Managed Care Contracts and the Affordable Care Act

Regardless of your feelings about the ACA (Obamacare), the insurance exchanges have allowed healthcare access for millions of people.  Increased enrollment necessitates comprehending the impact of these new patients while encouraging strategic service line development.  As service lines and payor mix are impacted, the associated managed care contracts should also be adjusted.

Due North Analytics was created with the provider in mind.  Our Reimbursement Simulation Models can assist providers to recognize the changing demographics, the revenue consequences, and deliver invaluable information for contract negotiations.

Address Declining Inpatient Volumes with Managed Care Contracts

A September 24, 2014 article spotlights hospital closings due to declining inpatient volumes. The most recent example being a 162 licensed bed HCA hospital in St. Petersburg, Florida.  The article highlights a recent survey where 68% of non-profit hospitals realized flat or declining Inpatient volume for the first half of 2014.  Conversely, lower revenue-producing Outpatient visits for the hospitals surveyed increased 72%.  This is but one of multiple forces converging on the health care industry.  Smaller rural hospitals are especially susceptible to current industry stresses.

Planning, modeling, and better managed care contracts are more critical than ever.  But while large organizations like HCA have extensive analytics tools at their disposal, many rural hospitals simply cannot afford to house such resources.

Due North Analytics can help with advanced analytics necessary in today’s healthcare environment.  Our high-value/low-cost model is especially suited for organizations who don’t have the resources to address all the converging forces on their own.