When I first started this blog, I wrote that no matter what happens with health care reform legislation that there would be changes driven by the marketplace. We can already see that happening.
For example, we have been working with the American Hospital Association to facilitate more timely communication between hospitals, insurers and physicians.
Timely communication helps to make sure that all clinical and administrative resources are activated as quickly as possible for the patient. For example, quickly engaging the patient’s primary care physician can go a long way in ensuring a fully coordinated treatment plan is activated in real time. Clinical teams have more time to put effective case and disease management programs in place for the patient.
The most important element of timely communication is notification by the hospital to the insurer that a patient has been admitted to its facility. It has long been a standard practice across the industry for insurers to require notification when a member is admitted to the hospital. The exact requirements differ based on the particular process of each insurer, but many programs require notification of hospital admissions and typically impose reimbursement adjustments if notification is not provided.
Our notification program facilitates timely communication so that we can quickly connect all parts of the health care system on behalf of patients. All it takes is a simple fax, phone, portal or online submission to notify the insurance carrier of a patient admission.
Our goal is to have real time 24/7 communication with hospitals. It’s not our intent for a single hospital to receive a reimbursement adjustment. Timely communication simply puts more focus and attention on patient care.
The employers with whom we have discussed our notification program understand it because they see that the sooner we can engage all the resources the patient needs, the more efficient care will be.
So what has happened is that insurers and health care systems are working together to become more efficient and to improve patient care, both of which drive down the cost of health care. It’s market-driven health care reform.