In the News: Mar 26–Apr 2

Medicare Fuels Health Care Spending Growth

A recent FierceHealthcare article highlights a new CMS report from the Office of the Actuary that anticipates health care spending will grow by 5.4% over the next 10 years, making health care expenditures about 19.7% of the US gross domestic product by 2028.

As the baby boomer generation continues to age into Medicare eligibility, Medicare is expected to be the largest source of the growing spending. While Medicare enrollment is expected to rise by 2.5% over the next decade, Medicare spending will increase by an average of 7.6% annually. The increase in enrollment is projected to offset the expected decrease in the national insured rate; CMS estimates the insured rate will decline from 90.6% in 2018 to 89.4% in 2028.

Sg2 frequently hears from clients who are concerned about their organizations’ payer mix. As Medicare and Medicaid volumes continue to increase, the number of commercially insured patients with higher reimbursement rates is dropping, squeezing the already thin operating margins of providers. To learn more about tackling the pressing problem of payer mix deterioration please see the Sg2 Payer Mix Erosion Resource Kit.

Data Sharing Impacts Social Determinants of Health

A recent Healthcare Finance article demonstrates the importance of integrating social determinants of health (SDOH) data into health care decision making to help improve community health. An evolving health care landscape focused on quality of care and cost reduction pushes providers to assume greater responsibility for patient outcomes. As providers continue to take on more risk tied to patient outcomes, data sharing is expected to increase, allowing providers insight into patients’ overall health.

There are currently many barriers that prevent sharing of this data across stakeholders; however, payers and providers are partnering to pool patient claims data to capture a comprehensive patient profile, which enables key stakeholders to better understand how to engage with individuals to improve their overall health.

As the health care landscape shifts, government, payers and private organizations are likely to increase their financial investments in SDOH programs, ultimately increasing the opportunities for providers to expand their efforts to meet the needs of their communities. To learn more about how hospitals and health systems have addressed social determinants of health, please read the Sg2 FAQ The Social Determinants of Health: Taking Action Beyond the System of Care.

Affordable Care Act’s Impact on Women’s Health Over 10 Years

The Affordable Care Act (ACA) celebrates its 10th anniversary this year, prompting Health Affairs to dedicate their March 2020 issue to its impacts, with one article focusing on a literature review of how the ACA has impacted women’s health in particular.

In this review, researchers saw improvements in insurance coverage, access, affordability of care, use of preventive care, mental health care, contraceptives and perinatal outcomes. One major finding showed there has been no change in access to care for high income women (ie, making 400% above the federal poverty line). Researchers also found the ACA expanded coverage for over 20.4 million women through its essential health benefits.

Women are powerful drivers of health care utilization, both directly and indirectly, and many organizations recognize the need for consumer-driven strategies to better understand, segment and capture utilization in this key consumer segment. To see how to develop a health care program that meets the evolving needs and wants of women, please read our new Sg2 FAQ Comprehensive Women’s Health: How to Develop Services and Engagement.

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