepare for value-based care by leveraging tools that efficiently and effectively move patients from illness to wellness — and back to work.
When providers are equipped with clinically validated, evidence-based guidelines, they can partner with patients to set recovery and return-to-work expectations. This framework promotes stronger engagement and a more rapid, cost-effective return to health — the overriding goal of advancing value-based care models.
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