By Stewart Gandolf
Chief Executive Officer
[SHSMD13 Podcast Series] In a few months, 2014 will be the tipping point–when the most significant components of the Affordable Care Act (ACA) take effect…with strategic implications for hospitals and healthcare providers.
In another in our continuing series of healthcare industry podcasts, Marc Sauve, Senior Healthcare Strategist with Gresham, Smith and Partners, talked with Healthcare Success Co-Founder Lonnie Hirsch about the immediate future of hospitals and the ACA.
“Even with the deferral to 2015 of the penalty for employers with more than 50 full-time employees, 2014 will still be a tipping point year,” Mr. Sauve said. “We still have Meaningful Use being rolled out, implemented and reimbursed; we still have the Medicaid expansion; we still have the insurance exchanges coming up; and that’s just to name a few of the big ones. We also have a lot of tiny initiatives that are rolling out as well.”
In his forthcoming presentation at the Society for Healthcare Strategy and Market Development (SHSMD Connections 2013), titled Healthcare 2014: The Tipping Point Year to Transformation, Mr. Sauve predicts a “new set of rules will drive success, new business models will take shape, and hospitals must adapt to survive.”
“With the specifics of the Medicaid expansion, for example, most people don’t realize that, today, we have 55 million Americans on Medicaid. And the expansion will add—or potentially could add—another 10 million people.
“But we only have 28 states right now that are committed to the Medicaid expansion. [There are] 14 states that are definitely not participating (as of today), and then we have the others somewhere in between…leaning back and seeing how things play out.”
LONNIE HIRSCH: How do you see hospitals being impacted by the new healthcare insurance exchanges in the states that have taken on that role, and in the states that have deferred to the federal government to manage their states’ healthcare exchanges?
MARC SAUVE: “Even if some of the health insurance exchanges are not up and running by October 1st —the date they are supposed to be online for people to begin shopping—there are still a couple of months to get a few things straightened out.
“Also, I don’t think a lot of people realize that half of the young adults is a big part of the uninsured. The 18-35 age group historically felt they didn’t needed health insurance. Half of the young adults that are uninsured—the 18 to 35 year olds—are in three states: Florida, California and Texas. We have California in one corner that’s committed and supportive. Texas is in the opposition mode. And Florida is somewhere in the middle.”
Insurance “Assist Stations” in the Emergency Department
Among several topics discussed in this podcast, Marc Sauve envisions the prospect of hospitals taking a proactive role with the large, uninsured segment of the population.
“Step one is to signup your eligible population, setup the mechanisms, the portals, the stations to move people from self-pay/no-pay designation to having insurance. And yes, you might still have to be selling it a tad, but I don’t think it’s going to be a hard sell once we see some of the pricing structure.
“We are talking about some hospitals doing some advertising, and some “assist stations” in the community and maybe even in the ED as people come in and you find out that they don’t have insurance, you’re probably going to have to help some of these people signup. If you can do it right there in the ED, to get them signed up, that would be a very positive thing.”
In our interview today we talk about related topics on the near-term horizon for hospitals, including:
- The changing role of the healthcare provider, and hospitals adapting from acute care to population health management;
- Challenges and liabilities faced by hospitals in their acquisition of primary care and specialty practices and the employment of those previously independent physicians;
- The relationship between hospital administration and physician employees; and
- How hospital marketing strategy may be growing in 2014 because of this transition.
On the subject of hospital marketing, Mr. Sauve indicated that many hospital administrators do not fully appreciate the importance and usefulness of marketing. “As a general rule, the American people need to be educated and guided, and they certainly can be with some good, quality marketing. For instance, 40 percent of Americans don’t even know the Affordable Care Act is law,” he said.
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Marc A. Sauve, Senior Healthcare Strategist, Gresham, Smith and Partners, works with hospitals on strategy development, business planning, service line development and market positioning. Marc is also an industry authority on future demand in healthcare, and is the author of This Is Not A Drill – The Real Emergency for American Hospitals and A Battle Plan for Survival. Marc will be speaking at SHSMD Connections 2013 in Chicago on September 30 on the topic: Healthcare 2014: The Tipping Point Year to Transformation.