In the News: Sept 15–22

Artificial Intelligence Reduces MRI No-Shows

A recent Healthcare Finance News article highlights the use of artificial intelligence (AI) to decrease the number of outpatient MRI appointment no-shows, using built-in data readily available in radiology departments. The AI, in this case, is a decision tree–based algorithm used to predict patients at the highest risk for missing appointments. During a 6-month intervention, these high-risk patients were identified and flagged to receive appointment reminders via phone. Following implementation, the model reduced the no-show rate by 3.4%—from 19.3% to 15.9%.

The health care industry loses $150 billion annually due to no-shows and open appointment slots, with a 60-minute appointment resulting in a potential $200 loss for physicians. AI applications using basic analytic models—such as the aforementioned—present a low-risk, cost-savings opportunity for health systems.

The potential of AI in health care is monumental, and future applications should be designed to increase efficiency, effectiveness and access to care in any service line. To learn more about incorporating AI into your health system’s virtual health strategy and maximizing its possible benefits, please read the following Sg2 Expert Insight AI Is Here to Stay: Adopting Artificial Intelligence for Service Line Strategy.

Accountable Care Organizations Show Greater Cost Savings

A recent FierceHealthcare article highlights $1.2 billion savings through Medicare’s “Pathways to Success” program, in which 541 participating accountable care organizations (ACOs) helped accelerate the shift from fee-for-service to value-based payment and increased risk by reducing the 6-year limit to remain in a one-sided risk model to 3 years.

The aggressive move to take on additional financial risk coincides with the third consecutive year of net program savings, with an average of $169 savings per beneficiary compared to $106 for ACOs participating in legacy tracks. Additionally, “low-revenue” ACOs achieved greater cost savings than “high-revenue” ACOs.

Despite years of talk about the evolution from volume to value in health care, most health systems still derive the vast majority of their revenue from their fee-for-service business. Such complacency should no longer cloud provider systems’ strategy. Exacting rate increases year over year will get harder, and the commercial portion of payer mix will continue to deteriorate. To learn more on how to create a balanced, synergistic portfolio across Medicare, Medicaid and commercial lines of business on the way to a more value-based business model, please read the Sg2 report Value Based Care: Achieving the Right Balance.

Number of Uninsured Americans Increased Before COVID-19

An article from The Hill details how the number of uninsured Americans increased last year, even before the COVID-19 pandemic, with almost 30 million people not covered in 2019 compared to 28.6 million in 2018.

According to a Census Bureau report, the amount of uninsured people has grown by 2 million since 2016, and though no specific reasons were provided for the increase in the report, some experts point to the current administration’s changes to the Affordable Care Act (eg, eliminating the law’s individual mandate).

The Census Bureau report was conducted before COVID-19, which shows how vulnerable many Americans already were when the pandemic hit the US. Now, COVID-19 has caused devastating consequences on population health and the economy, with rising unemployment not only reducing commercial insurance coverage further, but also impacting how patients access care. Organizations must understand the impact of payer mix erosion on balance sheets to be prepared to meet the evolving needs of their communities. Read the Sg2 Expert Insight Sg2 COVID-19 Payer Mix Scenario Model to learn how we can help with robust scenario planning for your specific market.

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